Topic 1: Acute Coronary Syndrome

What is the only NSAID that can be used concomitantly with Clopidogrel?
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Fibrinolytic therapy for STEMI: What are the 5 main ABSOLUTE Contraindications to fibrinolysis?1. Active Bleeding 2. Intracranial Hemmorrhage (any hx) 3. Intracranial/Intraspinal Surgery (<3 mo) 4. Ischemic Stroke (<3 mo) 5. Aortic DissectionWhat are 4 of the main RELATIVE Contraindications to fibrinolysis (following actue STEMI)?1. Pregnancy 2. Peptic Ulcer (active) 3. Uncontrolled HTN (>180/110) 4. Anticoagulants (current use)MOA of the fibrinolytic agent ALTEPLASE 1. What does Alteplase BIND to? 2. What CONVERISON does Alteplase enhance?1. Fibrin 2. Plasminogen --> PlasminMONA therapy for MI-- Morphine What are 3 +'s that Morphine provides to an MI patient?1. Analgesic 2. Anxiolytic 3. Reduces O2 DEMANDDoes morphine cause HYPER or HYPOtension?HYPOtensionMONA therapy for MI-- Nitrates T/F: Nitrates provide ANALGESIA for pts with Chest PainTrueT/F: Nitrates do NOT have an effect on SYSTEMIC vascular resistanceFalse--Nitrates DO reduce SYSTEMIC vascular resistanceT/F: Nitrates reduce AFTERLOADFalse--Nitrates reduce PRELOADMONA therapy for MI-- Aspirin What is the PRIMARY reason Aspirin is used to treat patients with Chest Pain?Evidence that Aspirin REDUCES Mortality in patients with STEMIIs Aspirin considered a MILD or MODERATE Analgesic?MILD--it is therefore NOT being used as an analgesic for pts experiencing chest painBeta Blockers and MI Why are beta blockers given to patients experiencing CHEST PAIN?Evidence that Beta Blockers REDUCE the risk of: 1. Progression to MI 2. MortalityGlycoprotein IIb/IIIa Receptor Antagonists Name the 3 GP IIb/IIIa receptor antagonists1. Abciximab 2. Eptifibatide 3. TirofibanWhat is the main indication for Glycoprotein IIb/IIIa Receptor Antagonists?PCI (Percutaneous Coronary Intervention)In what form (i.e. IV, PO) should Glycoprotein IIb/IIIa Receptor Antagonists always be given?IV only!! *PO has shown increase mortality risk!!What are the 4 main contraindications associated with Glycoprotein IIb/IIIa Receptor Antagonists?1. Major Bleed Risk (i.e. High INR) 2. Recent Surgery (<1 week) 3. Thrombocytopenia 4. Uncontrolled HTN