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What is the primary purpose of the medications Abciximab, Eptifibatide, and Tirofiban?
What is the primary purpose of the medications Abciximab, Eptifibatide, and Tirofiban?
Which anticoagulant is a low-molecular-weight heparin (LMWH) mentioned?
Which anticoagulant is a low-molecular-weight heparin (LMWH) mentioned?
What is a significant drawback of low-molecular-weight heparin (LMWH)?
What is a significant drawback of low-molecular-weight heparin (LMWH)?
What method is considered the gold standard for treating STEMI?
What method is considered the gold standard for treating STEMI?
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Which statement is true regarding fibrinolytics?
Which statement is true regarding fibrinolytics?
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What is the primary mechanism of action of nitroglycerin in heart treatment?
What is the primary mechanism of action of nitroglycerin in heart treatment?
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When is nitroglycerin contraindicated?
When is nitroglycerin contraindicated?
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Which of the following medications is used if chest pain does not resolve with nitroglycerin?
Which of the following medications is used if chest pain does not resolve with nitroglycerin?
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What should be monitored continuously when administering nitroglycerin?
What should be monitored continuously when administering nitroglycerin?
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Which class of antihypertensive drugs often ends in ‘lol’?
Which class of antihypertensive drugs often ends in ‘lol’?
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Which type of medication is used when a patient cannot tolerate an ACE inhibitor?
Which type of medication is used when a patient cannot tolerate an ACE inhibitor?
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What can be a side effect of morphine when used in treating chest pain?
What can be a side effect of morphine when used in treating chest pain?
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Which of the following medications acts primarily on pain receptors and also reduces cardiac oxygen requirements?
Which of the following medications acts primarily on pain receptors and also reduces cardiac oxygen requirements?
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What is the primary role of diuretics in patients with heart failure?
What is the primary role of diuretics in patients with heart failure?
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Which statement about ARB medications is true?
Which statement about ARB medications is true?
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What is the main function of HMG Coenzyme A Reductase Inhibitors (Statins)?
What is the main function of HMG Coenzyme A Reductase Inhibitors (Statins)?
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What is a common use of Clopidogrel (Plavix)?
What is a common use of Clopidogrel (Plavix)?
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What mechanism do Glycoprotein IIb/IIIa inhibitors use to function?
What mechanism do Glycoprotein IIb/IIIa inhibitors use to function?
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Why are diuretics sometimes prescribed for patients with heart failure?
Why are diuretics sometimes prescribed for patients with heart failure?
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In what situation are HMG Coenzyme A Reductase Inhibitors typically initiated?
In what situation are HMG Coenzyme A Reductase Inhibitors typically initiated?
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Which type of medication is primarily used to prevent clot formation in patients with ACS?
Which type of medication is primarily used to prevent clot formation in patients with ACS?
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What does acute coronary syndrome (ACS) primarily result from?
What does acute coronary syndrome (ACS) primarily result from?
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Which treatment is given first for a patient with ACS if their oxygen saturation is below 94%?
Which treatment is given first for a patient with ACS if their oxygen saturation is below 94%?
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What is the primary purpose of aspirin in the treatment of ACS?
What is the primary purpose of aspirin in the treatment of ACS?
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How often can nitroglycerin be administered if the initial dose does not relieve chest pain?
How often can nitroglycerin be administered if the initial dose does not relieve chest pain?
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What is the standard recommended dosage of aspirin for treating ACS?
What is the standard recommended dosage of aspirin for treating ACS?
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What property of nitroglycerin significantly aids in relieving chest pain during ACS?
What property of nitroglycerin significantly aids in relieving chest pain during ACS?
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Which of the following statements about the MONA acronym is correct?
Which of the following statements about the MONA acronym is correct?
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What is one of the main effects of oxygen therapy in ACS management?
What is one of the main effects of oxygen therapy in ACS management?
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Study Notes
Cardiovascular Drugs - Module 7
- Cardiovascular medications manage arrhythmias, angina (chest pain), blood pressure, cholesterol, and blood clots.
Acute Coronary Syndrome (ACS)
- ACS is a range of clinical symptoms linked to acute myocardial infarction (NSTEMI & STEMI) and angina (stable & unstable [UA]).
- In ACS, a plaque in a coronary artery ruptures or erodes, triggering the clotting cascade.
- A blood clot forms, obstructing the artery and halting blood and oxygen flow to the cardiac muscle.
Plaque Formation
- Atherosclerotic plaque develops within the artery walls.
- The endothelium (artery lining) is affected.
Lipid Deposition
- Lipid deposition is a factor in plaque formation.
- Endothelial injury is a site of lipid deposition.
Thrombus Formation
- Plaque rupture and fissure initiate thrombus formation.
Platelet Adhesion
- Platelets adhere to the injured arterial wall.
Embolus Formation
- A thrombus can detach and travel, becoming an embolus.
Occlusion Causes Infarction
- A thrombus blocks blood flow, leading to infarction.
- Collateral flow is the alternative blood flow path.
ACS Management
- Initial evaluation: ABCs, O2, IV, monitor vital signs, pulse oximeter, blood pressure, history, assess discomfort, and obtain 12-lead ECG.
- Antiplatelet and anticoagulants, aspirin, nitroglycerin, morphine, pain management, oxygen are used.
- 12-lead ECG evaluation - Normal, ischemia, injury
- Determine reperfusion strategy
- Initial interventions, pain management, Get baseline cardiac biomarker levels, electrolytes, coagulation studies, chest x-ray
ACS Drugs - MONA
- Providers use the acronym MONA to help remember the initial treatment options:
- M: Morphine
- O: Oxygen
- N: Nitroglycerin
- A: Aspirin
- Drugs are not given in the order MONA, but rather OANM.
Oxygen
- Oxygen (O2) is administered if the patient's oxygen saturation is below 94%.
Aspirin
- The usual dose for ACS is 160-325 mg of chewable aspirin to hasten absorption.
- It reduces platelet aggregation, minimizing the risk of further coronary artery blockage or recurrence of an ischemic event.
Nitroglycerin
- Used to resolve chest pain caused by ACS.
- Administered sublingually (under the tongue) via spray or rapidly dissolving tablet.
- The dose can be repeated every 5 minutes if the initial dose is ineffective.
- Nitroglycerin relaxes vascular smooth muscle beds, particularly in coronary arteries, to improve blood flow to ischemic areas and decrease myocardial oxygen consumption.
- Patient's blood pressure must be monitored continuously due to its vasodilation effects. Usage is contraindicated for systolic blood pressure below 90 mm/Hg.
Morphine
- Administered in cases where nitroglycerin fails to relieve chest pain
- Given every 5 minutes as an IV push.
- The maximum dose is 10mg.
- It acts on opioid receptors, reducing pain perception and ventricular preload, lowering cardiac oxygen needs.
Antihypertensive Drugs
- Drugs for blood pressure control:
- Alpha1 blockers, ending in "lol" (e.g., doxazosin, prazosin, terazosin)
- Beta blockers, ending in "lol" (e.g., propranolol, acebutolol, esmolol)
- ACE inhibitors, ending in "pril" (e.g., captopril, enalapril, lisinopril, quinapril, ramipril, benazepril, fosinopril)
- Angiotensin receptor blockers (ARBs), ending in "sartan" (e.g., valsartan, losartan, irbesartan, telmisartan, candesartan)
- Calcium channel blockers (CCBs), ending in "pine" (e.g., verapamil, diltiazem, nifedipine)
- Diuretics
- Vasodilators (e.g., hydralazine, sodium nitroprusside).
Beta Blockers (Class II)
- Beta blockers target beta-1 receptors in the heart linked to calcium channels.
- This mechanism reduces calcium influx, affecting heart rate and contractility.
ACE Inhibitors
- ACE inhibitors block the conversion of angiotensin I to angiotensin II, inhibiting vasoconstriction.
- They decrease blood pressure and reduce workload for the heart.
Calcium Channel Blockers (Class IV)
- These drugs affect the SA and AV nodal conduction and decrease myocardial contractility.
Antihyperlipidemic Drugs (Statins)
- Statins lower LDL cholesterol by blocking HMG CoA reductase, an enzyme that's required to synthesize cholesterol.
- They minimize the risk of heart attack and stroke.
Lipoproteins
- Lipoproteins transport lipids within the body.
- LDLs: "bad" cholesterol, deposit in the arteries.
- HDLs: "good" cholesterol, transport cholesterol out of the arteries.
Platelet Inhibitors
- Platelet inhibitors prevent aggregation, important in preventing clot formation in cases of MI or CVA.
Glycoprotein IIb/IIIa Inhibitors
- These drugs block the GP IIb/IIIa receptor, preventing platelets from aggregating.
- Used in cases of unstable angina or significant stenosis.
Anticoagulants
- Anticoagulants prevent blood clot formation.
- Unfractionated heparin and LMWH inhibit thrombin, preventing fibrin formation and platelet activation.
- Heparin (unfractionated and LMWH) and warfarin are used to prevent blood clots.
Fibrinolytics
- Fibrinolytics break up existing blood clots (thrombi) in arteries and veins.
Occlusion Mechanism
- Clots block blood flow, leading to decreased oxygen supply to heart tissues.
tPA Mechanism
- tPA activates plasminogen to plasmin, which then dissolves the fibrin of blood clots.
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Description
This quiz covers key topics related to cardiovascular medications and acute coronary syndrome (ACS). You'll explore the mechanisms of plaque formation, thrombus development, and lipid deposition in arteries. Understand how these factors lead to critical cardiac events and their management with drugs.
