Term
| what classifies as ACS? -3 |
|
Definition
chonric unstable angina
NSTEMI
STEMI |
|
|
Term
| typical symptoms of ACS-2 |
|
Definition
pain thru arm and jaw
GI pain |
|
|
Term
| some atypical symptoms of ACS-5 |
|
Definition
| back pain, nausea, dizzy, cold sweat, hypotension |
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|
Term
| what are the common syptoms for women? 3 |
|
Definition
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|
Term
| elderly may also have what smytpom? |
|
Definition
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|
Term
| diabetic ppl's symptoms may be reduced bc of? |
|
Definition
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|
Term
| what is the only thing given to a patient in ER that reduces mortality (reduces chance of dieing) |
|
Definition
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|
Term
| what is the acronym for ER/early h0spital pharmco? |
|
Definition
| MONA- morphine, oxygen, nitrate, aspirin |
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|
Term
| for ACS what is the dose and admin of aspirin |
|
Definition
|
|
Term
| when do you do oxygen therapy? |
|
Definition
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|
Term
| for management of chest pain fr ACS- what are the 3 agents in order of what start with |
|
Definition
-sublingual NTG
-IV morphine
-IV NTG |
|
|
Term
| when do you avoid sublingual NTG? |
|
Definition
|
|
Term
| what is the dose for SL NTG in ER? |
|
Definition
|
|
Term
| what is the dose for morphine in the ER |
|
Definition
|
|
Term
| what do you use if the person has morphine allergy |
|
Definition
|
|
Term
| what is the dose for IV NTG in ER? |
|
Definition
|
|
Term
| when do you hold off on IV NTG?-4 |
|
Definition
| hypotension, bradycardia, tachycardia, arrthymia |
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|
Term
| what med do you want to titrate off instead of cold turkey? |
|
Definition
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|
Term
| oral BBs are limited to what time limit? |
|
Definition
|
|
Term
what is the marker that diagnosis acute
MI? |
|
Definition
| cardiac troponin w/ 1 level > 99th precentile |
|
|
Term
| how do you determine from unstable angina and a STEMI/NSTEMI |
|
Definition
| the angia doesnt have elevated troponin |
|
|
Term
| are the symptoms for unstable agina and the NSTEMI/STEMI different? |
|
Definition
|
|
Term
| how do you differentiate btwn NSTEMI and STEMI |
|
Definition
|
|
Term
classify the risk for patients:
unstable angina
STEMI
NSTEMI |
|
Definition
low
highest
high- starts myocardial cell death |
|
|
Term
| what dianostic tool helps determine STEMI? |
|
Definition
|
|
Term
| on an ECG what classifies as a STEMI |
|
Definition
| ST elevation in at least 2 leads |
|
|
Term
| what helps determine high from low risk NSTEMI? |
|
Definition
| ROMI panel (cardiac enzyme) |
|
|
Term
| how often does a ROMI need to be done? |
|
Definition
| at presentation, ev 6-8 hrs |
|
|
Term
| ROMI contains what markers |
|
Definition
|
|
Term
what is the first cardiac enzyme to inreasE?
it has _ sensitivty and _ specific |
|
Definition
|
|
Term
what is the last cardiac enzyme to increase?
has _ sensitivity and _ specificity |
|
Definition
troponin I, C, T
high and high! |
|
|
Term
| what is the time limit that treatment for a STEMI can improve prognosois? |
|
Definition
|
|
Term
| goal of STEMI treatment is to restore blood flow in _ amt of time |
|
Definition
|
|
Term
| STEMI can be treated with- 2 things |
|
Definition
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|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| mesh tube to maintain patency |
|
|
Term
for STEMI what is the prefered treatment?
why? |
|
Definition
PCI
90% cornoary patency afterwards |
|
|
Term
Goal for PCI therapy in STEMI is?
goal for firinolysis? |
|
Definition
90 min upon arrival
30 min |
|
|
Term
when do you do fibrinolyis for STEMI?
after admin, what do you do with patient? |
|
Definition
when PCI cant be done
transfer to PCI able hospital |
|
|
Term
for UA/NSTEMI what is the first step?
why? |
|
Definition
risk stratification
prevent costly, not needed prodcedure |
|
|
Term
For high risk UA/NSTEMI what is the treatment time limit?
what treatment cna be done? |
|
Definition
w/i 12-24 hrs
angiography +/- PCI |
|
|
Term
| what do you do with low risk UA/NSTEMI patient |
|
Definition
| send to outpatient clinic |
|
|
Term
| these are candidates for early invasive procedure for NSTEMI-4 |
|
Definition
GRACe> 140
TIMI= 5-7
+ troponins
ST depression |
|
|
Term
| when do you do a CT/ECG/stress test? |
|
Definition
| moderate-low risk NSTEMI/UA |
|
|
Term
| What treatment is started for mod-low risk patients? |
|
Definition
| antiplatelet and anticoag |
|
|
Term
| for mod-low risk patients- does it matter when do PCI? |
|
Definition
|
|
Term
GO to ER for ACS:
-step 1: -3 things |
|
Definition
Start MONA
Get cardiac enzymes
get ECG |
|
|
Term
|
Definition
| dr reads ECG and says UA/NSTEMI or STEMI |
|
|
Term
| are pateints normally under or over dosed? |
|
Definition
|
|
Term
| the low risk UA/STEMI need high or low doses? |
|
Definition
|
|
Term
if categoized as PCI UA/NSTEMI you are at increased risk for?
need high or low potency?
whihc med is added? |
|
Definition
thombosis
high
GP 2b3a inhibitors |
|
|
Term
PCI STEMI fibrinolytic patients are increased risk for"?
want high or low potency?
what agents arent used |
|
Definition
bleeding
low
effient, heparin, b2/3a |
|
|
Term
all P2Y12 inhibitors have CI for: -2
what additonal CI does prasugrel have? |
|
Definition
hypersens, severe bleeding;
history of Stroke/TIA |
|
|
Term
all P2Y12 inhibitors have what ADES?
what additonal one does plavix and prasugrel have?
what additonal 2 does Ticagrelor have? |
|
Definition
GI upset, bleeding, bruisng
TTP;
dyspnea, ventricluar pause |
|
|
Term
| you skip the loading dose of clopidogrel for fibrinolysis when? |
|
Definition
|
|
Term
| the loading dose of PCI for clopidogrel is diff, what is it? |
|
Definition
|
|
Term
| what is the caution on prasugrel |
|
Definition
| dont admin until planning on stent placement |
|
|
Term
| prasugrel is really only used for what? |
|
Definition
|
|
Term
| when do you want to avoid giving prasugrel- 2 |
|
Definition
|
|
Term
| ticagrelor can be used for what?-2 |
|
Definition
| medicla managment and PCI |
|
|
Term
| GP 2b/3ai are added when doing? |
|
Definition
|
|
Term
| GP 2b/3a i are omitted when _ is used as anticoag for PCI |
|
Definition
|
|
Term
| when do you monitor platelets for GP 2b/3a? |
|
Definition
|
|
Term
all anticoags for ACS have CI of-2
heparinoids have what addiotnal risks-2 |
|
Definition
severe bleeding risk, active bleeding
HIT, recent stroke |
|
|
Term
| all anticoags have risk of bleeding, what addional ADEs do heparinoids have? |
|
Definition
| HIT- heparin induced thrombocyto |
|
|
Term
| when do you add IV bolus for enoxaparin |
|
Definition
|
|
Term
| what med do you titrate to aPTT? |
|
Definition
|
|
Term
| which anticoag is avoided in PCI |
|
Definition
|
|
Term
| when is Bivalirudin used as anticoag? |
|
Definition
|
|
Term
| HIT is thombocytopenia, what do you still worry about tho? |
|
Definition
| clotting in legs and lungs |
|
|
Term
| whcih med has the hgihest risk for HIT |
|
Definition
|
|
Term
| if doing fibrinolysis- what other 3 meds need to be added and doses? |
|
Definition
ASA 162-325
clopidogrel- 600 mg loading (skip if over 75 yo)
anicoag -varies |
|
|
Term
| heparin is titirated to what aPTT for fibrinolysis |
|
Definition
|
|
Term
secondary prevention:
hypertension, can use: -5 |
|
Definition
BB
ACEI/ARB
CCB
Aldosterone antags |
|
|
Term
by what time do you want to have admin BB and ACEI?
why wait on early IV ACEI tho? |
|
Definition
24 hrs
risk of hypotension |
|
|
Term
| when do you use aladosterone antags for 2nd prevention? |
|
Definition
|
|
Term
| whendo you have to start aldosterone antaf by? |
|
Definition
|
|
Term
| CI to using aladosertone anatg- 2 |
|
Definition
|
|
Term
| regardless of LDL, all ACS pateints should be sent home with high dose statin such as- 2 |
|
Definition
|
|
Term
PCIs are called platelet-
what antithrombitc therapy is required? how long? |
|
Definition
phillic
dual antiplatelet therapt DAPT; 1 yr |
|
|
Term
| if not PCI, what antithrombitc therapy is used? how long? |
|
Definition
| DAPT for 1 mo., maybe 12 mo |
|
|
Term
| what is used to reduce GI bleed with DAPT? |
|
Definition
|
|
Term
| what group of ppl benefit from PPIs durinf DAPT? -4 |
|
Definition
| old age, warfarin, NSAIDS, steroids |
|
|
Term
| if combine warfarin with DAPT what is new INR needed? |
|
Definition
|
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