Acute Coronary Syndromes Flashcards
MONA-GAP-BA
Morphine, Oxygen, Nitrates, Aspirin (MONA)
GPIIb/IIIa antagonists, Anticoagulants, P2Y12 inhibitors (GAP)
Beta-Blockers, ACE inhibitors (BA)
NSTE-ACS (Unstable angina and NSTEMI)
MONA-GAP-BA +/- PCI
STEMI
MONA-GAP-BA + PCI or fibrinolytic (PCI preferred)
clopidogrel
Plavix (LD 300-600 mg PO; MD 75 mg PO daily)
prasugrel (only use if pt getting PCI)
Effient
ticagrelol
Brillinta (LD 180 mg; MD 90 mg PO BID for one year, then 60 mg BID)
cangrelor (injectable-transition to oral P2Y12 inhibitor after PCI)
Kengreal
abciximab (GPIIb/IIIa receptor antagonist- injection)
ReoPro
eptifibatide (GPIIb/IIIa receptor antagonist- injection)
Integrillin
tirofiban (GPIIb/IIIa receptor antagonist- injection)
Aggrastat
vorapaxar (Protease-activated receptor-1 antagonist)(not yet in guidelines)
Zontivity
(for STEMI) If PCI is not possible within 2 hrs of medical contact:
fibrinolytic therapy is recommended and should be given within 30 minutes of hospital arrival
alteplase (recombinant tissue plasminogen activator (tPA, rtPA)
Activase
tenecteplase
TNKase
reteplase
Retavase
morphine
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
oxygen
Give to patient with arterial O2 sat <90% or those in respiratory distress
nitrates
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.
aspirin
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.
anticoagulants
LMWHs (enoxaparin, dalteparin, UFH and bivalirudin are preferred for STEMI
BBs and ACE Inhibitors
Start w/in the first 24 hours and continue indefinitely
