MI - PHARM EXAM 2| TOP SCORES MADE SIMPLE |
TRUSTED TEST SOLUTIONS!
acute coronary syndrome (ACS) Answer: umbrella term for situations when the heart
muscle has its blood flow blocked
3 types - unstable angina, NSTEMI, STEMI
unstable angina - cardiac biomarkers and EKG Answer: negative biomarkers
no ST elevation on EKG
NSTEMI - cardiac biomarkers and EKG Answer: positive biomarkers
no ST elevation on EKG
STEMI - cardiac biomarkers and EKG Answer: positive biomarkers
ST elevation on EKG
cardiac biomarkers Answer: cardiac troponin I or T
CK-MB
cardiac troponin I or T Answer: very specific for MI
draw levels at presentation and then 3-6 hrs after
can be used to assess how damaging the MI has been
CK-MB Answer: specific for MI
not commonly used anymore with the sensitivity and specificity of cardiac troponin
assays
initial treatment MI Answer: MONA
morphine, O2, nitrates, ASA
morphine Answer: opioid pain med
given IV to those that have continued ischemic chest pain despite being treated with the
max tolerated anti-ischemic medication
works by decreasing O2 demand and slowing HR
1
APPHIA - Crafted with Care and Precision for Academic Excellence.
, oxygen Answer: administer to patients who have O2 saturation <90%, those in resp
distress, and those with other high-risk features of hypoxemia (maybe asthma or
COPD)
nitrates - forms/doses Answer: sublingual: 0.3-0.4 mg every 5 minutes for up to 3
doses, assess need for IV nitro after those doses
IV: indicated for those with persistent ischemia, heart failure, or HTN
nitrates contraindications Answer: do not give to those who have taken a PDE inhibitor
within the past 24-48 hours (can cause severe hypotension)
Aspirin Answer: 162-325 mg of non-enteric coated, chewable aspirin should be given
as soon as possible after presentation
afterwards, 81-162 mg Aspirin should be taken daily indefinitely
if a patient is unable to tolerate aspirin due to an allergy, give clopidogrel
Aspirin MOA Answer: inhibits COX1 and COX2 enzymes
Aspirin SE Answer: bleeding, bruising, Reye's syndrome, rash, ulcer
Aspirin contraindications Answer: aspirin allergy
NSTEMI Tx (general) Answer: reperfusion therapy if needed, beta blockers, RAAS
inhibitor, statins, anticoagulation and antiplatelet therapy
two ways of reperfusion Answer: invasive - stents or CABG
fibrinolytic - using medication to break up the clot
bare metal stent Answer: requires at least 30 days of antiplatelet therapy
higher risk of restenosis where the stent is placed
drug eluting stent Answer: requires one year of antiplatelet therapy
higher risk of clotting occurring at the site of the stent (thus longer antiplatelet therapy
required)
PCI Answer: aspirin + ticagrelor or prasugrel
default strategy Answer: DAPT >12 mo
tricagrelor/prasugrel preferred post PCI
CABG Answer: aspirin + ticagrelor or clopidogrel
no planned invasive evaluation Answer: aspirin + ticagrelor
2
APPHIA - Crafted with Care and Precision for Academic Excellence.
TRUSTED TEST SOLUTIONS!
acute coronary syndrome (ACS) Answer: umbrella term for situations when the heart
muscle has its blood flow blocked
3 types - unstable angina, NSTEMI, STEMI
unstable angina - cardiac biomarkers and EKG Answer: negative biomarkers
no ST elevation on EKG
NSTEMI - cardiac biomarkers and EKG Answer: positive biomarkers
no ST elevation on EKG
STEMI - cardiac biomarkers and EKG Answer: positive biomarkers
ST elevation on EKG
cardiac biomarkers Answer: cardiac troponin I or T
CK-MB
cardiac troponin I or T Answer: very specific for MI
draw levels at presentation and then 3-6 hrs after
can be used to assess how damaging the MI has been
CK-MB Answer: specific for MI
not commonly used anymore with the sensitivity and specificity of cardiac troponin
assays
initial treatment MI Answer: MONA
morphine, O2, nitrates, ASA
morphine Answer: opioid pain med
given IV to those that have continued ischemic chest pain despite being treated with the
max tolerated anti-ischemic medication
works by decreasing O2 demand and slowing HR
1
APPHIA - Crafted with Care and Precision for Academic Excellence.
, oxygen Answer: administer to patients who have O2 saturation <90%, those in resp
distress, and those with other high-risk features of hypoxemia (maybe asthma or
COPD)
nitrates - forms/doses Answer: sublingual: 0.3-0.4 mg every 5 minutes for up to 3
doses, assess need for IV nitro after those doses
IV: indicated for those with persistent ischemia, heart failure, or HTN
nitrates contraindications Answer: do not give to those who have taken a PDE inhibitor
within the past 24-48 hours (can cause severe hypotension)
Aspirin Answer: 162-325 mg of non-enteric coated, chewable aspirin should be given
as soon as possible after presentation
afterwards, 81-162 mg Aspirin should be taken daily indefinitely
if a patient is unable to tolerate aspirin due to an allergy, give clopidogrel
Aspirin MOA Answer: inhibits COX1 and COX2 enzymes
Aspirin SE Answer: bleeding, bruising, Reye's syndrome, rash, ulcer
Aspirin contraindications Answer: aspirin allergy
NSTEMI Tx (general) Answer: reperfusion therapy if needed, beta blockers, RAAS
inhibitor, statins, anticoagulation and antiplatelet therapy
two ways of reperfusion Answer: invasive - stents or CABG
fibrinolytic - using medication to break up the clot
bare metal stent Answer: requires at least 30 days of antiplatelet therapy
higher risk of restenosis where the stent is placed
drug eluting stent Answer: requires one year of antiplatelet therapy
higher risk of clotting occurring at the site of the stent (thus longer antiplatelet therapy
required)
PCI Answer: aspirin + ticagrelor or prasugrel
default strategy Answer: DAPT >12 mo
tricagrelor/prasugrel preferred post PCI
CABG Answer: aspirin + ticagrelor or clopidogrel
no planned invasive evaluation Answer: aspirin + ticagrelor
2
APPHIA - Crafted with Care and Precision for Academic Excellence.
