ACS Flashcards
Immediate treatment for ACS?
ONAM
what are the 3 classes of unstable angina?
rest angina, new-onset agina, crescendo angina
definition of NSTEMI according to ACC/ECC
rise and fall of troponin, fall of CK-MB, ischemia, pathologic EKG changes
How to antiplatelets work?
ASA decreases thromboxane A2 levels to decrease platelet clumping
Uses for ASA
pain, ACS, stroke, rheumatic fever
Which trial showed reduction in risk of death when ASA is used after ACS?
ISIS-2
what are ADR for ASA?
respiratory, cutaneous, and systemic (anaphylaxis) sensitivity
how long do you need to be off ASA before procedures?
24 hours
how do oral antiplatelets work?
bind to ADP and downregulate Iib/IIIa which decreases platelet sticking to each other
name the oral antiplatelets
ticlid, plavix, effient, brillinta
what metabolizes clopidogrel?
2C19 (2 step reaction)
how is brillinta metabolised and dosed?
it is an active drug (faster onset) and needs to be taken twice a day
what drug can decrease clopidogrel efficacy?
nexium, PPIs
what causes clopidogrel resistance?
genetic basis that increases CYP2C19
according to the CHARISMA study, do oral antiplatelets decrease risk of death?
nope
ADR for antiplatelets
bleeding, rash, pruritis, GI hemorrhage, TTP
how soon does clopidogrel begin to work?
10-11 days
why is ticlid not used?
BID, life-threatening hematologic reactions
Which oral antiplatelet is weight-based?
effient
Who should not use effient?
>75 y/o, <60kg
how do IV antiplatelets work?
block Iib/IIIa to decrease pletelet binding
what are the IV antiplatelets?
abxicimab, eptifibatide, tirofiban
what are indications for abxicimab use?
when sending a pt to PCI
What are the indications for eptifibatide use?
medical management - “cooling off” in ED
Compare the plasma/platelet half lives of abxicimab and eptifibatide
abxicimab: short plasma, long platelet - eptifibatide: long plasma, short platelet
ADR for IV antiplatelets
bleeding, TTP (may need reversal therapy with platelets)
which IV antiplatelet are PAs not allow to prescribe?
integrellin
When does an integrellin infusion stop?
after 18 hours
what are the nitrates used in ACS?
isosorbide dinitrate, isosorbide mononitrate, nitroglycerin (explosive)
which nitrates have rapid onset and short duration?
nitroglycerin and isosorbide dinitrate SL
Which nitrates have slow onset and sustained duration?
nitroglycerin patch and isosorbide mononitrate tablets
does the use of a nitrate reduce mortality rates?
not really
when does SL nitroglycerin reach peak levels?
4 minutes - call 911 after this
what are oral and cutaneous nitro used for?
prophylaxis
What is the drug free zone?
time for nitroglycerin therapy where pt has no exposure to it: 12 hours
ADR for nitrates
HA, dizziness, weakness, postural HOTN
which drug is contraindicated when using nitrates?
viagra
what is the ROA for amyl nitrate?
inhalation - same MOA
what happens if amyl nitrates are used in combo with cocaine or ecstasy?
euphoric state is prolonged and intensified - “popper” were once thought to be the genesis of AIDs in the gay community
what BB is used in ACS?
metoprolol
what are the anticoagulants?
unfractionated heparin, LMW heparin, factor Xa inhibitors, direct thrombin inhibitors
which anticoagulant requires a CrCl level before administration?
LMWH/factor Xa inhibitors: enoxaparin (except in STEMI)
What labs are necessary to monitor with heparin therapy?
aPTTs (should be 1.5-2x the control)
which anticoagulants are used only in PCI?
direct thrombin inhibitors (bivalirudin)
name the fibrinolytics
alteplase, reteplase, tenecteplase
when are fibrinolytics contraindicated?
bleeding disorders, previous head injury, cranial neoplasm, stroke, aortic dissection, active bleeding
how do fibrinolytics work?
activate plasmin for fibrin breakdown
how soon should fibrinolytics be administered to pts with AMI?
30 minutes
for pts with ischemic sxs of an AMI of less than 12 hours and ST elevation which fibrinolytic is indicated?
any
for pts with sxs less than 6 hours which fibrinolytic is indicated?
alteplase, tenecteplase
what are uses for alteplase?
acute ischemic stroke, acute PE
What is the reversal agent for fibrinolytics?
none specific - unlabeled use of tranexamic acid which helps you clot
ADR of fibrinolytic therapy
bleeding, rapid lysis causing reperfusion (causing atrial/ventricular arrhythmias), cardiovascular events
how are statins useful post MI?
plaque stabilization
post MI/ACS care
ASA (clopidogrel), BB, ACEi, lipid lowering with HMGCoA reductase inhibitors
what are target lipid levels for post MI/ACS care?
LDL < 100, HDL > 40, TG < 200
