Cardiovascular- ACS & Associated Diagnoses

Question 1

What is the summary of treatment you would give to someone presenting with angina?

Answer 1

O-oxygen
N- nitroglycerin
A- aspirin
M- morphine (maybe)

Question 2

What kind of myocardial infarctions can receive fibrinolytic therapy?

Answer 2

STEMI

Question 3

How do antiplatelets works?

Answer 3

Affects thromboxane A2 in cox 1&2 pathway

Stops platelets from sticking together

Question 4

What are some side effects of aspirin?

Answer 4

Sensitivity

• respiratory
• cutaneous
• systemic

Question 5

Dose your maintenance antiplatelet

Answer 5

Aspirin 81mg

One tablet daily

Question 6

How does clopidogrel work?

Answer 6

Down regulation of platelets ability to stick together

Question 7

What genetic basis may affect how well clopidogrel works?

Answer 7

CYP2C19

Question 8

What drug should probably not be added to a patient on clopidogrel?

Answer 8

A PPI

Question 9

ADRs of Clopidogrel

Answer 9

Bleedings
Rash, puritus
GI hemorrhage
Thrombotic thrombocytopenic purpura

Question 10

Dose Plavix

Answer 10

Clopidogrel 75mg

1 tablet daily

Question 11

What would PPIs do to Clopidogrel levels? What would you be concerned about?

Answer 11

PPIs suppress CYP2C19, Clopiogrel levels lower

Worry about clots

Question 12

What is abciximab’s problem?

Answer 12

acute profound thrombocytopenia

-seen in use of IV platelets

Question 13

Dose an IV antiplatelet

Answer 13

Integrilin 180mcg/kg IV bolus over 1-2 min

then infuse 2mcg/kg/min intravenously

Question 14

How do nitrates work?

Answer 14

increase levels of nitric oxide, a potent vasodilator

Question 15

What are nitrates used for?

Answer 15

Relief of ischemic pain and reducing vasospasms and oxygen demand

Question 16

Dose nitrogylcerin

Answer 16

Nitroglycerin .4mg sublingually

1 tablet under the tongue q5 minutes for 3 doses

Question 17

Dose nitroglycerin patch

Answer 17

Nitroglycerin patch 0.4mg/hour

Apply patch in the morning, remove at 8 pm and repeat each day

Question 18

ADRs of anticoagulants

Answer 18

Bleeding

Question 19

What anticoagulant is commonly used in patient

Answer 19

Heparin Sodium

Question 20

How do fibrinolytics work

Answer 20

Activate plasmin and increase fibrin degredation

Question 21

Indication for alteplase

Answer 21

STEMI
Management of acute ischemia stroke
management of acute pulmonary embolism

Question 22

Dose a fibrinolytic

Answer 22

Alteplase 15mg IV bolus over 1-2min
then infuse 50mg over 30 min
then 35 mg over 1 hour

Question 23

What drug therapy is included in post MI care?

Answer 23

Aspirin
Beta Blocker
ACEI (if history of known heart disease)
Lipid-lowering statins