ACS: unstable angina//non st elevation MI (NSTEMI)
da Anneke Klomp
1. ACE/ARB
1.1. reduces mortality rates
1.1.1. administered w/in first 24 hrs or before discharge in UA/STEMI pts and pulmonary congestion or LVEF<0.40
2. morpine sulfate
2.1. ONLY FOR SEVERE PAIN that's not relieved after 3 sublingual nitroglycerin or whose symptoms recur despite adequate therapy; pt must be otherwise stable w/ normal HR and RR
2.2. reduces sympathetic effects on heart; venodilation, arterial dilation; reduces work of breathing; GOOD FOR PULMONARY EDEMA
2.3. AE: hypotension; respiratory depression; some evidence decreases survival
3. oxygen
3.1. used in hypotoxic patients only in order to maintain O2 above 90%
4. nitrates
4.1. reduces myocardial oxygen demand and improves supply; reduces preload (venodilate); reduces afterload; reduces oxygen demand; dilates coronary arteries
4.2. *monitor BP, can drop quickly
4.3. CI: RV infarction; severe aortic stenosis; HYPOTENSION (not for pts w/ SBP<90; don't administer until 24-48 hrs after last does of a phosphodiesterase inhibitor (like viagra)
5. acs physio
5.1. rupture of atherosclerotic plaque-> platlet activation-> clotting cascade-> aterial thrombus
6. beta blockers
6.1. MOA: competitively block the effects of catecholamines on cell membrane beta-receptors
6.2. use: started asap (first 24hrs) if no contraindications
6.3. reduces infarct size and reduces mortality
6.4. Contraindications
6.4.1. marked first degree AV block (PR interval >.2s)
6.4.2. 2nd or 3rd AV block w/o fxning pacemaker
6.4.3. hx of asthma or COPD exacerbations
6.4.4. severe LV dysfunction with CHF