Pharmacologic Management of STEMI and Angina

Question 1

What is the underlying pathophysiologic imbalance in myocardial infarction?

Answer 1

More oxygen demand than oxygen supply

Question 2

What is the a factor that can decrease myocardial O2 supply and increase myocardial O2 demand?

Answer 2

tachycardia

Question 3

First medication to be given when patient presents with cardiac chest pain?

Answer 3

aspirin chewed up (faster absorption)

Question 4

Two major steps in pharmacologic treatment of MI:

Answer 4

1. reperfuse the coronary artery (immediate phase)
2. prevent remodeling that increases heart failure & death risk (late phase)

Question 5

In the immediate phase of an MI, what pharmacologic therapy is indicated?

Answer 5

1. anticoagulant (like aspirin)
2. decrease O2 demand (opioid like morphine)
3. break up clot already there (sometimes thrombolytic like tPA versus procedure to remove)

Question 6

Why is nitroglycerin used in angina?

Answer 6

decreases preload (decreased O2 demand)
decreases coronary artery spasm

Question 7

How to administer nitroglycerin for active chest pain?

Answer 7

sublingual ASAP
Q5mins, take another dose if no relief (up to 3 doses)

*pt should be calling 911 as an outpatient after the first dose

Question 8

All patients with CAD should be on which two drugs (types of drugs)?

Answer 8

Antiplatelet
Cholesterol lowering agent

Question 9

cornerstone of immediate interventions for new onset chest pain:

Answer 9

“MOAN”
morphine
oxygen
aspirin (chewed)
nitroglycerin

Question 10

How do we reperfuse the coronary arteries after MI?

Answer 10

pharmacologic: fibrinolytics

OR

mechanical: percutaneous coronary intervention

Question 11

What other things might we give the patient after a PCI?

Answer 11

anticoagulants
antiplatelets
ACE inhibitors or ARBs

Question 12

Why is an ACE inhibitor or an ARB indicated post-MI?

Answer 12

decreases CV remodeling