N3 Mar 14: MONA & Cardiac Arrest Flashcards

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Questions and Answers

What does MONA stand for?

  • Morphism, Oxide, Nitrogen, Acetylcholine
  • Methane, Olives, Nitrate, Acetic acid
  • Magnesium, Oxytocin, Norepinephrine, Acetaminophen
  • Morphine, Oxygen, Nitroglycerin, Aspirin (correct)

What does Morphine do?

Vasodilates, relaxes the patient, and reduces SNS response.

What is morphine's antidote?

Narcan

What does O2 do?

<p>Perfuses the myocardium.</p> Signup and view all the answers

What does Nitroglycerin do?

<p>Vasodilation, dilates veins more than arteries at low doses.</p> Signup and view all the answers

What does aspirin do?

<p>Inhibits platelet activity and growth of blood clots.</p> Signup and view all the answers

What diagnostics will we look at?

<p>Troponin T, Troponin I, CK-MB, Myoglobin, 12-lead electrocardiograms.</p> Signup and view all the answers

Do we care much about the pain from an MI?

<p>True (A)</p> Signup and view all the answers

What can we do to decrease pain?

<p>Nitroglycerin, Morphine sulfate, Oxygen, Position of comfort.</p> Signup and view all the answers

Would we see Beta Blockers used for MI?

<p>True (A)</p> Signup and view all the answers

Are Alpha Blockers used during an active MI?

<p>False (B)</p> Signup and view all the answers

Do ACE inhibitors help lower blood pressure?

<p>True (A)</p> Signup and view all the answers

What do calcium channel blockers (CCBs) do?

<p>Interrupt calcium movement into heart and blood vessel cells.</p> Signup and view all the answers

What do ACE and ARB do?

<p>Reduce ventricular remodeling by reducing afterload.</p> Signup and view all the answers

Are statins for emergency or long-term use?

<p>False (B)</p> Signup and view all the answers

What do anti-coagulants do?

<p>Decrease the clotting ability of blood.</p> Signup and view all the answers

Do anti-platelets dissolve existing clots?

<p>False (B)</p> Signup and view all the answers

How does a heparin drip help MI patients?

<p>It's good if bleeding is due to narrowing of the arteries.</p> Signup and view all the answers

What labs do we look for with heparin?

<p>PTT, anti-Xa; goal is 1.5 - 2.5 times the control.</p> Signup and view all the answers

What lab value will cause us to stop heparin?

<p>100 seconds or more.</p> Signup and view all the answers

When would we use Lovenox?

<p>In a NSTEMI.</p> Signup and view all the answers

What are Tissue plasminogen activators?

<p>Fibrinolytics that dissolve thrombi in coronary arteries.</p> Signup and view all the answers

When should we use tPA?

<p>It is not specified.</p> Signup and view all the answers

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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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