angina emergent

Question 1

initial mi treatment

Answer 1

o2
ekg
bp
if ekg and bp support give nitroglycerin 
*do not give nitro if inferior MI
morphine to ease cp

Question 2

asa for mi

Answer 2

initial dose 162-325 mg oral

antiplatelets

Question 3

clopidogrel for mi

Answer 3

in addition to or with asa
300-600 mg loading
then 75 mg daily
antiplatelet

Question 4

to replace clopidogrel

Answer 4

prasugrel or ticagrelor

Question 5

stemi treatment

Answer 5

fibrinolysis unless contraindicated

Question 6

fibrinolysis contraindications

Answer 6

Any previous intracerebral hemorrhage
Known structural cerebrovascular lesion
Known malignant intracranial neoplasm (primary or metastatic)
Ischemic stroke in past 3 months (unless in last 3 hours)
Suspected aortic dissection
Active bleeding or bleeding diathesis (excluding menses)
Severe closed-head or facial trauma in past 3 months

Question 7

for stemi in adition of fibrinolysis give …

Answer 7

anticoagulant
enoxaparin
unfractinated heparine
fondaparinux

Question 8

if stemi patient does not improve must cath lab

Answer 8

anticoagulant
give bivalrudin or unfratinated hep
will have percutaneous coronary intervention and then based on results cabg

Question 9

NSTEMI oral antiplatelets

Answer 9

Aspirin: 181-325 mg initially, then 81-162 mg daily- we do in ER
Plavix -Clopidogrel: 300 mg initially, then 75 mg daily

Question 10

oral anticoagulants nstemi

Answer 10

Warfarin: no additional benefit over aspirin and clopidogrel unless specific indications are present (i.e. atrial fibrillation, thrombus, prosthetic valves)

Question 11

stents invasive treatment for nstemi

Answer 11

Drug eluting stent: Same as angioplasty, but a stent is left behind. This stent slowly releases drug to prevent cell proliferation. Must still take aspirin and clopidogrel for at LEAST 1 year to prevent clots from forming on stent
Bare metal stent: This stent does not release any drug to prevent scar tissue from closing off artery, but antiplatelet therapy may be as short as 1 month after placement

Question 12

mi discharge therapy first three

Answer 12

Aspirin: most will be discharged on aspirin 81 mg daily, may be higher if stent was placed
Clopidogrel: 75 mg daily for at least 1 month, may be longer if stent
Beta-blockers: decrease risk of recurrent MI. Dose should be targeted to resting heart rate of 50-60 BPM. Initiate in first 24 hours if possible.

Question 13

mi discharge therapy next three

Answer 13

ACE-I/A2RB: should be administered within 24 hours to pts with pulmonary congestion or LV ejection fraction 40% or lower. Decreases risk of future MIs
Statins: for ALL patients regardless of LDL. High intensity doses: atorvastatin 80 mg, or rosuvastatin 20-40 mg.
Calcium Channel Blockers: verapamil or diltiazem for STEMI pts with beta-blocker failure or contraindication for control of Afib/flutter with RVR as long as no CHF or AV block. Nifedipine is contraindicated for STEMI patients, other non-dihydropyridines not tested for STEMI patients.