Pharm chapter 53 - Management of ST-Elevation Myocardial Infarction

In acute MI, if blood flow is not restored within ________ minutes, cell death begins.

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STEMI what causes it

ACUTE MI complete interruption of regional myocardial blood flwo

When caring for a patient during a STEMI who is prescribed alteplase, the nurse would question the prescriber if which drug was also prescribed?

Abciximab

Research suggest which treatments improve outcomes in STEMI?

Administration of aspirin, Beta blocker, ibuprofen, morphine, SL nitroglycerin,

To lower the risk of a second MI

All patients should decrease cardiovascular risk factors (smoking, hypercholesterolemia, hypertension, diabetes), exercise for 30 minutes at least 3-4 days a week, and undergo long-term therapy with four drugs: a beta blocker, an ACE inhibitor or an ARB, an anti platelet drug or warfarin and statin.

Remodeling of the myocardium that occurs with MI is driven in part by local production of ______________.

Angiotensin II

Almost all coronary occlusions occur at the site of a ruptured _______________ _____________.

Atherosclerotic plaque

In patients undergoing acute STEMI

Beta blockers reduce cardiac pain, infarct size, short-term mortality, recurrent ischemia, and reinfection. Continues used increases long-term survival. All patins should receive a beta blocker in the absence ion specific contraindications.

The major complication of fibrinolytic therapy

Bleeding, intracranial hemorrhage is the greatest concern.

The ED triage nurse answers the call of a patient who has a history of angina pectoris and chronic obstructive pulmonary disease. The patients reports chest pain that has not been relived by three doses of nitroglycerine. The patient had been told by the physician that he should take chewable aspirin should this occur, but he does not has any aspirin. Wha should the nurse tell the patient to do?

Call 911

What is an expected response within minutes of administering IV morphine during a STEMI

Decrease in pain and improved hemodynamics

ACE inhibitors

Decrease mortality, severe heart failure and recurrent MI in patients with acute MI. All patins should receive one of these in the absence of specific contraindications or an ARB can be used instead.

STEMI

Diagnosed by the presence of chest pain, characteristic ECG changes and elevated serum levels of cardiac troponin

Fibrinolytic drugs

Dissolve clots by converting plasminogen into plasmin, an enzyme that digests the fibrin meshwork that holds clots together

Which laboratory result in the history of a patient who is experiencing STEMI would be most important to report to the prescriber who has just ordered catopril?

Estimated glomerular filtration rate 38 mL/min

In Addition to age, genetics, and sedentary lifestyle, risk factors for ST elevation myocardial infarction (STEMI) include ________________, ______________, _______________, and _______________.

High sclerotic cholesterol, hypertension, smoking and diabetes

The medical term for a heart attack is ________ ___________.

Myocardial infarction

In myocardial infarction, heart muscle is _______________ secondary to local ischemia.

Necrosed

Myocardial infarction

Necrosis of the myocardium secondary to cause occlusion of a corollary artery.

Which drug prescribed for acute STEMI should be withheld and the prescriber consulted immediately if the patins pulse is 118 beats/min?

Nitroglycerin - Nitroglycerine should be avoided in patients with tachycardia due to increased risk of reflex tachycardia

There is some evidence that _____________- may be harmful.

Oxygen

routine therapy suspecter for STEMI

Oxygen, Morphine and Nitroglycerin, These should be started as appropriate, soon after symptom onset

Reperfusion can be accomplished with

PCI or with fibrinolytic drugs, both approbates are highly effective, but PCI is now generally preferred.

Cause of MI

Platelet plugging and thrombus formation at the site of a ruptures atherosclerotic plaque.

Glycoprotein IIb/IIIa inhibitors (abcximab)

Powerful IV anti platelet drugs that can enhance benefits of primary PCI.

Aspirin combined with clopidogrel

Recommended for all patients under going repercussion therapy with a fibrinolytic drug.

Myocardial inactions where there is partial blockage of the coronary artery are called non- __________________ MI.

ST-elevation

The abbreviation for an MI with complete blockage of the coronary artery is ____________.

STEMI

Increase the risk for bleeding. The nurse must be diligent in assessing for and reporting signs and symptoms of bleeding including decreased level of consciousness, painful or swollen joints, oozing gums, hematuria, or decrease in platelet or hemoglobin values

Safety alert: All of the anticoagulant and anti platelet drugs

Aspirin

Suppresses platelet aggregation, decreasing mortality, reinfarction, and stroke. All patients should chew a 162- 325 mg dose on hospital admission and should take 81 to 162 mg/day intently after discharge.

Reperfusion Therapy

The most beneficial treatment for STEMI, restores blood flow through blocked coronary arteries.

Alteplase

The most effective fibrinolytic drug when treatment is initiated within 4-6 hours of pain onset. Otherwise all fibrinolytic drugs are equally effective.

Intracellular proteins release when cardiac muscle cells are damage called ______________ and _____________.

Troponin's and creatine kinase

A patient who is undergoing an acute STEMI is prescribed metoprolol 50 mg by mouth every 6 hours. It would be a priority to immediately contact the prescriber if which assessment finding was present?

Wheezing - Patents with asthma or other similar diseases should not receive Beta lockers, including metoprolol. because of its relative B1 selectivity, however, metoprolol may be used with caution in patients with asthma who cannot tolerate other treatments. Since beta1 selectivity is not absolute, a beta2 stimulating agent should be administered concomitantly, and the lowest possible dose of metoprolol used. In this instance, the nurse should clarify the dose (which totals 200 mg/day) with the prescriber.

all patients undergoing fibrolynic therapy should receive

anticoagulant, antiplatelet drugs

all post MI (stemi) patients should take four drugs, all four should be taken indefinitely

beta blocker, ace inhibitor, antiplatelet/anticoagulant, statin

when do ventricular dysrhythmias happen

develop frequently and are major cause of death after MI (stemi -prophylactic antidysrhythmics not successful -amiodarone.

estrogen therapy for postmenopausal women is not effective as secondary prevention and should not be

initiated

Heparin

recommended for all patients undergoing fibrinolytic therapy or PCI

The nurse knows that nitroglycerine decrease the workload of the heart by

reducing venous return to the heart

cardiogenic shock

results from tissue perfusion reduction during STEMi

PCI

usually consists of balloon angioplasty coupled with placement of a drug-eluting stent.

complications from stemi

ventricular dysrhythmias and cardiogenic shock