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Pharmacology quiz 2 > ACS > Flashcards

ACS Flashcards

1
Q

Immediate treatment for ACS?

A

ONAM

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2
Q

what are the 3 classes of unstable angina?

A

rest angina, new-onset agina, crescendo angina

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3
Q

definition of NSTEMI according to ACC/ECC

A

rise and fall of troponin, fall of CK-MB, ischemia, pathologic EKG changes

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4
Q

How to antiplatelets work?

A

ASA decreases thromboxane A2 levels to decrease platelet clumping

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5
Q

Uses for ASA

A

pain, ACS, stroke, rheumatic fever

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6
Q

Which trial showed reduction in risk of death when ASA is used after ACS?

A

ISIS-2

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7
Q

what are ADR for ASA?

A

respiratory, cutaneous, and systemic (anaphylaxis) sensitivity

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8
Q

how long do you need to be off ASA before procedures?

A

24 hours

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9
Q

how do oral antiplatelets work?

A

bind to ADP and downregulate Iib/IIIa which decreases platelet sticking to each other

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10
Q

name the oral antiplatelets

A

ticlid, plavix, effient, brillinta

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11
Q

what metabolizes clopidogrel?

A

2C19 (2 step reaction)

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12
Q

how is brillinta metabolised and dosed?

A

it is an active drug (faster onset) and needs to be taken twice a day

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13
Q

what drug can decrease clopidogrel efficacy?

A

nexium, PPIs

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14
Q

what causes clopidogrel resistance?

A

genetic basis that increases CYP2C19

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15
Q

according to the CHARISMA study, do oral antiplatelets decrease risk of death?

A

nope

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16
Q

ADR for antiplatelets

A

bleeding, rash, pruritis, GI hemorrhage, TTP

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17
Q

how soon does clopidogrel begin to work?

A

10-11 days

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18
Q

why is ticlid not used?

A

BID, life-threatening hematologic reactions

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19
Q

Which oral antiplatelet is weight-based?

A

effient

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20
Q

Who should not use effient?

A

>75 y/o, <60kg

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21
Q

how do IV antiplatelets work?

A

block Iib/IIIa to decrease pletelet binding

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22
Q

what are the IV antiplatelets?

A

abxicimab, eptifibatide, tirofiban

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23
Q

what are indications for abxicimab use?

A

when sending a pt to PCI

24
Q

What are the indications for eptifibatide use?

A

medical management - “cooling off” in ED

25
Q

Compare the plasma/platelet half lives of abxicimab and eptifibatide

A

abxicimab: short plasma, long platelet - eptifibatide: long plasma, short platelet

26
Q

ADR for IV antiplatelets

A

bleeding, TTP (may need reversal therapy with platelets)

27
Q

which IV antiplatelet are PAs not allow to prescribe?

A

integrellin

28
Q

When does an integrellin infusion stop?

A

after 18 hours

29
Q

what are the nitrates used in ACS?

A

isosorbide dinitrate, isosorbide mononitrate, nitroglycerin (explosive)

30
Q

which nitrates have rapid onset and short duration?

A

nitroglycerin and isosorbide dinitrate SL

31
Q

Which nitrates have slow onset and sustained duration?

A

nitroglycerin patch and isosorbide mononitrate tablets

32
Q

does the use of a nitrate reduce mortality rates?

A

not really

33
Q

when does SL nitroglycerin reach peak levels?

A

4 minutes - call 911 after this

34
Q

what are oral and cutaneous nitro used for?

A

prophylaxis

35
Q

What is the drug free zone?

A

time for nitroglycerin therapy where pt has no exposure to it: 12 hours

36
Q

ADR for nitrates

A

HA, dizziness, weakness, postural HOTN

37
Q

which drug is contraindicated when using nitrates?

A

viagra

38
Q

what is the ROA for amyl nitrate?

A

inhalation - same MOA

39
Q

what happens if amyl nitrates are used in combo with cocaine or ecstasy?

A

euphoric state is prolonged and intensified - “popper” were once thought to be the genesis of AIDs in the gay community

40
Q

what BB is used in ACS?

A

metoprolol

41
Q

what are the anticoagulants?

A

unfractionated heparin, LMW heparin, factor Xa inhibitors, direct thrombin inhibitors

42
Q

which anticoagulant requires a CrCl level before administration?

A

LMWH/factor Xa inhibitors: enoxaparin (except in STEMI)

43
Q

What labs are necessary to monitor with heparin therapy?

A

aPTTs (should be 1.5-2x the control)

44
Q

which anticoagulants are used only in PCI?

A

direct thrombin inhibitors (bivalirudin)

45
Q

name the fibrinolytics

A

alteplase, reteplase, tenecteplase

46
Q

when are fibrinolytics contraindicated?

A

bleeding disorders, previous head injury, cranial neoplasm, stroke, aortic dissection, active bleeding

47
Q

how do fibrinolytics work?

A

activate plasmin for fibrin breakdown

48
Q

how soon should fibrinolytics be administered to pts with AMI?

A

30 minutes

49
Q

for pts with ischemic sxs of an AMI of less than 12 hours and ST elevation which fibrinolytic is indicated?

A

any

50
Q

for pts with sxs less than 6 hours which fibrinolytic is indicated?

A

alteplase, tenecteplase

51
Q

what are uses for alteplase?

A

acute ischemic stroke, acute PE

52
Q

What is the reversal agent for fibrinolytics?

A

none specific - unlabeled use of tranexamic acid which helps you clot

53
Q

ADR of fibrinolytic therapy

A

bleeding, rapid lysis causing reperfusion (causing atrial/ventricular arrhythmias), cardiovascular events

54
Q

how are statins useful post MI?

A

plaque stabilization

55
Q

post MI/ACS care

A

ASA (clopidogrel), BB, ACEi, lipid lowering with HMGCoA reductase inhibitors

56
Q

what are target lipid levels for post MI/ACS care?

A

LDL < 100, HDL > 40, TG < 200

Pharmacology quiz 2 (6 decks)

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