Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

PHRM 845 > Exam 1: ACS (Rogers) > Flashcards

Exam 1: ACS (Rogers) Flashcards

1
Q

Signs and Symptoms of ACS

A
  • nausea or vomiting
  • diaphoresis (sweating)
  • shortness of breath
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Atypical Symptoms

A
  • epigastric pain
  • indigestion
  • stabbing or pleuritic pain
  • increasing dyspnea in the absence of chest pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Diagnosing ACS

A

all patients with acute chest pain should have an ECG and troponin measured within 10 minutes of arrival at an emergency facility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

STEMI on ECG

A
  • persistent ST elevation
  • Q wave not present on initial ECG, but develops over hours to days
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

NSTEMI/UA on ECG

A
  • may have normal ECG
  • ST depression, transient ST elevation, or new T-wave inversion
  • Q wave changes unlikely
  • no ST elevation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

high sensitivity troponin unit

A

ng/L (preferred)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

conventional troponin unit

A

ng/mL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

high sensitivity troponin normal value

A

< 14 ng/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

conventional troponin normal value

A

< 0.05 ng/mL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

need to check troponin trends

A

3 levels over 12 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Unstable Angina Signs

A
  • chest pain may occur at rest, while sleeping, or with little physical exertion
  • is more severe and lasts longer than stable angina (>30 min)
  • comes as a suprise
  • less ischemia
  • does not lead to detectable quantities of troponin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

NSTEMI

A
  • troponin is elevated
  • not a full occlusion of the vessel
  • chest pain
  • no ST elevation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

STEMI

A
  • chest pain
  • troponin is elevated
  • persistent ST elevation on ECG
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Ventricular Remodeling

A

changes in the size, shape and function of the left ventricle after an ACS

leads to heart failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

If initial ECG is not diagnostic but the patient remains symptomatic and there is a high clinical suspicion for ACS

A

serial ECGs should be performed every 15-30 minutes for the first hour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

serial troponin levels

A

levels should be obtained at presentation and 3-6 hours after symptom onset

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

MONA: M

A

Morphine
4-8 mg IV, followed by 2-8 mg IV q5-15 min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Side Effects: Morphine

A
  • sedation
  • respiratory depression
  • nausea/vomiting
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

MONA: O

A

oxygen
maintain oxygen saturation > 90%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

MONA: N

A

Nitroglycerin
0.3-0.4 mg q5min x 3 for ischemic pain

IV for persistent ischemia: start at 10 mcg/min and titrate by 5 mcg/min q5min (max 200mcg/min)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Side Effects: NTG

A
  • headache
  • hypotension
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

MONA: A

A

Aspirin
162-325 mg chewable x 1 dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

coronary angiography

A

catheter is inserted into the radial and femoral artery and fed up the heart to show blocked artery

stent will be placed if needed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

percutaneous coronary intervention (PCI)

A

small balloon is used to reopen a blocked artery to increase blood flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
fibrinolytic mechanism of action
promotes the conversion from plasminogen to plasmin to increase rate of fibrin degradation
26
tenecteplase (TNK-tPA) dosing
weight based
27
reteplase (rPA) dosing
10 units x 2 doses (30 minutes apart)
28
alteplase (tPA)
15 mg bolus, then weight based dosing
29
Steptokinase (SK)
- first fibrinolytic - less expensive - less specific for fibrin - not often used in the US
30
absolute contraindications for Fibrinolytics
- history of intracranial hemorrhage - ischemic stroke within the past 3 months - aortic bleeding or dissection - significant closed-head or facial trauma within the past 3 months
31
Reperfusion in STEMI
should be administered to all eligible STEMI patients whose symptoms began in the past 12 hours
32
Is PCI or use of fibrinolytic preferred
PCI: lower rates of death, recurrent ischemia or infarction, intracranial hemorrhage
33
door to needle time: stemi
within 30 minutes of hospital arrival
34
door-to-balloon time: stemi
within 90 minutes of hospital arrival
35
fibrinolytic use in therapy
recommended for stemi patients at non-PCI capable hospital or when ≥120 minutes away from PCI-capable hospital not recommended for NSTEMI/UA
36
Early Invasive: NSTEMI
coronary angiography +/- revascularization preferred for patients with high-risk featurs
37
Ischemia Guided: NSTEMI
treatment with evidence-based medications no heart cath unless patient has recurrent ischemic symptoms or becomes hemodynamically unstable
38
P2Y12 inhibitors in ACS
DAPT recommended for 12 months in STEMI/NSTEMI/UA DAPT is always ASA+P2Y12
39
Cangrelor in ACS
IV option used during PCI when patient does not receive loading dose
40
Cangrelor Dosing
30 mcg/kg followed by 4 mcg/kg/min x 2hours
41
When to use 300 mg Plavix loading dose
fibrinolytic + ≤75 yoa
42
when to not use a loading dose of plavix
fibrinolytic + > 75 yoa
43
Prasugrel not recommended in
ischemia guided strategy (ticagrelor/clopidogrel) preferred
44
Contraindication: Prasugrel
history of TIA/stroke not recommended in patients ≥ 75, <60kg, or high bleeding risk
45
P2Y12 in NSTEMI/UA: Ischemia Guided Therapy
clopidogrel and ticagrelor preferred
46
P2Y12 in NSTEMI/UA: PCI
any could be used, preference for ticagrelor or prasugrel
47
P2Y12 in STEMI: Fibrinolytic
clopidogrel preferred
48
P2Y12 in STEMI: PCI
ticagrelor or prasugrel preferred
49
Patient Counseling: Aspirin
- bleeding - take with food - take lifelong
50
Patient: P2Y12 inhibitors
- bleeding - take with aspirin for 1 year - Take ticagrelor 12 hours apart and let Dr. know of SOB
51
GP IIb/IIIa Inhibitors place in therapy
potent IV anti-platelets given in addition to ASA and P2Y12 inhibitor given at the time of PCI
52
Considering GP IIb/IIIa inhibitors in NSTEMI
highrisk features such as positive troponin inadequate P2Y12 inhibitor loading bail out
53
Considering GP IIb/IIIa inhibitors in STEMI
large thrombus burden inadequate P2Y12 inhibitor loading bail out
54
Abciximab (Reopro) bolus dose
0.25 mg/kg IV
55
Abciximab (Reopro) maintenance dose
0.125 mcg/kg/min continue up to 12 hours
56
Eptifibatide (Integrilin) bolus dose
180 mcg/kg IV x 2 (10 minute apart)
57
Eptifibatide (Integrilin) : maintenance dose
2 mcg/kg/min continue up to 18 hours
58
Eptifibatide (Integrilin) : Renal adjustment
CrCl<50 mL/min 1 mcg/kg/min
59
Tirofiban (Aggrastat): bolus dose
25 mcg/kg IV
60
Tirofiban (Aggrastat): maintenance dose
0.15 mcg/kg/min continue up to 18 hours
61
Tirofiban (Aggrastat): renal dosing
CrCl < 60 mL/min 0.075 mcg/kg/min
62
Anticoagulation place in ACS
recommended in addition to anti-platelet therapy to improve vessel patency and prevent reocclusion
63
Unfractionated Heparin (UFH) MOA
Anti-Xa and anti-IIa activity
64
Risk of UFH Therapy
HIT: drop in platelet count and increased thrombosis
65
Enoxaparin MOA
Anti Xa and anti IIa activity (higher ratio than UFH) accumulates in renal impairment (avoid)
66
Bivalirudin MOA
direct thrombin inhibitor
67
Bivalirudin in ACS
may not be effective for MACE and stent thrombosis may have lower bleeding risk not used together with GPIIb/IIIa inhibitors except for bail out
68
Fondaparinux MOA
Factor Xa inhibitor
69
Fondaparinux in ACS
do not use alone for PCI (high risk of thrombosis) if already giving fondaprinux and patient needs a PCI, need to give unfractionated heparin or bivalirudin
70
Fondaparinux Renal Impairment
contraindicated for CrCl < 30 mL/min
71
UFH Bolus Dose
60 units/kg iv (max 4000 units) 50-100 units/kg during PCI
72
UFA maintenance dose
12 units/kg/hr infusion titrated to aPPT target no maintenance dose during PCI
73
Enoxaparin bolus dose
30 mg IV
74
Enoxaparin maintenance dose
1 mg/kg sc q12h (first dose 15 min after bolus) ≥75 years reduce to 0.75 mg sc q12h
75
Enoxaparin Renal Adjustment
CrCl < 30 mL/min 1 mg/kg q24
76
Bivalirudin Bolus Dose
0.75 mg/kg IV
77
Bivalirudin maintenance dose
1.75 mg/kg/hr infusion
78
Bivalirudin renal dosing
CrCl < 30 mL/min 1 mg/kg/hr dialysis 0.25 mg/kg/hr
79
Fondaparinux bolus dose
2.5 mg IV
80
fondaparinux maintenance dose
2.5 mg sc q24h
81
UFA: NSTEMI Ischemia Guided Strategy
Yes: 48 hours
82
UFA: NSTEMI Early Invasive Strategy
Yes (until PCI)
83
UFA: STEMI Fibrinoltyic
yes: 48 hours
84
UFA: STEMI PCI
yes: until pci
85
Bivalirduin: UA/NSTEMI Ischemia Guided Strategy
NO
86
Bivalirduin: UA/NSTEMI early invasive
Yes (until PCI)
87
Bivalirudin: STEMI fibrinolytic
NO consider using for HIT
88
Bivalirudin: STEMI PIC
yes until PCI (preferred for high bleeding risk)
89
Enoxaparin: UA/NSTEMI ischemia guided
yes (LOS up to 8 days)
90
Enoxaparin: UA/NSTEMI early invasive
yes until pci
91
Enoxaparin: STEMI fibrinoltyic
Yes (LOS up to 8 days)
92
Enoxaparin: STEMI PCI
no
93
Fondaparinux: UA/NSTEMI ischemia guided
Yes (LOS up to 8 days)
94
Fondaparinux: UA/NSTEMI PCI
not ideal, do not use alone for pci
95
Fondaparinux: STEMI fibrinolytic
yes (LOS up to 8 days)
96
Fondaparinux: STEMI pci
no
97
Beta Blockers place in ACS
initiate within the first 24 hours of ACS
98
reasons not to start a beta blocker
- bradycardia - HF or other low-output state - risk for cardiogenic shock - PR interval > 0.24s - second or third degree heart block - active asthma or reactive airway disease
99
Metoprolol target dose
tartrate: 100 mg BID succinate: 200 mg daily
100
carvedilol starting dose
6.25 mg bid
101
carvedilol target dose
25 mg bid
102
propranolol starting dose
40 mg BID/TId
103
propranolol maintenance dose
80 mg qid
104
atenolol starting dose
25-50 mg daily
105
atenolol target dose
100 mg daily
106
beta blockers without beta 2 activity
atenolol, metoprolol, bisoprolol, nebivolol
107
Calcium Channel Blockers place in ACS
administer nonDHP to patients with recurrent ischemia and contraindications to beta blockers
108
do not use CCBs in patients with
-LV dysfunction - increased risk for cardiogenic shock - PR interval > 0.24s - second or third degree AV block without a cardiac pacemaker
109
Statins in ACS
- initiate or continue high intensity statin - obtain lipid profile
110
High intensity statins
atorvastatin 40-80 mg rosuvastatin 20-40 mg
111
ACE inhibitor/ARB place in ACS
recommended in all patients use cautiously in the first 24 horus of AMI, initiate after 24 hours
112
captopril starting dose
6.25-12.5 mg tid
113
captopril target dose
25-50 mg tid
114
lisinopril starting dose
2.5-5mg daily
115
lisinopril target dose
≥10 mg daily
116
ramipril starting dose
2.5 mg bid
117
ramipril target dose
5 mg bid
118
valsartan starting dose
20 mg bid
119
valsartan target dose
160 mg bid
120
when not to use ACE inhibitor
- hypotension/shock - bilateral renal artery stenosis - acute renal failure -drug allergy/angioedma
121
monitoring ACEis
- serum creatinine - potassium (increases) - decreased blood pressure - angioedema
122
maintenance dual antiplatelet
ASA 81 mg P2Y12 inhibitor x 12 months
123
Triple Antithrombotic Therapy
- some patients require oral anticoagulation in addition to DAPT - AFib - STEMI and asymptomatic LV mural thrombi - STEMI and anterior apical kinesis or dyskineases

PHRM 845 (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions