acute coronary syndromes

Question 1

oxygen goal in ACS

Answer 1

> 94%

Question 2

why should oxygen therapy be used cautiously in ACS

Answer 2

it promotes coronary vasoconstriction and generates toxic O2 metabolites

Question 3

dosing for nitroglycerin

• CP
• recurrent pain, CHF, of high BP

Answer 3

CP: 0.4 mg SL or by mouth spray
-repeat every 5 min x 2 if needed

RP, CHF, High BP: 5 ug/min and increase 5-10 ug/in every 5 min to desired effect

Question 4

what is the max dose rate of nitro

Answer 4

200 ug.min

Question 5

ASA dose ACS

Answer 5

325 chewable initially

75-162 mg enteric coated tablets daily

Question 6

BB blocker dose ACS

Answer 6

atenolol 10 mg IV then 100 mg PO daily

Metoprolol 5 mg V every 5 min for 3 doses then 50 mg PO q6 for 48 hrs then 100 mg PO BID

Question 7

when do not use BB in ACS

Answer 7

cocaine induced chest pain or MI

Question 8

chest pain not relieved by nitro should prompt immediate administration of what

Answer 8

morphine

Question 9

when to not use nitro

Answer 9

R sided infarct, recent pde5 inhib use

Question 10

is morphine induced respiratory depression common in ACS

Answer 10

no

Question 11

what are the absolute contraindications to thrombolytic therapy

Answer 11

Active bleeding other than menses
Malignant intracranial neoplasm (primary or metastatic)
Cardiovascular anomaly (e.g. AV malformation)
Suspected aortic dissection
Ischemic stroke within 3 months (but not within 3 hrs)
Prior history of intracranial hemorrhage
Significant closed-head or facial trauma in past 3 months

Question 12

when should thrombolytic threrapy for MI be started

Answer 12

30 mintues after initial onset of presentation

Question 13

major bleeding from thromolysis can be treated with what

Answer 13

cryoprecipitate 10-15 bags then FFP up to 6 units

Question 14

what is goal serum fibrinogen after cryo and FFP tx

Answer 14

over 1

Question 15

PCI should be performed within ____ ___ after hospital arrival

Answer 15

90 minutes

Question 16

what kind of anticoagulation should be used for pts who receive therapy with fibrinolytic agents or pci

Answer 16

unfractionated heparin

Question 17

what kind of anticoagulation should be used for pts who do not receive reperfusion therapy

Answer 17

LMWH aka lovenox aka enoxaparin

Question 18

enoxaparin with renal insuffiiency

Answer 18

if CrCl under 30 then reduce dose by 50%

Question 19

pts with HIT and need anticoagulation for MI and had pci

Answer 19

bivalirudin

Question 20

pts with HIT and had ACS with thromboyctic therapy or no reperfusion use what

Answer 20

fondaparinux

Question 21

how early before a surgery should clopidogrel be stopped

Answer 21

5 days

Question 22

what drug should you avoid with clopidogrel

Answer 22

PPI, can inhibit activation

Question 23

how do glycoprotein receptor antagonists work

Answer 23

block IIb IIIa receptors on platelets from binding fibrinogen and then no bridge formed between platelets

Question 24

what are the GP receptor antagonists

Answer 24

abciximab
eptifibatide
tirofiban

Question 25

acute aortic dissection diagnosis

Answer 25

MRI best

CTA most likely best bc fasater

Question 26

goals in acute aortic dissection

Answer 26

blood pressure control and repair

Question 27

blood pressure treatment in acute aortic dissection

Answer 27

esmolol, if this does not work use nitroprusside

• never use nitroprusside as monotherapy bc will increase CO
• can also use labetolol