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PHRM 845 > ACS pt2 > Flashcards

ACS pt2 Flashcards

1
Q

What are the goals of therapy for ACS?

A
  • Restore blood flow
  • Provide relief of ischemia
  • Prevent morbidity/mortality
  • Prevent re-occlusion of artery
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2
Q

What are the initial recommendations within arrival to ED?

A
  • 12 lead ECG
  • Serial troponin levels
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3
Q

What is 12 lead ECG?

A
  • Done within 10 min of arrival at an emergency facility
  • If initial is not diagnostic but pt is symptomatic and has signs of ACS, do an ECG every 15-30 min for the 1st hour
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4
Q

When should serial troponin levels be taken?

A

Troponin levels should be obtained at presentation and 3-6 hrs after sx onset

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5
Q

What does MONA stand for?

A

Morphine, oxygen, NTG, ASA

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6
Q

When is MONA initiated?

A

Immediately upon arrival

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7
Q

What is morphine used for?

A

Relieve chest pain

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8
Q

What dose of morphine is given?

A

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

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9
Q

What are the SEs of morphine?

A

Sedation, respiratory depression, nausea/vomiting

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10
Q

Why must all NSAIDs except ASA be avoided during hospitalization and use with morphine?

A

NSAIDs lead to sodium and water retention which increases risk of MACE

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11
Q

What is the goal oxygen saturation?

A

To maintain pt’s oxygen saturation >90%

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12
Q

What is NTG used for?

A

To increase blood flow to the heart (vasodilator)

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13
Q

What is the dose of SL NTG?

A

0.3-0.4 mg q5min x 3 for ischemic pain

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14
Q

What is the dose of IV NTG?

A
  • Start at 10 mcg/min
  • Titrate by 5 mcg/min q5min (MAX: 200 mcg/min)
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15
Q

What are the SEs of NTG?

A

Headache, hypotension

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16
Q

Why is transdermal NTG not recommended?

A
  • Onset of duration is not rapid enough
  • Takes 15-60 min
17
Q

What is a problem with NTG?

A

Tolerance develops after >24 hours of continuous use

18
Q

How is NTG tolerance resolved?

A
  • Increase dose or change to intermittent admin
  • Aim for >10 hours of a NTG free period/day
19
Q

What dose of ASA is given in MONA?

A
  • 162-325 mg; 325 mg is most common loading dose
  • Given to ALL pts w/o CI to ASA
20
Q

Can enteric coated ASA be used?

A
  • Yes
  • Must be chewed
21
Q

Is ASA still given even if pt has taken a dose of ASA before hospitalization?

A
  • Yes
  • Pt is given dose that is the difference of 325 mg and what the pt has already taken
22
Q

How is a coronary angiography done?

A
  • Cath is inserted into radial and femoral artery and fed up to heart
  • Dye is injected into coronary arteries
  • X-ray pic is taken and that shows blocked arteries
  • Stent is placed into blocked arteries, if needed
23
Q

What is a percutaneous coronary intervention (PCI)?

A
  • Uses a small balloon to reopen a blocked artery to increase blood flow
  • A stent is placed, if needed, to keep artery open long term
24
Q

What is a coronary artery bypass graft (CABG)?

A
  • Open heart surgery
  • Vein or artery from another part of body is removed and attached to heart to “bypass” blocked artery/arteries
25
Q

What are fibrinolytics?

A

Clot busters

26
Q

What are the drugs in fibrinolytics class?

A
  • Tenecteplase
  • Reteplase
  • Alteplase
27
Q

How is tenecteplase dosed?

A

By pt’s actual weight

28
Q

When should reperfusion therapy be administered in STEMI pts?

A

Reperfusion therapy should be admin to ALL eligible STEMI pts whose sxs began in past 12 hours

29
Q

Why is PCI the preferred reperfusion therapy option over fibrinolytics?

A
  • Higher rates of infarct artery patency
  • Lower rates of recurrent ischemia, reinfarction, emergency repeat revascularization procedures
  • Lower rates of intracranial hemorrhage
  • Lower rates of death
30
Q

What is the door to needle time in STEMI pts?

A

Fibrinolytics should be admin within 30 min of hospital arrival

31
Q

What is the door to balloon time in STEMI pts?

A

PCI should occur within 90 min of hospital arrival

32
Q

What reperfusion therapy should be done if pt is at a non PCI capable hospital?

A

Fibrinolytic therapy is recommended

33
Q

When is fibrinolytic therapy recommended for a pt at a non PCI capable hospital?

A

> =120 min away from PCI capable hospital

34
Q

What is early invasive reperfusion therapy that’s for UA/NSTEMI pts?

A

Coronary angiography +/- revascularization

35
Q

When is early invasive therapy preferred?

A

For pts with high risk features:
- Refractory angina
- New onset HF
- Rising troponin
- New ST segment depression

36
Q

What is ischemia guided reperfusion therapy that’s for UA/NSTEMI pts?

A

“Medical” management

37
Q

What does ischemia guided therapy consist of?

A
  • Tx w evidence-based meds
  • No heart cath (unless pt has refractory or recurrent ischemic sx or becomes hemodynamically unstable)

PHRM 845 (51 decks)

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