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2688050
NSTEMI/UA
Descrição
ACS
Sem etiquetas
acs
nstemi
ua
0
Mapa Mental por
Devin Welke
, atualizado more than 1 year ago
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Criado por
Devin Welke
mais de 9 anos atrás
45
0
0
Resumo de Recurso
NSTEMI/UA
Early Invasive
Increased troponins and/or 3 TIMI risk factors
Early Conservative (cath/revasc. only if ischemia recurs or is unresolved-->EI)
MONA
Morphine
1-4 mg IV q5-15 min prn
Oxygen
4 L/min
Nitrate
Nitroglycerin 0.4 mg SL X 3 doses prn
Alternative: 5 mcg/min infustion up to 200 mcg/min
Aspirin
162-325 mg STAT (chew if not scheduled) then 75-162 mg daily FOR LIFE!
Anticoagulation
UFH
60-70 units/kg bolus, then 12-15 units/kg/h infustion
aPTT q6h until therapeutic, then q12-24h
Monitor H/H and platelets
LMWH
no aPPTs
1 mg/kg SQ q12h
q24h if CrCl <30 ml/min
Fondaparinux
no aPPTs
2.5 mg IV then 2.5 mg SQ daily
Need supplemental UFH in PCI
Bivalirudin
0.75 mg/kg IV then 1.75 mg/kg/h
1mg/kg/h if CrCl <30 ml/min
EI only NOT EC
Start if + troponins or unrelieved chest pain
Thienopyridines
Ticlodipine
Prasugrel
60 mg load then 10 mg daily
No renal/hepatic adjustments
Avoid concurrent NSAIDs and warfarin (if possible)
Contraindicated if prior TIA/CVA
Not recommended if >75 unless diabetic or prior MI
Clopidogrel
300-600 mg load >6 hours before PCI then 75 mg daily
>1 month for medically managed or BMS and >1 year for DES
Uses: in place of aspirin or in addition for EC/PCI (not used if CABG planned)
Reversible non-thienopyridine
Ticagrelor
180 mg load then 90 mg BID
No hepatic activation
Contraindicated in intracranial bleeds, severe hepatic dysfunction, CYP 3A4 inducers, and ASA >100 mg
Glycoprotein IIb/IIIa Inhibitors
Addition to anticoagulation with EI (PCI planned)
If clopidogrel 300 mg load was given >6 hours prior to cath, GP not needed
Abciximab
Irreversible
PCI only
Clearance: RES
Eptifibatide
UA/NSTEMI and elective PCI
Reversible
Renal (no dialysis pts.)
Tirofiban
Reversible
UA/NSTEMI only
Renal (no dialysis pts.)
Beta Blockers
Metoprolol 5 mg IV q5min X 3 doses then 25-50 mg po bid and increase as tolerated
Life long following UA/MI
Avoid acebutalol
ACEi
Use in pts. with diabetes, LVEF <40, HTN
May benefit all pts. after MI
Statins
See statin lecture
Aldosterone Blockers
Post MI with symptomatic HF, EF <40, and on ACEi and beta blocker
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