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Chapter 8. Acute Coronary Syndromes

Student Questions

Which of the following is a contraindication to eplerenone in a patient with heart failure following MI?

A. EF less than 40% (0.40)

B. Angioedema to an ACE inhibitor

C. Serum potassium of 5.6 mEq/L (mmol/L)

D. Heart rate less than 60 beats/min

Answer: C

Answer A: Incorrect. To reduce mortality, administration of either eplerenone or spironolactone should be considered within the first 7 days following MI in all patients who are already receiving an ACE inhibitor (or ARB) and a β-blocker and have an LVEF of equal to or less than 40% (0.40) and either HF symptoms or DM.

Answer B: Incorrect. Angioedema to an ACE inhibitor is not a contraindication to eplerenone use.

Answer C: Correct. Contraindications to eplerenone include hyperkalemia or an estimated CrCl < 30 mL/min (0.50 mL/s).

Answer D: Incorrect. Eplerenone does not affect heart rate and therefore a heart rate < 60 beats/min is not a contraindication.

Which of the following represents the most appropriate monitoring regimen for a patient receiving UFH for ACS who is undergoing an ischemia-guided approach?

A. Monitor aPTT every 3 hours until therapeutic

B. Monitor aPTT every 6 hours until therapeutic

C. Monitor ACT every 12 hours until therapeutic

D. Monitor ACT daily until therapeutic

Answer: B

Answer A: Incorrect. In patients receiving an unfractionated heparin infusion on the floor, an aPTT should be monitored every 6 hours, not 3 hours, until therapeutic and daily thereafter.

Answer B: Correct. In patients receiving an unfractionated heparin infusion on the floor, an aPTT should be monitored every 6 hours until therapeutic and daily thereafter.

Answer C: Incorrect. Unfractionated heparin may be monitored by aPTT, or anti-Xa , or activated clotting time (ACT) for therapeutic accuracy. In patients going to the cath lab, an ACT is normal, as it can be tested at the bedside with relatively instant results during the procedure. Conversely, an ACT is not measured in a patient such as this who is managed with an ischemia-guided approach (ie, not going to the cath lab).

Answer D: Incorrect. Unfractionated heparin may be monitored by aPTT, or anti-Xa , or activated clotting time (ACT), for therapeutic accuracy. In patients going to the cath lab, an ACT is normal, as it can be tested at the bedside with relatively instant results during the procedure. Conversely, an ACT is not measured in a ...

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