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Flashcards in Management of STEMIs-MJ Deck (33)
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1
Q

How many minutes can a client experience cardiac ischemia before cell death occurs?

A

20 minutes, if longer than 20 minutes, myocyte injury is irreversible

2
Q

What does myocardial injury trigger?

A

Ventricular remodling

3
Q

What is ventricular remodeling?

A

A process when ventricular mass increases and the chambers change in volume and shape

4
Q

What is ventricular remodeling driven by?

A

Local production of angiotensin II

5
Q

What does ventricular remodeling increase the risk of?

A

HF and death

6
Q

There are 4 main signs and symptoms for an acute STEMI. What are they?

A
  1. Presence of chest pain
  2. Characteristic ECG changes
  3. Elevated serum levels of myocardial cellular components
  4. “Other”
7
Q

S&S for acute STEMI: Presence of chest pain

  • Severe substernal pressure results in unbearable ____ or ______.
  • Where does the pain radiate?
  • How is this different from angina pectoris?
A
  • unbearable crushing or constriction
  • radiates down the arm and up to the jaw
  • Pain by STEMI lasts longer! & not relieved by nitroglycerine
8
Q

S&S for acute STEMI: Characteristic ECG changes

-What do we see almost immediately in response to ischemia: ST elevation or depression? Then what develops?

A

ST elevation..then a prominent Q wave develops in the majority of patients

*Q waves are small or absent in a normal ECG

9
Q

S&S for acute STEMI: Elevated serum levels of myocardial cellular components
-What levels are looked at?

A

Troponin and creatinine kinase

10
Q

S&S for acute STEMI: What are the 4 “other” symptoms?

A

Sweating

  • Weakness
  • Sense of impending doom
  • Know that about 20% of people with STEMI experience NO symptoms
11
Q

What are considered the BEST serum markers for STEMI?

A

Troponin!–cardiac troponin I and cardiac troponin T

12
Q

Under normal conditions, troponin is NOT detectable in the blood. When do they come detectable?

A

2-4 hours after symptom onset and peaks 10-24 hours…they return undetectable again in 5-14 days.

13
Q

What happens to troponin when STEMI occurs?

A

100 fold or more above the lower limits of detection

14
Q

Measurements of troponin I and T are more -____ (sensitive or specific)

A

Sensitive

15
Q

Before troponins, the preferred biomarker for STEMIs were measuring the creatinine-kinase (CK-MB). Where is CK-MB found?

A

Primarily in cardiac muscle rather than skeletal muscle

16
Q

What does an increase in serum CK-MB mean?

A

Cardiac injury

17
Q

What medication must be given immediately to a client with a STEMI? What meds should be discontinued?

A

Aspirin can be given..all other NSAIDs should be discontinued!!!!

NSAIDs, with the exception of aspirin, have a BBW for increased risk of stroke and MI

18
Q

Why do we give aspirin immediately to a client with a STEMI?

A

Suppresses platelet aggregation (producing an immediate anti-thrombiotic effect)

19
Q

When should aspirin therapy begin and when should it end?

A

Aspirin therapy should begin immediately after onset of symptoms for a STEMI and it should be continued indefinitely!

20
Q

Why is chewable aspirin given for the first dose?

A

The first dose should be chewed to allow rapid absorption across the buccal mucosa

21
Q

What should the dose be for the chewable aspirin?

A

162-325 mg

22
Q

For prolonged aspirin therapy, what should the dose be? And why do we give aspirin indefinitely after STEMIs?

A

81-162 mg/d

Reduces the risk of re-infarction, stroke, and death

23
Q

What is the analgesic of choice for STEMIs?

A

IV morphine

24
Q

What does IV morphine improve?

A

Hemodynamics and relieves pain

25
Q

What does IV morphine reduce?

A

Cardiac PRELOAD by promoting venodilation

26
Q

Since IV morphine reduces preload, that means it ____ the work of the heart

A

Decreases

27
Q

IV morphine also may cause some reduction in after load by promoting _____

A

Arterial dilation

28
Q

IV morphines combined reduction in preload and after-load _____ cardiac oxygen demand and that helps preserve the ischemic myocardium

A

Lowers

29
Q

What BB reduces cardiac pain, infarction size, and short-term mortality?

A

Atenolol and metoprolol

30
Q

Continued use of oral BB _____ long term survival

A

Increases

31
Q

T/F: Nearly all patients can benefit from BB, but many don’t get them.

A

True

32
Q

T/F: The patients that DO get a BB, get a dose that is too high.

A

False. The patients that do get the BB usually has a dose that is too LOW

33
Q

As STEMI evolves, the HR and force of contraction rises substantially, _____ cardiac demand.

A

Increases