Chapter 10: ACS

Question 1

Risk Factors for ACS (11)

Answer 1

Family History if MI
HTN
Smoking 
HLD
Increasing age
Postmenopausal State
Obesity 
DM
Other Vascular Disease
Sedentary Life Style
Cocaine/amphetamine

Question 2

Should you use supplemental O2 in ACS patients satting well on RA?

Answer 2

Probably not but it is part of MONABASH

Question 3

____ improves survival and reduces incidence of MI

Answer 3

aspirin

Question 4

when should nitrates not be administered in ACS

Answer 4

SBP <90 or 30 below baseline

HR<50 or >100

Question 5

How long before tolerance to nitro becomes clinically significant

Answer 5

24 hours

Question 6

med contraindication to nitrates if taken in the last 24 hours

Answer 6

phosphodiesterase inhibitors

Question 7

DO CCB reduce risk of MI in ACS

Answer 7

no

Question 8

Nitro Dose MI (oral and IV)

Answer 8

.3-.4 mg tablet (max 3 doses)

10 micrograms/min, increase by 10 micrograms/min every 3-5 min prn. max 200 micrograms/min

Question 9

Propranalol dose Oral and IV

Answer 9

20-80 mg every 6-8 hrs
.5-1mg as a single dose
then 5mg every 5 min up to 15mg

Question 10

Contraindications to BB in ACS

Answer 10

Heart rate < 50
moderate to severe left ventricular dysfunction (uncompensated)
shock or increased risk of cariogenic shock
Marked 1st degree AV block (PR>.24)
Second degree or third degree heart block without cardiac pacemaker
Systolic <90
Peripheral hypo perfusion
Active bronchospastic disease

Question 11

Types of anti platelet that help with myocardial ischemia

Answer 11

Aspirin (162 0r 325)

clopidogrel or ticagrelor or prasugrel

Question 12

____ is contraindicated in ACS if patient has hx of stroke or TIA and is associated with increased bleeding risk

Answer 12

Prasugrel

Question 13

Do patients that get fondaparinux need additional anticoagulation if they are getting a PCI

Answer 13

Yes

Question 14

HIT patients get ____ for anticoagulant

Answer 14

Argatroban

Question 15

Is PCI contraindicated in coma of TTM post cardiac arrest

Answer 15

no

Question 16

Absolute contraindications to fibrinolytic therapy

Answer 16

Prior intracranial hemorrhage 
known cerebral vascular lesion
ischemic stroke within past 3 months
allergy to agent
significant head trauma in last 3 months
known intracranial neoplasm
suspected aortic disection
active internal bleeding 
intracranial or intraspinal surgery within past 2 months
sever uncontrolled hypertension

Question 17

streptokinase and ateplase doses for STEMI

Answer 17

1.5 million units iv over 30-60 min

15mg iv bolus then .75 mg/kg max of 50 over 30 min then .50mg/kg max of 35 iv over 60 min

Question 18

Can you use nifedipine in acute MI

Answer 18

no contra indicated

Question 19

When are ditalizam and verapamil contraindicated in STEMI

Answer 19

If there is also left ventricular dysfunction and heart failure

Question 20

Cariogenic shock in setting of acute MI is an indication for emergent _____

Answer 20

revascularization

Question 21

PCI is preferred for ___ or ___ vessel disease while CABG is preferred for ___ vessel or ___ disease

Answer 21

1 or 2, 3 or significant left main coronary artery disease

Question 22

In right ventricular infarction what agents should be avoided

Answer 22

Things that reduce preload like morphine, nitrates, ACEi, and diuretics

Question 23

Atropine dose for hemodynamically significant atrial bradycardia or AV block

Answer 23

IV .5 mg every 3-5 minutes up to 3 mg