Acute Coronary Syndromes (ACS) Pre-intervention

Question 1

What are the goals of therapy for ACS?

Answer 1

relieve ischemic chest pain/discomfort
prevent complete occlusion and MI (in UA patients)
early restoration of blood flow to infarcted myocardium
prevent coronary artery reocclusion or reinfarction
prevent complications and death
resolve EKG changes

Question 2

Pre-Intervention Non-Pharm

Answer 2

Supportive care
oxygen
- Indication: oxygen saturation (SaO2) adjust flow rate to maintain SaO2 > 90%
- discontinue after acute episode is resolved (SaO2 > 90%)

Question 3

Pre-intervention Pharm

Answer 3

Anti-anginal: beta-blockers
pain reliever: morphine
antiplatelet: aspirin

Question 4

Beta-blockers (pre-intervention)

Answer 4

Efficacy: reduces risk of recurrent ischemia, infarct size, risk of reinfarction, and occurrence of ventricular arrhythmias. increases the risk of cardiogenic shock and death in some patients if used incorrectly. reduces mortality and morbidity
Indicaation: consider use in pre-intervention stage, but use with caution. avoid if signs of HF, evidence of low-output state, increased risk of cardiogenic shock, or other CI

Question 5

Tenormin (atenolol)

Answer 5

Dose: 50-100 mg q24 hours

Question 6

Lopressor (metoprolol tartrate)

Answer 6

Dose: 25-50 mg q6 hours

Question 7

Inderal (propranolol)

Answer 7

Dose: 40-80 mg q6-8 hours

Question 8

Nitrates (pre-intervention)

Answer 8

Efficacy: reduces chest pain. no change in mortality but reduces morbidity
Indication: SL NTG all patients at home or by EMS. IV NTG use within 48 hours of symptom onset after other anti-anginal agents are used if patient has persistent ischemia, HF, or HTN

Question 9

Pain Relievers (pre-intervention)

Answer 9

Efficacy: decrease chest pain. no change in mortality, but a decrease in morbidity.
Indication: chest pain despite optimal use of short acting NTG

Question 10

Astramorph PF & Duramorph (morphine)

Answer 10

Dose: 2-4 mg IV q 5-15 min PRN chest pain

Question 11

Antiplatelet (pre-intervention)

Answer 11

Efficacy: reduces death and MI. decrease mortality
Indication: all patients

Question 12

Aspirin

Answer 12

Dose: 162-325 mg x1 (chew and swallow)

Most common dose is 325 mg