Master the board step 3

Master the Boards: USMLE Step 3
Effects of Therapy Used in Acute Coronary Syndromes
Always Lower Mortality
• Aspirin
• Thrombolytics
• Primary angioplasty
• Metoprolol
• Statins
• Clopidogrel, prasugrel, or
ticagrelor
Lower Mortality in Certain
Conditions
• ACE inhibitors if ejection fraction
is low
• ARBs if ejection fraction is low
Do Not Lower Mortality
• Oxygen
• Morphine
• Nitrates
• Calcium channel blockers
• Lidocaine
• Amiodarone
Clopidogrel or ticagrelor is
used when:
• There is aspirin allergy
• The patient undergoes
angioplasty and stenting
• There is acute MI
Prasugrel has greater
efficacy than clopidogrel
but causes more bleeding.
Prasugrel increases
bleeding in:
• Age > 75
• Weight < 60 kg
··
When is prasugrel, clopidogrel, or ticagrelor the answer?
--
They are the answer when a platelet antagonist is to be used for acute chest
pain, there is aspirin allergy, the patient is to undergo angioplasty, or an
acute infarction is occurring. Ticlopidine is associated with neutropenia.
--
Add one of them to aspirin when there is an acute MI.
··
When are calcium channel blockers (verapamil, diltiazem) the answer?
--
The patient has an intolerance to beta blockers, such as severe reactive
airway disease (asthma).
--
There is cocaine-induced chest pain.
--
There is coronary vasospasm/Prinzmetal’s angina.
··
When is a pacemaker the answer for acute MI?
--
Third-degree AV block
--
Mobitz II, second-degree AV block
--
Bifascicular block
--
New left bundle branch block
--
Symptomatic bradycardia
··
When is lidocaine or amiodarone the answer for acute MI?
--
Only when there is ventricular tachycardia or ventricular fibrillation.
--
Do not give antiarrhythmic medications to prevent ventricular
arrhythmias.
Complications of Myocardial Infarction (MI)
All the complications of myocardial infarction result in hypotension. Step 3
rarely asks what the diagnosis is; instead, it most often hands it to you and asks
what to do in further management.
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