Cardiovascular Conditions: Acute Coronary Syndromes

Question 1

Risk factors for acute coronary syndrome

Answer 1

Men > 45 or Women > 55
FH o1st degree relative coronary event before 55 (men) and 65 (women)
Smoking
HTN
Known CAD
Dyslipidemia
Diabetes
Chronic stable angina
Lack of exercise
Excessive alc

Question 2

Classic ACS symptoms

Answer 2

Chest pain > 10 min
severe dyspnea
diaphoresis
pain can radiate down arms/back/neck/jaw/epigastric region

females, elderly + diabetics less likely to experience classic symptoms

Question 3

NTG dose for ACS?

Answer 3

1 dose every 5 min, for up to 3 doses to relieve chest pain

if not relieved or worse 5min after first dose call 911

Question 4

non-ST segment elevation cute coronary syndromes (NSTE-ACS) treatment

Answer 4

either medications or PCI

Question 5

STEMI treatment

Answer 5

require blocked arteries be opened as quick as possible with PCI or fibrinolysis

PCI - within 90 min of hospital arrival or 120min within 1st contact
Fibrinolysis = if cant do PCI ( 120min) , should be done within 30min of arriving to hospital

Question 6

MONA-GAP-BA

Answer 6

Morphine
Oxygen
Nitrates
Aspirin

GPIIb/IIIa antagonist = Abciximab/Eptifibatide/Tirofiban (anti platelet)
Anticoagulant
P2Y12 inhib = clopidogrel

(given within 24hrs prn, continue outpatient)
Beta blockers
ACE inhibitors

Question 7

When should you not use IV NTG?

Answer 7

SBP < 90mmHG, HR < 50 bpm or pt has right ventricular infarction

Question 8

Which meds shouldn’t be used in ACS acute setting?

Answer 8

NSAID = inc mortality and other stuff
IR nifedipine = inc mortality

Question 9

P2Y12 inhibitor dosing

Answer 9

Loading dose at start, then go to maintenance dose

usually used as DAPT with Aspirin

Question 10

Clopidogrel warnings

Answer 10

dont use 5 days before elective surgery
Dont use with omeprazole or esomeprazole

Question 11

Prasugrel (Effient) warnings

Answer 11

CI = serious bleeding, hx of TIA or stroke

Stop 7 days prior to elective surgery
Dont use if CABG likely

Question 12

Ticagrelor (Brillinta) warnings

Answer 12

dont exceed maintenance dose of 100mg/day aspirin if taking

stop 5 days before any surgery
dont sue if CABG likely

Question 13

GIIb/IIa receptor angagonists

Answer 13

Abciximab
Eptifibatide
Tirofiban

Question 14

GIIb/IIa receptor angagonists CI

Answer 14

platelets < 100K
Hx of bleeding predispostion
Active internal bleed
sever uncontrolled HTN
Recent major surgery/trauma (4 wk Tirofiban, 6wk others)
Hx of stroke 2yrs (abciximab) n hx stroke w/in 30 days or any history of hemorrhagic stroke (eptifibatide)

Question 15

How do fibrinolytics work?

Answer 15

converting plasminogen to plasmin

Question 16

Fibrinolytics are used only for…

Answer 16

STEMI

should be given 30min within hospital arrival

Question 17

Alteplase info

Answer 17

recombinant tissue plasminogen activator (tPA)

Question 18

Alteplase Contraindications

Answer 18

Active internal bleeding
Hx of recent stroke
prior intracranial hemorrhage
severe uncontrolled hypertension

** different CI when using for stroke **