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Flashcards in Acute Coronary Syndrome Deck (38):
1

Acute coronary syndromes include

Unstable angina, myocardial infarction (these are forms of coronary heart disease, which is the most common cause of cardiovascular disease death

2

typically results in an injury that transects the thickness of the myocardial wall. Pathologic Q-waves

STEMI

3

typically is limited to sub-endocardial myocardium. Patients do not usually develop the pathologic Q wave

NSTEMI

4

how is NSTEMI different from unstable angina

NSTEMI ischemia is severe enough to produce myocardial necrosis (need to draw blood, because they look alike on ECG)

5

general measures for patients presenting with ACS

oxygen
stool softeners
bedrest
diet
anxiolytics

6

this is generally preferred over fibrinolytic therapy for treating acute STEMI

primary PCI

7

what is PCI

percutaneous coronary intervention. Involves the placement of a coronary stent and percutaneous transluminal coronary angioplasty (PTCA)

8

dont give to a patient on a phosphodiesterase inhibitor

nitrates

9

there is no data demonstrating efficacy at reducing cardiac events, and is primarily used for symptom relief

nitroglycerin

10

this drug has sedative properties that tend to decrease anxiety and causes venodilation, decreases HR and BP

morphine

11

this drug class is shown to decrease mortality but had NO recommendation for NSTEMI/UA

fibrinolytics

12

therapy with this drug should be administered within 12 hours of symptom onset, should not be administered to pts whose symptoms begin more than 24 hours earlier

fibrinolytics

13

patients should take this drug if they cant chew an aspirin

clopidrogel

14

initial conservative therapy strategy that should be started ASAP after admission and continued for at least 1 month, ideally 1 year

clopidrogel plus ASA plus anticoagulant

15

initial invasive therapy strategy that should be given prior to diagnostic angiography or PCI

ASA plus either clopidregel or an IV GP IIaIIIb inh (such as abciximab)

16

for STEMIs, these drugs should not be given to patients aged over 75 years because of an increased risk of ICH

abciximab plus half dose reteplacse or tenecteplase

17

for STEMIs, full dose fibrinolytic therapy should not be followed by what

PCI (may be harmful)

18

NSTEMI- anticoagulant therapy should be added ASAP. For conservative therapy, which ones are best?

enoxaparin or UFH (followed by fondaparinux)

19

NSTEMI- conservatively, this anticoagulant is preferred in patients who have an increased risk of bleeding

fondaparinux

20

NSTEMI-invasively, these two anticoagulants have the strongest support

enoxaparin and UFH (followed by bivalirudin and fondaparinux)

21

do not use this drug as the sole anticoagulant to support PCI

fondaparinux

22

Usually UFH and LMWH are interchangeable UNLESS

over 75 receiving thrombolytic therapy or have significant renal dysfunction

23

this class limits myocardial damage and mortality when used for acute STEMI and reduce reinfarction and mortality when used chronically post-STEMI

BB

24

cautions to this class: HR<50 bpm, heart block, hypotension, moderate/severe LV dysfunction, COPD, asthma, signs of peripheral hypo perfusion

BB

25

this class decreases progression to CHF, reinfarction, and mortality. It limits post infarction LV remodeling and preserves ventricular pump functions

ACEI

26

T or F: an IV ACE inhibitor should be given to patients within the first 24 hours with anterior infarction, pulmonary congestion, or LVEF <40

FALSE. only oral

27

this class has no beneficial effect on death or nonfatal MI. It may increase mortality in some patients (LV dysfunction or pulmonary edema)

CCB

28

NSTEMI- these CCBs should be given to pts with continuing or recurring ischemia and in whom BB are contraindicated

non-dyhydropyridines (verapamil or diltiazem)

29

NSTEMI- these CCB should not be administered to patients with NSTEMI/UA in the absence of a bb

dihydropyridines

30

STEMI- these drugs should not be given to pts with STEMI and associated systolic LV dysfunction and CHF

verapamil or diltiazem (reasonable in pts who BB are ineffective in the absence of CHF, LV dysfunction, or AV block)

31

Overall, EVERY PATIENT with NSTEMI/UA and STEMI should get:

ASA
NTG
BB
ACEI

32

long term prevention of CAD: STEMI

ASA indefinitely plus
-1-12 months of clopidrogel if metal or no stent
-at least 12 months of clopidrogel if drug eluding stent
-THROMBOLYTIC for at least 14 days

33

long term prevention of CAD: NSTEMI/UA

ASA indefinitely plus
-1-12 months of clopidrogel if metal or no stent
-at least 12 months of clopidrogel if drug eluding stent

34

Long term prevention drugs for all patients

NTG (SL)
BB (unless contraindicated)
ACEI or ARB

35

this class decreases CV mortality and all cause mortality in pts with a variety of cholesterol concentrations. They are good for primary and secondary prevention of MI- long term prevention

HMG-CoA reductase inhibitors (statins)

36

this class can be used for long term prevention when BBs are not successful, contraindicated

CCB (verapamil and diltiazem- NOT dihydropyridine CCB)

37

can be used in pts with paroxysmal or chronic atrial fib or flutter and in post MI patients

warfarin

38

INR goal

2.0-3.0