ACS drugs

Question 1

when is prasugrel indicated

Answer 1

in combination with aspirin for prevention of atherothrombotic events in pt with ACS who are undergoing PCI

Pt who are undergoing coronary angiography within 48 admission for unstable angina or NSTEMI but do not administer until time of PCI to minimise risk of bleeding!

can only be used if PCI!

Question 2

what is the dose of prasugrel
- hint depends on weight and age

Answer 2

75 and over: initially 60mg for one dose, then 5mg once daily for maintenance

18-74, up to 60kg: initially 60mg for one dose then 5mg OD for maintenance

18-74, 60kg and above: initially 60mg for one dose then 10mg OD for maintenance

usually 12 months maintenance

Question 3

what is given for secondary prevention of CV events after pt has ACS

Answer 3

• BB (up to 12 months if no REF, if there is then indefinitely)
• statin
• ACEi indefinitely
• Dual antiplatelet therapy - aspirin indefinitely; other one up to 12 months

Question 4

if you are using prasugrel in pt over 75 ensure you …

Answer 4

evaluate benefit of treatment with risk of bleeding !

Question 5

if pt is NOT undergoing PCI, what is the medical management that you would give in STEMI or NSTEMI/unstable angina

Answer 5

ticagrelor + aspirin unless high bleeding risk

clopidogrel with aspirin or aspirin alone for high bleeding risk

Question 6

in NSTEMI/unstable angina initial treatment is with loading dose 300mg aspirin. What else?

Answer 6

fondaparinux unless high bleeding risk or immediate angiography
if RI or creatinine >264, give unfractionated heparin instead with dose adjusted to clotting function