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AACN PCCN Review: Acute Coronary Syndrome Exam |Questions with 100% Correct Answers
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AACN PCCN Review: Acute Coronary Syndrome Exam |Questions with 100% Correct Answers
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AACN PCCN Review: Acute CoronarySyndrome Exam |Questions with 100% Correct
Answers
Immediate Chest Pain Treatment - ✔️✔️MONA: morphine, oxygen, nitrogen, aspirin and P2Y
Receptor Inhibitors (Plavix, Effient, Brilinta)
a. Oxygen at 4L/min
b. Aspirin 160-325mg (chewed)
c. Nitroglycerin SL or spray
d. Morphine IV (if pain not relieved by NTG)
e. Clopidogrel (Plavix) 600 mg, or prasugel (Effient) 60mg, or Ticagrelor (Brilinta) 180mg
Possible ACS Treatment - ✔️✔️a. Give Aspirin - may have already done so
b. Consider Primary Coronary Intervention in Cath Lab
c. Consider Antithrombin Tx: ASA, Glycoprotein IIb/IIIa Inhibitor: Abciximab (ReoPro),
Eptifibatide (Integrelin), Tirofiban (Aggrastat), Heparin
d. Consider Beta Blocker
Acute Myocardial Infarction Pathophysiology - ✔️✔️Complete Occluding Thrombus
AMI Treatment - ✔️✔️a. Give triple anti-thrombin tx
b. NTG if pain present
c. If ST-segment elevation - evaluate for reperfusion
--Thrombolytics
--Percutaneous Coronary Interventions
--Coronary Artery Bypass Grafting
, Thrombolytic Agents and MI - ✔️✔️Decrease mortality and complications of acute MI.
Thrombolytic Agent Uses - ✔️✔️Being given IV, directly into peripheral clot, intracoronary &
intracerebral
a. Acute Coronary Thrombosis
b. DVT
c. Massive Pulmonary Emboli
d. Adjunct to PCI
e. Thrombotic Stroke
f. Combination tx of thrombolytic agents and GP IIb/IIIa, UFH, & LMWH have been shown to
increase long term perfusion, mortality & morbidity
Thrombolytic Contraindications - ✔️✔️Absolute Contraindications
a. Active Bleeding
b. Aortic Dissection
c. Cerebral Neoplasm
d. History of Intracranial Hemorrhage
e. Recent (within 2 mo) intracranial or intraspinal surgery or trauma
f. Cerebral Vascular Disease (aneurysm, arteriovenous malformation)
Acute Coronary Syndromes
g. Bleeding Diathesis
h. Severe Uncontrolled Hypertension (> 180/110)
Other Thrombolytic Contraindications - ✔️✔️a. Recent (within 10 mo) Major Surgery
b. Recent (within 10 days) GI or GU bleeding
c. High likelihood of Left Heart Thrombus (mitral stenosis or A-fib)
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