nstemi - woodywoodpecker

[ArchivalUser]

When treating a patient with a non-ST-segment elevation
myocardial infarction (NSTEMI), risk stratification
and timely administration of anti-ischemic and antithrombotic
therapies are paramount. For a patient with
unstable angina with negative biomarkers, which medication
regimen is most appropriate as initial treatment?
A. Aspirin, beta blocker, spironolactone, HMG-CoA
reductase inhibitor (statin)
B. Aspirin, clopidogrel, nitroglycerin, beta blocker, heparin
C. Aspirin, nitroglycerin, beta blocker, heparin, glycoprotein
IIB/IIIa inhibitor
D. Aspirin, morphine, oxygen, nitrates

[ArchivalUser]

c.

[ArchivalUser]

cc

[ArchivalUser]

cc

[ArchivalUser]

ccc

[ArchivalUser]

BBB

[ArchivalUser]

ccccc

[ArchivalUser]

The answer is B. Unstable angina is defined as angina or ischemic discomfort
with at least one of three factors: pain at rest lasting >10 min, severe recent pain
(within 4“6 weeks), or crescendo angina. NSTEMI is diagnosed when a patient with unstable
angina has positive cardiac biomarkers. Anti-ischemic therapy (nitrates, beta
blockers) is important for symptom relief and to prevent recurrence of chest pain. Antithrombotic
therapy is directed against the platelet aggregation at the site of the ruptured
plaque. Initially, this therapy should consist of aspirin. Addition of clopidogrel confers an
additional 20% risk reduction in both low- and high-risk NSTEMI patients, as demonstrated
in the CURE trial. Continuation of treatment for up to 12 months confers additional
benefit in patients treated conservatively and among those who underwent
percutaneous coronary intervention. The glycoprotein IIb/IIIa inhibitors are usually reserved
for high-risk (i.e., troponin-positive) patients and may not be beneficial for patients
treated conservatively. Statin therapy is important for secondary prevention;
however, spironolactone is not a first-line therapy for NSTEMI.