ACS and I'm an ACMess
Today's Study Topic: ACS. MONA-GAP-BA! Morphine-Oxygen-Nitrates-Aspirin, GPIIB/IIIA-Anticoag-P2Y12, BetaBlockers-ACEi! Avoid PPIs with Plavix (300-600 load, 75 maint) because they inhibit 2C19 (Charley doesn't have that!) Effient (Pras) not safe for hx stroke/TIA, also really only for PCI! Also it is in it's original container only, super suceptible to moisture. Brilinta (tica) concurrent ASA *maintenance* dose should be less than 100mg! 90 mg bid 1 year then 60mg bid. Also potentially causes dypsnia? GPIIB/IIIA inhibs are kind of agressive and really only used acutely, they block a receptor preventing fibrinogen from binding. Also morphine is used for pain management in ACS because it vasodilates which is preferred here!
In STEMI PCI is preferred to fibrinolytics (optimally 90 min or less door-to-bloon time) but if you local hospital doesn't have a cath lab (can't get PCI within 120min), fibrinolysis is the next best thing (optimal time 30 min or less door-to-needle) They convert plasminogen to plasmin which binds to the fibrin mesh and degrades the clot. Time is brain MUSCLE (dying).
Secondary prevention DAPT for at least 12 months wether they had a PCI or not! NTG prn, HR 50-60 bpm target BB 3 years or indefinitely in HF (whech might be CAUSED by STEMI/NSTEMI, BP managment, statin (probably high intensity). If patient is on triple antiplatelet/coag, P2y12 is first to drop + add PPI within reason if hx gi bleed.
First Post!