NSTEMI/STEMI

Question 1

General

Answer 1

NSTE-ACS: MONA-GAP-BA +/- PCI

STEMI: MONA-GAP-BA +/- PCI or FIB

Question 2

MONA

Answer 2

Morphine: vasodilator of coronary vessels, 2-5 mg IV PRN 5-30 min

Oxygen: if <90% oxygen sat or respiratory distress

Nitroglycerin: decreases O2 demand/preload, 0.4 mg SL or 10 mcg/min IV (if persistent ischemic pain)

Aspirin: inhibits platelet aggregation, CHEWABLE 325 mg tab ASAP

Question 3

GAP-BA

Answer 3

G: Abciximab or Eptifibatide (CI in anything that makes you bleed)

A: LMWH, UFH, bivalrudin

P: P2Y12 - clop/tica for MM/PCI, pras for PCI only

B: BB - within 24 hrs

A: ACEI - within 24 hrs

Question 4

AVOID

Answer 4

NSAIDs and Nifedipine IV (increase mortality)

Question 5

P2Y12s

Answer 5

Clopidogrel:
-Prodrug, 2C19, avoid omeprazole/eso

Prasugrel:
-CI in TIA/stroke history (not studied)
-Original container d/t moisture
-Only for PCI

Ticagrelor:
-ASA < 100 mg MD
-90 mg BID x1 year then 60 mg BID

All: bleeding AE

Question 6

Fibrinolytics

Answer 6

Break up existing clots = only in STEMI (complete blockage)

1. PCI preferred, 90 min door-to-balloon time
2. If can’t within 120 min = fibrinolytic
3. Optimal fib time is within 30 min

Alteplase: 100 mg IV (STEMI dose)
also Tenecteplase
-CI in stroke, ICH, surgery, un. HTN, bleeding

Question 7

2ndary Prevention

Answer 7

1. ASA 81
2. P2Y12 (CTP-PCI, CT-MM) + ASA x1 year (DAPT)
3. NTG
4. BB x3 yr or forever
5. ACEI (EF, HTN, DIA, CKD)
6. ALDO anta: HF/DM/low EF
7. Statin