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Cardio Exam 3 > Acute Coronary Syndromes (ACS) intervention > Flashcards

Acute Coronary Syndromes (ACS) intervention Flashcards

1
Q

Non-pharm therapies

A

bed rest
continuous EKG monitoring (ST-segment elevations)
frequent vital sign measurements
procedures and surgery

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2
Q

Non-pharm therapies

A

bed rest
continuous EKG monitoring (ST-segment elevations)
frequent vital sign measurements
procedures and surgery

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3
Q

Angiography (aka cardiac catheterization)

A

patient is consciously sedated. a guide wire and catheter inserted into femoral, brachial, or radial artery and fed into aorta. contrast dye injected through catheter. x-ray cameras allow interventionalist to visualize coronary arteries and determine where obstruction is.

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4
Q

Angioplasty

A

occurs during angiography. mechanical widening of narrowed or occluded coronary arteries via balloon inflation.

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5
Q

Percutaneous coronary intervention (PCI)

A

occurs during angiography. mechanical widening of narrowed or occluded coronary artery via balloon inflation and stent placement.

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6
Q

what is the door-to-ballon time?

A
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7
Q

what is the door-to-ballon time?

A
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8
Q

Angiography (aka cardiac catheterization)

A

patient is consciously sedated. a guide wire and catheter inserted into femoral, brachial, or radial artery and fed into aorta. contrast dye injected through catheter. x-ray cameras allow interventionalist to visualize coronary arteries and determine where obstruction is.

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9
Q

Angioplasty

A

occurs during angiography. mechanical widening of narrowed or occluded coronary arteries via balloon inflation.

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10
Q

Percutaneous coronary intervention (PCI)

A

occurs during angiography. mechanical widening of narrowed or occluded coronary artery via balloon inflation and stent placement.

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11
Q

Coronary artery bypass graft (CABG)

A

usually occurs following an angiography that reveals substantial blockage in more than or equal to 3 coronary arteries. surgical procedure grafting veins from another part of the patient’s body to the coronary vasculature.

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12
Q

Glycoprotein IIb/IIIa inhibitors

A

Efficacy: prevents reinfarction, recurrent ischemia, and salvages myocardial tissue. decreases mortality
Indication: consider for use in early invasive strategy in patients with excessive clot burden or continual ischemia despite other treatments.

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13
Q

Antiplatelet Therapies

A

P2Y12 inhibitors

Glycoprotein IIb/IIIa inhibitors

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14
Q

P2Y12 receptor inhibitor

A

Efficacy: decreases the rate of stent thrombosis, MI, stroke, and CV death. decreases mortality
Indication: all patients. only Clopidogrel and Ticagrelor approved for ischemia-guided strategy

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15
Q

GP IIb/IIIa inhibitors contraindications

A 
active bleed within 30 days
h/o ischemic stroke within 30 days
h/o hemorrhagic stroke
hypertensive urgency/emergency
major surgery within 6 weeks
GI/GU bleed within 6 weeks
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16
Q

Effient (prasugrel)

A

Loading dose: 60 mg

only used in cath lab!

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17
Q

Brillinta (ticagrelor)

A

Loading dose: 180 mg

18
Q

Glycoprotein IIb/IIIa inhibitors

A

Efficacy: prevents reinfarction, recurrent ischemia, and salvages myocardial tissue. decreases mortality

19
Q

Reopro (abciximab)
Integrillin (eptifibatide)
Aggrastat (tirofiban)

A

Dose: continuous IV infusion

20
Q

GP IIb/IIIa inhibitors cautions

A

thrombocytopenia (platelets

21
Q

GP IIb/IIIa inhibitors contraindications

A 
active bleed within 30 days
h/o ischemic stroke within 30 days
h/o hemorrhagic stroke
hypertensive urgency/emergency
major surgery within 6 weeks
22
Q 
Monitoring:
bleeding signs/symptoms
H/H
Platelets
SCr
A 
Medications: 
all
all
all
eptifibatide, tirofiban
Frequency:
every shift
daily
4 hours after initiation, then daily
daily
23
Q

who should be on anticoagulants?

A

all patients should receive 1 anticoagulant

24
Q

Unfractionated Heparin (UFH)

A

Efficacy: reduces MI refractory angina when used with ASA. decreases mortality
Indication: ischemia-guided or early invasive strategy

25
Q

Ischemic-guided strategy (low risk)

Early invasive strategy (high-moderate risk)

A

Dose: 60 IU/kg bolus, then 12 IU/kg/hour infusion

26
Q

UFH cautions

A

malignant hypertension

thrombocytopenia (

27
Q

UFH contraindications

A

active bleed
h/o HIT
thrombocytopenia (

28
Q

Low Molecular Weight Heparin (LMWH)

A

Efficacy: greater or equal reduction in MI and death compared to UFH. decreases mortality
Indication: ischemia-guided or early invasive strategy

29
Q

Lovenox (enoxaparin)

A

Dose: 1 mg/kg q 12 hours SQ

CrCl

30
Q

LMWH cautions

A

malignant hypertension

thrombocytopenia (

31
Q

Angiomax (bivalirudin)

A

Dose: IV bolus, then continuous infusion

32
Q

Factor X Inhibitors

A

Efficacy: similiar reduction in death and MI compared to enoxaparin. similiar efficacy/safety compared to UFH when used with fibrinolytics. decreases mortality
Indication: UA/NSTEMI patients treated with ischemia-guided strategy. STEMI patients when using a fibrinolytic (ischemia-guided)

33
Q

Reperfusion therapy

STEMI patients

A

Efficacy: decreases mortality by 20% via myocardial salvage. greater benefit with earlier administration.
Indication: STEMI patients ONLY! presenting to hospital within 12 hours of symptom onset
–> initiate within 30 minutes of hospital arrival (door-to-needle time)
–>preferred method of perfusion if:
* (door-to-balloon time)- (door-to-needle time) > 60 mins
* delay in PCI availability: door to balloon > 90-120 mins

34
Q

Factor X inhibitor Cautions

A

age > 75 yo

thrombocytopenia (

35
Q

Factor X inhibitor contraindications

A

active bleeding

CrCl

36
Q

Activase (alteplase t-PA)
Retevase (reteplase r-PA)
TNKase (tenecteplase TNK)
Streptase (streprokinase SK)

37
Q

Angiomax (bivalirudin)

A

Dose: IV bolus, then continuous infusion

38
Q

Direct Thrombin inhibitor contraindications

A

active bleeding

39
Q

Reperfusion therapy

STEMI patients

A

Efficacy: decreases mortality by 20% via myocardial salvage. greater benefit with earlier administration.
Indication: STEMI patients ONLY! presenting to hospital within 12 hours of symptom onset
–> initiate

40
Q

Direct Thrombin inhibitor contraindications

A 
active internal bleeding
suspected aortic dissection
h/o hemorrhagic stroke
h/o ischemic stroke within 3 months
known intracranial neoplasm
41
Q

Direct Thrombin inhibitor cautions

A

age > 75 yo
uncontrolled HTN (SBP > 180 mmHg and/or DBP >110 mmHG)
h/o CVA
anticoagulant therapy or an INR greater than or equal to 2
known bleeding diathesis
trauma within 2-4 weeks
major surgery with

42
Q

Activase (alteplase t-PA)
Retevase (reteplase r-PA)
TNKase (tenecteplase TNK)
Streptase (streprokinase SK)

Cardio Exam 3 (6 decks)

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