ACS pt 2 contd

Question 1

what is cangrelor?

Answer 1

IV option of P2Y12 inhibitor
platelet inhibition with 2 minutes
very expensive

Question 2

when should cangrelor be used?

Answer 2

during a PCI when a patient did not receive loading P2Y12 inhibitor

Question 3

when is DAPT recommended?

Answer 3

12 months in STEMI or NSTEMI/UA patients
always aspirin and P2Y12 inhibitor with loading dose and maintenance

Question 4

what is the dosing of clopidogrel (plavix)?

Answer 4

300-600mg
75mg daily

Question 5

what is dosing of ticagrelor (brilinta)?

Answer 5

loading: 180mg
maintenance: 90mg BID

Question 6

what is the dosing of prasugrel (effient)?

Answer 6

loading: 60mg
maintenance: 10mg daily

Question 7

what is the dosing of cangrelor?

Answer 7

loading: 30mcg/kg IV, followed by 4mcg/kg/min for 2 hours
maintenance: not recommended, use oral agent

Question 8

why is the 600mg of clopidogrel preferred?

Answer 8

results in greater, more rapid, and more reliable platelet inhibition compared to 300mg

Question 9

when would a 300mg loading dose of clopidogrel be preferred?

Answer 9

when a patient is on a fibrinolytic and under the age of 75

Question 10

when is no loading dose of clopidogrel required?

Answer 10

if a patient is over 75 and on a fibrinolytic

Question 11

what are the SE of ticagrelor (brilinta)?

Answer 11

dyspnea (SOB)
ventricular pauses

Question 12

what P2Y12 inhibitors have greater inhibition of platelet aggregation?

Answer 12

ticagrelor and prasugrel

Question 13

what enzyme converts clopidogrel?

Answer 13

CYP2C19

Question 14

when is prasugrel (effient) CI?

Answer 14

in pts with history of TIA/stroke

Question 15

when is prasugrel (effient) not recommmended?

Answer 15

in patients over 75 years old, under 60kg, or have a high bleeding risk
maintenance dose of 5mg may be used if deemed necessary

Question 16

what P2Y12 inhibitor drugs are recommended in ischemia guided strategy?

Answer 16

ticagrelor and clopidogrel preferred

Question 17

why would a person switch from clopidogrel to either ticagrelor or prasugrel?

Answer 17

inadequate response due to genetics or CV events

Question 18

why would a person switch from ticagrelor to clopidogrel?

Answer 18

bleeding
cost
SOB
adherence

Question 19

why would a person switch from prasugrel to clopidogrel?

Answer 19

bleeding
cost
stroke/TIA

Question 20

when treating via early invasive strategy for NSTEMI/UA, what P2Y12 inhibitor should be used?

Answer 20

any is fine
preference for ticagrelor or prasugrel

Question 21

for a STEMI pt, what P2Y12 inhibitors are preferred?

Answer 21

if taking fibrinolytic, clopidogrel
if had PCI, ticagrelor or prasugrel preferred

Question 22

what is the counseling points of aspirin?

Answer 22

need to take lifelong to prevent heart attack
take with food
risk of bleeding

Question 23

what is the counseling points for generic P2Y12 inhibitor?

Answer 23

take with aspirin for one year to prevent heart attack
risk of bleeding

Question 24

what is the counseling points for specifically ticagrelor?

Answer 24

take 12 hours apart
let doctor know if experience SOB

Question 25

what are some minor signs and symptoms of bleeding?

Answer 25

bruising light nosebleeds bleeding gums when flossing

Question 26

what are some major signs and symptoms of bleeding?

Answer 26

blood in urine or stool (often dark and tarry) coughing up blood (coffee grounds) cut that won't stop bleeding after putting strong pressure on it for 10 minutes

Question 27

how should aspirin be held prior to a CABG?

Answer 27

does not need to be held

Question 28

how should P2Y12 inhibitors be held prior an elective CABG?

Answer 28

clopidogrel - 5 days ticagrelor - 3 days prasugrel - 7 days

Question 29

how should P2Y12 inhibitors be held prior to an urgent CABG?

Answer 29

24 hours prior if possible