NAPLEX ACS Questions with Correct Answers (Grade A+)
Question 1: What causes acute coronary syndromes?
Answer: atheroscerlosis in coronary arteries leading to a ruptured plaque, thrombus, and ischemia
Question 2: What are the s/sx of ACS?
Answer: chest pain e10min (can radiate to arms, back, neck, jaw, epigastric region), SOB, sweating,
syncope, palpitations; less classical in women and elderly pts
Question 3: NSTE-ACS
Answer: non-ST elevation acute coronary syndromes - NSTEMI and unstable angina
Question 4: How is ACS diagnosed?
Answer: 12-lead EKG within 10min of first contact + troponins (may also do CK-MB or myoglobin)
Question 5: Why are CK-MB and myoglobin not used as often as troponin in diagnosing ACS?
Answer: not as sensitive
Question 6: PCI
Answer: percutaneous coronary intervention - inflate balloon in coronary artery, may also place stent;
required in STEMI, may not do in NSTE-ACS
Question 7: When is a fibrinolytic used in ACS?
Answer: if can't meet door-to-balloon goal of 90min or within 120min of first contact for STEMI
Question 8: What is the acronym for treating ACS?
Answer: MONA-GAP-BA (morphine, oxygen, nitrates, aspirin, GPIIb/IIIa, anticoagulation, P2Y12i, beta
blocker, ACEi)
Question 9: Why is morphine used in ACS?
Answer: for pain and anxiety relief, but should only be used if a patient continues to have chest pain after
nitrates given
Question 10: How is morphine dosed in ACS?
Answer: 2-5mg IV q5-30min prn
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, Question 11: When is oxygen used in ACS?
Answer: if SaO2 <90% or respiratory distress
Question 12: When is NTG used in ACS?
Answer: every time (unless hypotension or PDE-5 use); SL NTG x3 q5min, then can use IV if continued
chest pain
Question 13: When is IV NTG contraindicated?
Answer: SBP <90, HR <50, right ventricular infarction
Question 14: How is aspirin dosed in ACS?
Answer: 162-325mg chewed immediately; continued maintenance dose of 81-162mg QD
Question 15: When are beta blockers given in ACS?
Answer: start within 24h for all pts and continue; prefer beta-1 selective without ISA
Question 16: Which beta blockers have ISA?
Answer: acebutolol, pindolol
Question 17: When are ACEi given in ACS?
Answer: start within 24h and continue if HFrEF, HTN, diabetes, or CKD (could use ARB if needed)
Question 18: Why are beta blockers used post-ACS?
Answer: antianginal properties, prevent cardiac remodeling, increase long-term survival
Question 19: Why are ACEi used post-ACS?
Answer: prevent cardiac remodeling, lower preload and afterload
Question 20: Why are NSAIDs avoided in ACS?
Answer: risk of mortality, reinfarction, cardiac rupture, renal insufficiency, HF
Question 21: Why is IR nifedipine avoided in ACS?
Answer: risk of mortality
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Question 1: What causes acute coronary syndromes?
Answer: atheroscerlosis in coronary arteries leading to a ruptured plaque, thrombus, and ischemia
Question 2: What are the s/sx of ACS?
Answer: chest pain e10min (can radiate to arms, back, neck, jaw, epigastric region), SOB, sweating,
syncope, palpitations; less classical in women and elderly pts
Question 3: NSTE-ACS
Answer: non-ST elevation acute coronary syndromes - NSTEMI and unstable angina
Question 4: How is ACS diagnosed?
Answer: 12-lead EKG within 10min of first contact + troponins (may also do CK-MB or myoglobin)
Question 5: Why are CK-MB and myoglobin not used as often as troponin in diagnosing ACS?
Answer: not as sensitive
Question 6: PCI
Answer: percutaneous coronary intervention - inflate balloon in coronary artery, may also place stent;
required in STEMI, may not do in NSTE-ACS
Question 7: When is a fibrinolytic used in ACS?
Answer: if can't meet door-to-balloon goal of 90min or within 120min of first contact for STEMI
Question 8: What is the acronym for treating ACS?
Answer: MONA-GAP-BA (morphine, oxygen, nitrates, aspirin, GPIIb/IIIa, anticoagulation, P2Y12i, beta
blocker, ACEi)
Question 9: Why is morphine used in ACS?
Answer: for pain and anxiety relief, but should only be used if a patient continues to have chest pain after
nitrates given
Question 10: How is morphine dosed in ACS?
Answer: 2-5mg IV q5-30min prn
Page 1
, Question 11: When is oxygen used in ACS?
Answer: if SaO2 <90% or respiratory distress
Question 12: When is NTG used in ACS?
Answer: every time (unless hypotension or PDE-5 use); SL NTG x3 q5min, then can use IV if continued
chest pain
Question 13: When is IV NTG contraindicated?
Answer: SBP <90, HR <50, right ventricular infarction
Question 14: How is aspirin dosed in ACS?
Answer: 162-325mg chewed immediately; continued maintenance dose of 81-162mg QD
Question 15: When are beta blockers given in ACS?
Answer: start within 24h for all pts and continue; prefer beta-1 selective without ISA
Question 16: Which beta blockers have ISA?
Answer: acebutolol, pindolol
Question 17: When are ACEi given in ACS?
Answer: start within 24h and continue if HFrEF, HTN, diabetes, or CKD (could use ARB if needed)
Question 18: Why are beta blockers used post-ACS?
Answer: antianginal properties, prevent cardiac remodeling, increase long-term survival
Question 19: Why are ACEi used post-ACS?
Answer: prevent cardiac remodeling, lower preload and afterload
Question 20: Why are NSAIDs avoided in ACS?
Answer: risk of mortality, reinfarction, cardiac rupture, renal insufficiency, HF
Question 21: Why is IR nifedipine avoided in ACS?
Answer: risk of mortality
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