Questions and Answers
What does MONA stand for?
What does Morphine do?
Vasodilates, relaxes the patient, and reduces SNS response.
What is morphine's antidote?
Narcan
What does O2 do?
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What does Nitroglycerin do?
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What does aspirin do?
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What diagnostics will we look at?
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Do we care much about the pain from an MI?
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What can we do to decrease pain?
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Would we see Beta Blockers used for MI?
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Are Alpha Blockers used during an active MI?
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Do ACE inhibitors help lower blood pressure?
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What do calcium channel blockers (CCBs) do?
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What do ACE and ARB do?
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Are statins for emergency or long-term use?
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What do anti-coagulants do?
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Do anti-platelets dissolve existing clots?
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How does a heparin drip help MI patients?
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What labs do we look for with heparin?
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What lab value will cause us to stop heparin?
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When would we use Lovenox?
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What are Tissue plasminogen activators?
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When should we use tPA?
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Study Notes
MONA Overview
- MONA is an acronym for emergency treatment of Myocardial Infarction (MI).
- Components include Morphine, Oxygen, Nitroglycerin, and Aspirin.
Morphine
- Acts as a vasodilator and relaxes patients, reducing sympathetic nervous system response.
- Decreases respiration rate.
- Narcan is the antidote for Morphine overdose.
Oxygen
- Administered to perfuse the myocardium, ensuring adequate oxygen supply to heart tissue.
Nitroglycerin
- Functions as a vasodilator.
- At low doses, primarily dilates veins, reducing preload; at higher doses, also dilates arteries to reduce afterload.
Aspirin
- Inhibits platelet activity, preventing further clot growth and maintaining blood flow in coronary arteries.
Diagnostic Tests
- Key diagnostics for MI include Troponin T and I, Creatine kinase-MB (CK-MB), Myoglobin levels, 12-lead electrocardiograms, Imaging assessments, and Cardiac catheterization.
Pain Management in MI
- Pain is crucial to address as it intensifies the sympathetic nervous system response.
- Pain relief strategies include Nitroglycerin, Morphine sulfate, Oxygen, maintaining a semi-Fowler's position, and creating a calm environment.
Beta Blockers
- Used to manage MI by lowering heart rate, blood pressure, and overall heart workload.
Alpha Blockers
- More relevant for hypertension than active MI treatment; patients may still be on them.
ACE Inhibitors
- Indicated for lowering blood pressure by inhibiting Angiotensin-Converting Enzyme, helping to prevent fluid retention and vasoconstriction.
Calcium Channel Blockers (CCBs)
- Block calcium movement into heart and blood vessel cells, decreasing heart strength and promoting vessel relaxation.
ACE Inhibitors and ARBs
- Focus on reducing afterload, thereby minimizing ventricular remodeling post-MI.
Statins
- Primarily utilized for long-term cholesterol management rather than emergency treatment.
Anticoagulants
- Decrease blood clotting ability without dissolving existing clots; examples include Rivaroxaban, Dabigatran, Apixaban, Heparin, and Warfarin.
Antiplatelet Agents
- Prevent clot formation by inhibiting platelet aggregation; should be administered post-MI to prevent additional clot development.
Heparin in MI Treatment
- Beneficial when MI is linked to artery narrowing; generally administered for up to 48 hours.
- Monitoring involves PTT and anti-Xa levels with a therapeutic goal of 1.5 - 2.5 times the control value.
Critical Lab Values for Heparin
- Heparin should be discontinued if PTT reaches 100 seconds or more.
Lovenox Usage
- Recommended for treatment in Non-ST-Elevation Myocardial Infarction (NSTEMI); classified as low molecular weight heparin.
Tissue Plasminogen Activators (tPA)
- Include Reteplase and Tenecteplase; specifically dissolve existing blood clots and restore blood flow in coronary arteries.
Indications for tPA
- Administered to dissolve clots when patients present with specific criteria suggesting acute ischemic conditions.
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Description
This quiz covers key concepts related to the MONA acronym used in the emergency treatment of myocardial infarction (MI). It includes definitions for each component of MONA, the role of morphine, and the importance of oxygen. Test your knowledge of these critical cardiac procedures and medications.
