1. T1: Post ACS Treatment Tutoring
By Alaina Darby

2. A bit more on immediate therapy…
Anti-ischemic
Reperfusion

3. Which of the following should DR not receive? SL Nitroglycerin
DR is a 76 yo WM who presents to the ED with chest pain that is diagnosed as STEMI. PMH: diabetes, HTN Vitals/Labs: BP 120/70, HR 96, K 5.1
Which of the following should DR not receive?
SL Nitroglycerin
IV Nitroglycerine
IV morphine
PO Metoprolol
PO Verapamil D

4. Why should DR not receive metoprolol? Age >70 SBP <140
DR is a 76 yo WM who presents to the ED with chest pain that is diagnosed as STEMI. PMH: diabetes, HTN Vitals/Labs: BP 120/70, HR 96, K 5.1
Why should DR not receive metoprolol?
Age >70
SBP <140
HR <100
Diabetes A

5. Which may increase mortality in DR? SL Nitroglycerin IV Nitroglycerine
DR is a 76 yo WM who presents to the ED with chest pain that is diagnosed as STEMI. PMH: diabetes, HTN Vitals/Labs: BP 120/70, HR 96, K 5.1
Which may increase mortality in DR?
SL Nitroglycerin
IV Nitroglycerine
IV morphine
PO Metoprolol
PO Verapamil C

6. DR is a 76 yo WM who presents to the ED with chest pain that is diagnosed as STEMI. PMH: diabetes, HTN Vitals/Labs: BP 120/70, HR 96, K 5.1
Which of the following could be considered an alternative to a beta blocker, since in DR a beta blocker shouldn’t be used?
SL Nitroglycerin
IV Nitroglycerine
IV morphine
PO Metoprolol
PO Verapamil E

7. Which of the following would most likely be added to DR’s regimen?
DR is a 76 yo WM who presents to the ED with chest pain that is diagnosed as STEMI. PMH: diabetes, HTN Vitals/Labs: BP 120/70, HR 96, K 5.1
Which of the following would most likely be added to DR’s regimen?
Lisinopril
Carvedilol
Verapamil
Spironolactone C

8. What is the door to needle time for tPA?
<30 minutes
<60 minutes
<90 minutes
<120 minutes A

9. What is the door to balloon time for PCI?
<30 minutes
<60 minutes
<90 minutes
<120 minutes C

10. Which of the following is not evidence of successful reperfusion?
Relief of chest pain
Resolution of ST segment changes
Reperfusion arrhythmias
Early trough of troponin D

11. Which of the following patients would be indicated for thrombolytics?
78 yo M with STEMI, presents 6 hours after onset of chest pain, BP 170/100, TIA 6 months prior
22 yo M with NSTEMI, presents 14 hours after onset of chest pain, BP 190/100, no history of TIA
78 yo M with NSTEMI, presents 18 hours after onset of chest pain, BP 170/120, no history of TIA
22 yo M with STEMI, presents 3 hours after onset of chest pain, BP 160/125, no history of TIA A

12. Which of the following should be given peri-procedurally for PCI?
UFH with tirofiban with both infusing for hours post procedure
UFH with bivalirudin
200 mg load of clopidogrel with 75 mg/day for 12 months
180 mg load of ticagrelor with 90 mg/day for 12 months
60 mg load of prasugrel with 10 mg/day for 12 months
ASA 81 mg/day indefinitely E

13. Stents
There was a question about stents last year, so be sure to look over that!! A

14. Which patient’s RAAS regimen is most indicated?
Valsartan for a patient with STEMI and no comorbidities
Valsartan for a patient with NSTEMI and no comorbidities
Lisinopril for a patient with STEMI and no comorbidities
Lisinopril for a patient with NSTEMI and no comorbidities C

15. Case:
FG is a 48 yo WM who presented to the ED with chest pain that was determined to be NSTEMI.
PMH: CHF (EF 52), DM
SH: smokes ½ ppd, drinks 8 beers/week, denies elicit drug use
FH: father died of MI at age 45
Vitals/Labs:
K: 6
BP: 140/90
HR: 85

16. Labetolol, ASA 81 mg, Ticagrelor 90 mg BID
FG is a 48 yo WM who presented to the ED with chest pain that was determined to be NSTEMI.
PMH: CHF (EF 52), DM
SH: smokes ½ ppd, drinks 8 beers/week, denies elicit drug use
FH: father died of MI at age 45
Vitals/Labs: K+ 6, BP 140/90, HR 85
What medications should he receive chronically if he does not under go PCI?
Labetolol, ASA 81 mg, Ticagrelor 90 mg BID
Labetolol, ASA 81 mg, Prasugrel 10 mg
Metoprolol, ASA 81 mg, Ticagrelor 90 mg BID
Metoprolol, ASA 81 mg, Prasugrel 10 mg
C… Labetalol has ISA

17. Metoprolol, ASA 81 mg, Ticagrelor 90 mg BID, Lisinopril
FG is a 48 yo WM who presented to the ED with chest pain that was determined to be NSTEMI.
PMH: CHF (EF 52), DM
SH: smokes ½ ppd, drinks 8 beers/week, denies elicit drug use
FH: father died of MI at age 45
Vitals/Labs: K+ 6, BP 140/90, HR 85
What medications should he receive chronically if he does under go PCI?
Metoprolol, ASA 81 mg, Ticagrelor 90 mg BID, Lisinopril
Metoprolol, ASA 81 mg, Prasugrel 10 mg, Lisinopril
Metoprolol, ASA 81 mg, Ticagrelor 90 mg BID
Metoprolol, ASA 81 mg, Prasugrel 10 mg BID
C… look at K+!

18. Metoprolol, ASA 81 mg, Ticagrelor 90 mg BID, Lisinopril
FG is a 48 yo WM who presented to the ED with chest pain that was determined to be NSTEMI.
PMH: CHF (EF 52), DM
SH: smokes ½ ppd, drinks 8 beers/week, denies elicit drug use
FH: father died of MI at age 45
Vitals/Labs: K+ 6, BP 140/90, HR 85
FG’s K+ decreases to 3.4 once stabilized. Now, what medications should he receive chronically if he did not under go PCI?
Metoprolol, ASA 81 mg, Ticagrelor 90 mg BID, Lisinopril
Metoprolol, ASA 81 mg, Prasugrel 10 mg, Lisinopril
Metoprolol, ASA 81 mg, Ticagrelor 90 mg BID
Metoprolol, ASA 81 mg, Prasugrel 10 mg BID A

19. FG is a 48 yo WM who presented to the ED with chest pain that was determined to be NSTEMI.
PMH: CHF (EF 52), DM
SH: smokes ½ ppd, drinks 8 beers/week, denies elicit drug use
FH: father died of MI at age 45
Vitals/Labs: K+ 6, BP 140/90, HR 85
FG’s K+ decreases to 3.4 once stabilized. Why should he receive an ACEi?
CHF
HTN DM
HR >75 C

20. FG is a 48 yo WM who presented to the ED with chest pain that was determined to be NSTEMI.
PMH: CHF (EF 52), DM
SH: smokes ½ ppd, drinks 8 beers/week, denies elicit drug use
FH: father died of MI at age 45
Vitals/Labs: K+ 6, BP 140/90, HR 85
FG’s K+ decreases to 3.4 once stabilized. Which of the following would not confer mortality benefits post-MI?
Metoprolol
ASA
Lisinopril
NTG D

21. Case:
HR is a 65 yo AAM who presented to the ED with chest pain that was determined to be STEMI.
PMH: CHF (EF 38)
Vitals/Labs:
K+: 3.9
BP: 120/80
HR: 45

22. HR is a 65 yo AAM who presented to the ED with chest pain that was determined to be STEMI.
PMH: CHF (EF 38)
Vitals/Labs: K+ 3.9, BP 120/80, HR 45
What medications should he receive chronically if he does under go PCI?
ASA 81 mg, Ticagrelor 90 mg BID
ASA 81 mg, Prasugrel 10 mg, Lisinopril
Metoprolol, ASA 81 mg, Ticagrelor 90 mg BID, Lisinopril
Metoprolol, ASA 81 mg, Prasugrel 10 mg BID, Lisinopril
B… look at HR!!

23. HR is a 65 yo AAM who presented to the ED with chest pain that was determined to be STEMI.
PMH: CHF (EF 38)
Vitals/Labs: K+ 3.9, BP 120/80, HR 45
HR develops a dry cough, which should be used instead of Lisinopril?
Candesartan
Losartan
Olmesartan
Why can’t they use Lisinopril? A

24. HR is a 65 yo AAM who presented to the ED with chest pain that was determined to be STEMI.
PMH: CHF (EF 38)
Vitals/Labs: K+ 3.9, BP 120/80, HR 45
Which of the following should be added due to his CHF?
Lisinopril
Eplenerone
ASA
A&B
All of the above
D… ASA is for EVERYONE!!