acute coronary syndromes Flashcards
(27 cards)
oxygen goal in ACS
> 94%
why should oxygen therapy be used cautiously in ACS
it promotes coronary vasoconstriction and generates toxic O2 metabolites
dosing for nitroglycerin
- CP
- recurrent pain, CHF, of high BP
CP: 0.4 mg SL or by mouth spray
-repeat every 5 min x 2 if needed
RP, CHF, High BP: 5 ug/min and increase 5-10 ug/in every 5 min to desired effect
what is the max dose rate of nitro
200 ug.min
ASA dose ACS
325 chewable initially
75-162 mg enteric coated tablets daily
BB blocker dose ACS
atenolol 10 mg IV then 100 mg PO daily
Metoprolol 5 mg V every 5 min for 3 doses then 50 mg PO q6 for 48 hrs then 100 mg PO BID
when do not use BB in ACS
cocaine induced chest pain or MI
chest pain not relieved by nitro should prompt immediate administration of what
morphine
when to not use nitro
R sided infarct, recent pde5 inhib use
is morphine induced respiratory depression common in ACS
no
what are the absolute contraindications to thrombolytic therapy
Active bleeding other than menses
Malignant intracranial neoplasm (primary or metastatic)
Cardiovascular anomaly (e.g. AV malformation)
Suspected aortic dissection
Ischemic stroke within 3 months (but not within 3 hrs)
Prior history of intracranial hemorrhage
Significant closed-head or facial trauma in past 3 months
when should thrombolytic threrapy for MI be started
30 mintues after initial onset of presentation
major bleeding from thromolysis can be treated with what
cryoprecipitate 10-15 bags then FFP up to 6 units
what is goal serum fibrinogen after cryo and FFP tx
over 1
PCI should be performed within ____ ___ after hospital arrival
90 minutes
what kind of anticoagulation should be used for pts who receive therapy with fibrinolytic agents or pci
unfractionated heparin
what kind of anticoagulation should be used for pts who do not receive reperfusion therapy
LMWH aka lovenox aka enoxaparin
enoxaparin with renal insuffiiency
if CrCl under 30 then reduce dose by 50%
pts with HIT and need anticoagulation for MI and had pci
bivalirudin
pts with HIT and had ACS with thromboyctic therapy or no reperfusion use what
fondaparinux
how early before a surgery should clopidogrel be stopped
5 days
what drug should you avoid with clopidogrel
PPI, can inhibit activation
how do glycoprotein receptor antagonists work
block IIb IIIa receptors on platelets from binding fibrinogen and then no bridge formed between platelets
what are the GP receptor antagonists
abciximab
eptifibatide
tirofiban
