Acute coronary syndromes

vitohuxo's version from 2016-02-29 23:19


Question Answer
troponin levels should be doneat presentation and 3-6 hrs after symptom onset
unstable anginachest pain with negative cardiac enzymes and no or transient ischemic ECG changes
NSTEMIchest pain with positive cardiac enzymes and no or transient ischemic ECG changes
STEMIchest pain with positive cardiac enyzmes and positive ST segment elevation in at least 2 contingious leads
for STEMI give fibrinolytics if cant doPCI within 2 hours of first medical contact or 90 mins optimal door to balloon time.
MONAmorphine in patients ongoing chest pain despite nitroglycerin, oxygen saturation <90%, nitrates, aspirin 325mg given immediately if no CI and continued indefinitely
nitrates for chest painif chest pain not improved after 5 mins after first dose call 911. can take every 5 mins up to 3 doses.
nitrates and PDE-5 inhibitorsdont admin nitrate within 24 hrs of taking viagra, or 48 hrs cialis
GAP-BAglycoprotein IIb/IIIa inhibitors, anticoagulants, p2y12 inhibitors, beta blockers, ace inhibitors
medications to avoid in the acute settingNSAIDS and immediate release nifedipine
Glycoprotein IIb/IIIa antagonists moablock the platelet glycoprotein receptor which is the final common receptor blocks platelet aggregation and prevents further thrombosis.
Reoproabciximab. glycoprotein inhbiitor.
intergrilineptifibatide. glycoprotein inhibitor.
glycoprotein inhibitors side effects and notesbleeding, thrombocytopenia, hypotension. must filter abciximab with administration.
plavix prodrug....converted by 2c19. there are tests to check genotype.
plavix reduced function allele 2c19*2 and *3
plavix avoid concomitent use withomeprazole and esomeprazole
effient indicationprasugrel. P2Y12 ACS who are to be managed with PCI. keep in original container.
dont use in history of TIA or strokeeffient
brillintaticagrelor. P2Y12.
dyspnea side effect (>10%)brillinta
avoid maintenance dose of aspirin above 100mg because causes decreaed effectivenessbrillinta
kengrealcangrelor P2Y12. intravenous!
switching from cangrelor to oral P2Y12:to transition to effient 60mg or plavix 600mg immediately after stopping cangrelor
fibrinolytics MOAplasminogen to plasmin.
fibrinolytic should be given within30 mins of hospital arrival.
activase, T-PA, rt-TPAalteplase fibrinolytic.
activase dose100mg IV over 1.5 hrs.
TNKasetenecteplase fibrinolytic.
fibrinolytic SEbleeding, hypotension, intracranial hemorrhage
contine these meds for CABGaspirin and heparin unfractionated
stop before CABG plavix and brillina5 days
stop before CABG effient 7 days
stop eptifibaitde and trifoiban before CABG2-4 hours
stop abcixamibab before CABG12 hours
enoxparin, fondaparinux, and bivalirudin stop before CABG12-24 hrs, 24 hrs, 3 hours before