Medications
What is tissue plasminogen activator (tPA)?
*Remember that tPA is a thrombolytic/fibrinolytic!
This procedure involves placing a heart catheter with a balloon at the end to inflate and breakdown the plaque or clot blocking a blood vessel
What is an angioplasty?
*Combined with stenting makes it a percutaneous coronary intervention (PCI)
This gas represents the O in MONA
What is oxygen?
*Meant to maintain O2 saturation in a patient
For any thrombolytics, the major contraindication is if a patient is susceptible to this general process related to blood
What is bleeding?
*Matters especially for surgery!
Antiplatelets, RAAS inhibitors, and drugs that lower levels of this macromolecule are primarily used to mitigate CAD risk factors
What are lipids?
*Aim to lower LDLs and saturated fats in particular!
Typical calcium-channel blockers (CCBs) will inhibit this calcium channel that is also called voltage-gated L-type calcium channels
What is dihydropyridine/DHP?
*Non-DHP CCBs will inhibit calcium-dependent cells in the AV node instead to lower HR
Using a blood vessel from another part of your body to create an alternate pathway for blood flow in the heart is known as this surgical procedure
What is coronary artery bypass graft (CABG)?
*You can get multiple grafts to help increase blood flow
To prevent and/or thin blood clots for a heart attack, this anticoagulant that is part of MONA is used
What is aspirin?
*This is the only treatment in MONA that is still useful according to recent data
Nitrates, beta-blockers, calcium-channel blockers, and ranolazine are all used to treat this acute symptom often related to coronary artery disease
What is angina?
*This is just the term for chest pain due to reduced blood flow to heart muscle
Be careful with using nitrates like nitroglycerin, as a rapid tolerance, otherwise known as this phenomenon, can occur
What is tachyphylaxis?
*Can occur even on first dose! Go 10-12 hours without using them to mitigate risk
Nitrates will convert into this compound that activates guanylyl cyclase (GC) and eventually lead to vasodilation
What is nitric oxide?
*GC will increase cGMP -> Dephosphorylate MLCK -> Vasodilation
If a STEMI progresses to sudden cardiac arrest, use this device to attempt to reestablish a normal heart rhythm
What is a defibrillator?
*Often in a setting of ventricular tachycardia or fibrillation
This opioid medication in MONA acts as a pain reliever
What is morphine?
*Some studies say this may actually increase risk of death, so be cautious if using this drug
All calcium-channel blockers (except amlodipine and felodipine) should not be used if a patient has this health complication
What is heart failure?
*Will further lower HR (chronotropy) and contractility (inotropy)
Ranolazine works by reducing the concentration of this ion which then minimizes calcium influx into cells
What is sodium/Na+?
*It does NOT affect HR, BP, and coronary blood flow
Metoprolol and atenolol are cardioselective, meaning they will inhibit this specific receptor
What is β1?
*Like with all β-blockers, avoid using if patients have severely low HR
Alongside an angioplasty, a metal mesh coil known as this item will be used to keep an artery open
What is a stent?
*Can be bare metal to minimize bleeding risk or be drug-eluting to prevent scar tissue formation
Nitroglycerin increases blood flow to the heart by doing this action to blood vessels
What is (vaso)dilation?
*Relaxing blood vessels increases the ability for more blood to come into the heart
Discharge medications after an acute myocardial infarction include dual platelet therapy, RAS inhibitors, beta-blockers, and this other class of lipid-lowering medications
What are statins?
*Remember a statin inhibits HMG-CoA reductase to limit cholesterol synthesis
For more preventative use of nitrates, it should be given in large doses through this drug administration method
What is oral?
*More immediate forms would be IV and sublingual
To lower the risk of clots, this rapid-onset anticoagulant can be given intravenously to bind to antithrombin III
What is heparin?
*Further activating antithrombin III will inhibit factors II and X in the coagulation cascade!
Generally, an antiproliferative drug is placed on a drug-eluting stent, such as this immunosuppressant that inhibits the mTOR pathway
What is sirolimus?
*Generally more expensive to have drug-eluting stents compared to bare metal, so keep cost in mind
MONA has been expanded to include 10 different treatments, all of which may be remembered with this mnemonic
What is a THROMBINSS or THROMBINS2?
T = Thienopyridines (P2Y12 inhibitors - Platelets)
H = Heparin
R = RAAS blockers
O = Oxygen
M = Morphine
B = Beta-blockers
I = Intervention (Angioplasty w/ stenting)
N = Nitroglycerine
S = Statins
S = Salicylates (Aspirin)
If there is any history of ischemia or blockage around this region of the body, you should NEVER use a direct fibrinolytic to treat a STEMI
What is the head?
*Intracranial hemorrhage or neoplasm, ischemic stroke in 3 months, or head trauma in 3 months are examples
Having decreased stress, heart-healthy diet, and exercise are all components of this program meant for patients recovering from a heart complication
What is cardiac rehabilitation?
*Often done after heart attacks and heart failure and associated procedures