UA and NSTEMI

Question 1

How do you differentiate between UA and NSTEMI?

Answer 1

NSTEMI - positive biomarkers of necrosis (e.g.,
troponin)
UA - no biomarkers

Question 2

what does TIMI Risk Score means in UA/NSTEMI

Answer 2

likelihood of a patient having another ischemic events , death or urge for revasculisation with UA/NASTEMI in 14 days

Question 3

Goals of ACS

Answer 3

To relieve pain and anxiety
• To prevent/reduce myocardial damage
• To prevent or arrest complications
• To reopen closed coronary vessels

Question 4

Treatment of UA and NSTEMI

Answer 4

M- Morphine 2-5 mg IV if pain is not relieved by nitrates;
O-supplemental O2
N-GTN
A- ASA 162 mg - 325mg (chewed) AND Clopiidogril
B -B adrenergic blocker Prevent progression to MI and deathCalcium
Channel blocker should not be used as initial therapy but can be
added to the regimen of patients who are unable
to tolerate nitrates or beta blockers or in whom
these agents were not effective
A- ACEI
S-statin
H- UFH/Enoxaparin, Dalteparin

Question 5

TIMI Grade Flow

Answer 5

a score from 0-3 referring to levels of coronary blood flow
assessed during percutaneous coronary
angioplasty:

the higher the grade the more perfusion acuring

Question 6

what is the TIMI Risk Score For STEMI

Answer 6

a score system that predict the probability of death within the 30 days

Question 7

Management of STEMI in the Emergency Room

Answer 7

–Oxygen (if saturation is < 90%)

– Nitroglycerin (SL) – q5 min for up to 3 doses

– Morphine (if unresponsive to GTN)

– Non enteric coated ASA 325 mg chewed

—Reperfusion - Thrombolytic or PCI
(preferred) – pts within 12 hrs of symptom
onset; treat within 90 min of medical
contact

– High intensity Statin (before PCI)

Question 8

Treatment that must be given within 24hours for STEMI

Answer 8

1. Dual Antiplatelet therapy (DAPT)
2. Fibrinolytics: UFH or LMWH or
   Fondaparinux- Enoxaparin - 1 mg/kg subcutaneous (SC) every
   12 hours
   OR
   PCI: Bivalirudin alone or UFH with GP IIb/IIIa antagonists

Question 9

When do you give Thrombolytics

Answer 9

30 minutes from the time they present to the ER

Question 10

Name the Thrombolytic use in STEMI and its MOA

Answer 10

Alteplase: 15 mg IV bolus followed by
0.75 mg/kg infusion over 30 minutes, followed by 0.5 mg/kg
infusion

MOA;
dissolve blood clots by activating plasminogen,which forms plasmin. Plasmin break cross-links between fibrin molecules,

Question 11

give 3 contraindications for Fibrinolysis Use in STEMI

Answer 11

1. Any prior intracranial hemorrhage
2. Ischemic stroke within 3 months EXCEPT acute
   ischemic stroke within 3hours
3. Active internal bleeding (excluding menses)

Question 12

what are the drugs patients are sent home with for STEMI

Answer 12

—Antiplatelets
—Statins – Atorvastatin /Rosuvastatin
—Long term BB – target HR 50-60;continue
for at. Least 3 years
—ACEI

Question 13

what is the MOA of LMWH

Answer 13

prevent the formation of blood clots (thrombi) in the veins or arteries
activating antithrombin — > in activate prothombin – no thrombin , no fibrinogen , no fibrin no clot.

inhibition of factor Xa

Question 14

Patient A was overdosed with Heparin what is the recomended treatment

Answer 14

Protamin sulphate 1mg for each 100 unit of heparin

Question 15

What is Heparin‐induced thrombocytopenia (HIT) and how is it treated

Answer 15

decrease platelets in the blood

give Argatroban

Question 16

What is activated partial thromboplastin time (aPTT) and what is the normal rage

Answer 16

test measures the time it takes for a blood clot to form.

monitoring therapy with unfractionated heparin

1.5 to 2.5 fold

Question 17

what class of drug is Heparin

Answer 17

Anticoagulant

Question 18

what is the difference between LMWH and unfractionated heparin

Answer 18

the average molecular weight; the need for only once or twice daily dosing; the absence of monitoring the aPTT; and the lower risk of bleeding, osteoporosis, and HIT.

Question 19

what class of drug is Clopiidogril what is the MOA .

Answer 19

Antiplatelets

Prevent the binding of ADP to platelets receptor preventing the activation GP IIb/III a receptor which is needed for platelets to bide together.

Question 20

what is the interaction of Clopiidogril or ticlopidine and omeprazole or esomeprazole

Answer 20

omeprazole inhibits CYP2C19 which prevents the metabolism of Clopidogrel

Question 21

what is the MOA for ASA and its class

Answer 21

antiplatelets

Inactivate COX1 which prevents the formation of thromboxane which is responsible for platelets aggregation

Question 22

Why can’t you give aspirin to a child?

Answer 22

Aspirin is associated with a risk of Reye’s syndrome in children

Question 23

Name the Different types of Thrombolytics or Fibrinolytics and the MOA

Answer 23

Urokinase
Streptokinase
Alteplase

dissolve clot

they convert plasminogen to plasmin which cleaves fibrin thus lysing thrombi .