Exam 3 - STEMI

Question 1

Six main treatments done in ED for STEMI

Answer 1

1. ASA
2. Morphine
3. NTG sublingual
4. Oxygen via NC for 96%
5. Anticoagulation (LMWH or UFH)
6. Beta-blocker

Question 2

What oral antiplatelets to use? Which P2Y12?

Answer 2

ASA and P2Y12.

Clopidogrel, Pasagrul, or Ticagralor. Don’t use Pasagrul if prior TIA/CVA.

Question 3

Max time for DAPT? Time for smokers?

Answer 3

Max 30 months. Smokers get life-long DAPT.

Question 4

Which anticoagulant to use in preparation for PCI? Kidneys?

Answer 4

Enoxaparin (LMWH)

CrCl less than 30 reduce. Less than 20 don’t use.

Question 5

Which anticoagulant to use with HIT and need PCI?

Answer 5

Bivalrudin

Question 6

Precautions with Bivalrudin?

Answer 6

Reduce dose if CrCl less than 30. Elderly.

Question 7

What are three fibrinolytic options?

Answer 7

1. Alteplase
2. Reteplase
3. Tenecteplase

Question 8

Alteplase vessel patency percent and within what time? What need as cofactor? What specific for?

Answer 8

75% patency within 90 minutes. Fibrin as co-factor or does’t work. Very specific for clot-bound Fibril.

Question 9

Reteplase vessel patency percent and within what time? Can act on what? Clearance?

Answer 9

84% vessel patency within 30-90 minutes. Can act on free-fibrin. Renal clearance.

Question 10

Tenecteplase vessel patency percent and within what time? Works on Fibrin in what specific places? Where comes from? Half-life? Where in activated?

Answer 10

85% vessel patency in 90 minutes. More specific for clout-bond fibrin and less on systemic fibrin. Biphasic half-life. Comes from Chinese hamster ovary cells. Inactivated in liver.