Acute Coronary Syndromes

Question 1

MONA-GAP-BA

Answer 1

Morphine, Oxygen, Nitrates, Aspirin (MONA)
GPIIb/IIIa antagonists, Anticoagulants, P2Y12 inhibitors (GAP)
Beta-Blockers, ACE inhibitors (BA)

Question 2

NSTE-ACS (Unstable angina and NSTEMI)

Answer 2

MONA-GAP-BA +/- PCI

Question 3

STEMI

Answer 3

MONA-GAP-BA + PCI or fibrinolytic (PCI preferred)

Question 4

clopidogrel

Answer 4

Plavix (LD 300-600 mg PO; MD 75 mg PO daily)

Question 5

prasugrel (only use if pt getting PCI)

Answer 5

Effient

Question 6

ticagrelol

Answer 6

Brillinta (LD 180 mg; MD 90 mg PO BID for one year, then 60 mg BID)

Question 7

cangrelor (injectable-transition to oral P2Y12 inhibitor after PCI)

Answer 7

Kengreal

Question 8

abciximab (GPIIb/IIIa receptor antagonist- injection)

Answer 8

ReoPro

Question 9

eptifibatide (GPIIb/IIIa receptor antagonist- injection)

Answer 9

Integrillin

Question 10

tirofiban (GPIIb/IIIa receptor antagonist- injection)

Answer 10

Aggrastat

Question 11

vorapaxar (Protease-activated receptor-1 antagonist)(not yet in guidelines)

Answer 11

Zontivity

Question 12

(for STEMI) If PCI is not possible within 2 hrs of medical contact:

Answer 12

fibrinolytic therapy is recommended and should be given within 30 minutes of hospital arrival

Question 13

alteplase (recombinant tissue plasminogen activator (tPA, rtPA)

Answer 13

Activase

Question 14

tenecteplase

Answer 14

TNKase

Question 15

reteplase

Answer 15

Retavase

Question 16

morphine

Answer 16

Morphine sulfate (2-5 mg IV repeated at 5-30 min intervals PRN) may be used in patients with ongoing chest discomfort despite NTG therapy

Question 17

oxygen

Answer 17

Give to patient with arterial O2 sat <90% or those in respiratory distress

Question 18

nitrates

Answer 18

Give SL NTG (0.3-0.4mg) if not already administered. Start IV NTG for persistent ischemic pain, HTN, or HF. Nitrates can reduce BP.

Question 19

aspirin

Answer 19

non-enteric-coated, chewable aspirin (162-325 mg) should be given to all patient immediately. MD of 81-162 mg daily should be continued indefinitely.

Question 20

anticoagulants

Answer 20

LMWHs (enoxaparin, dalteparin, UFH and bivalirudin are preferred for STEMI

Question 21

BBs and ACE Inhibitors

Answer 21

Start w/in the first 24 hours and continue indefinitely