Chapter 56

Question 1

What is a STEMI?

Answer 1

A big heart attack where a coronary artery is COMPLETELY blocked

Question 2

What is the goal in the presence of a STEMI?

Answer 2

To get blood back & reduce workload

Question 3

CLOPIDOGREL
-What is the brand name of this?

Answer 3

Plavix

Question 4

CLOPIDOGREL
-What is the drug class?

Answer 4

Antiplatelet –> prevents clots by stopping platelet aggregation

Question 5

CLOPIDOGREL: Therapeutic Use
-When will this be used? (2)

Answer 5

1. MI patients undergoing PCI (stent)
2. Fibronolytic therapy

Question 6

CLOPIDOGREL: Therapeutic Use
-What is the duration for pts undergoing PCI?

Answer 6

12 months

Question 7

CLOPIDOGREL: Therapeutic Use
-What is the duration for pts undergoing fibronolytic therapy?

Answer 7

14 days-1yr

Question 8

CLOPIDOGREL: Therapeutic Use
-Other antiplatelet drugs can be used for fibronolytic therapy (T/F)

Answer 8

FALSE; clopidogrel is the ONLY antiplatelet drug that is recommended

Question 9

CLOPIDOGREL: Mechanism of Action
-What does this suppress?
-How?

Answer 9

-Platelet aggregation
-By blocking receptors for adenosine diphosphate (ADP)

Question 10

CLOPIDOGREL: Pharmacokinetics
-What is the route?

Answer 10

PO

Question 11

CLOPIDOGREL: Adverse Effects
-What is the adverse effect?

Answer 11

Increased risk of bleeding

Question 12

CLOPIDOGREL: Drug Interactions
-What are they?

Answer 12

Any drugs that promote bleeding, such as warfarin, heparin, or NSAIDs

Question 13

CLOPIDOGREL: Nursing Actions
-Monitor for what?
-What are these signs? (4)

Answer 13

-Bleeding
-Decreased LOC, oozing gums, hematuria, decreased platelet or hemoglobin

Question 14

MANAGEMENT OF STEMI
-What are the goals of reperfusion therapy? (2)

Answer 14

1. Restore blood flow to myocardium
2. Reduce myocardial oxygen demand

Question 15

MANAGEMENT OF STEMI
-What are the goals of routine drug therapy?

Answer 15

To balance O2 supply with O2 demand

Question 16

MANAGEMENT OF STEMI
-What are the 3 major threats to life during acute STEMI?

Answer 16

1. Ventricular dysrhythmias
2. Cardiogenic shock
3. HF

Question 17

MANAGEMENT OF STEMI
-What should you do if you suspect a STEMI?

Answer 17

Begin interventions immediately

Question 18

MANAGEMENT OF STEMI
-What are the routine drug therapies & what is a way to remember them?

Answer 18

-MONA-B
Morphine (IV)
Oxygen
Nitroglycerin
Aspirin
Beta blockers

Question 19

MANAGEMENT OF STEMI: Oxygen
-How is it administered?
-What is the purpose of giving oxygen?
-You will only give if O2 saturation is < ____%

Answer 19

-through a NC
-to increase arterial oxygen saturation & oxygen delivery to the ischemic myocardium
-90%

Question 20

MANAGEMENT OF STEMI: Aspirin
-What is the purpose of aspirin?
-When should you give it to pts with suspected STEMI?

Answer 20

-To suppress platelet aggregation
-IMMEDIATELY

Question 21

MANAGEMENT OF STEMI: Aspirin
-What is the first dose?

Answer 21

162-325 mg (chewed)

Question 22

MANAGEMENT OF STEMI: Aspirin
-What is the prolonged therapy dose?

Answer 22

81-162 mg/day

Question 23

MANAGEMENT OF STEMI: IV Morphine
-What is the purpose of this? (4)

Answer 23

1. Relieve STEMI pain
2. Reduce preload through vanodilation
3. Reduce afterload through arterial dilation
4. Reduce oxygen demand

Question 24

MANAGEMENT OF STEMI: Beta Blockers
-What are two types?

Answer 24

Atenolol & metoprolol

Question 25

**MANAGEMENT OF STEMI**: *Beta Blockers* -What are these going to do to the heart? (3) -As a result, what is reduced? (3)

Answer 25

-decrease HR, contractility, & oxygen demand -Cardiac pain, infarct size, & short-term mortality

Question 26

**MANAGEMENT OF STEMI**: *Beta Blockers* -When should treatment begin?

Answer 26

Within 24 hours

Question 27

**MANAGEMENT OF STEMI**: *Beta Blockers* -When DO YOU NOT give beta blockers? -Examples? (5)

Answer 27

-When it is too weak or too slow!! 1. Severe HF 2. Bradycardia 3. Hypotension 4. Heart block 5. Cardiogenic shock

Question 28

**MANAGEMENT OF STEMI**: *Nitroglycerin* -What is the purpose of this? (2)

Answer 28

1. Reduce preload, which reduces oxygen demand 2. Increase coronary blood flow

Question 29

**MANAGEMENT OF STEMI**: *Nitroglycerin* -What are the ultimate outcomes of this medication? (2)

Answer 29

1. Relieve ischemic chest pain 2. Improve LV function

Question 30

**MANAGEMENT OF STEMI**: *Nitroglycerin* -When should you NOT give nitroglycerin? (6)

Answer 30

1. HYPOtension (systolic < 90) 2. Bradycardia (HR< 50) 3. Tachycardia (HR> 100) 4. Suspected right ventricular infarction 5. Erectile dysfunction 6. Pulmonary hypertension