ACS pt 3 Flashcards
how long for dual antiplatelet therapy in ACS?
12 months
when to use cangrelor
when pt did not get loading dose P2Y12 prior to PCI
cangrelor dosing
load: 30 mcg/kg then 4 mcg/kg/min x 2 hours
when to use 300 mg loading dose of clopidogrel?
fibrinolytic
if 75+ and on fibrinolytic: no loading
clopidogrel is activated by what enzyme?
CYP2C19
which P2Y12 has lowest inhibition of platelet aggregation?
clopidogrel
which drug is max dose of ASA 81 mg
ticagrelor
ticagrelor side effects
dsypnea nad ventricular pauses
prasugrel contraindications and reccomendations against
TIA/stroke
avoid: 75+, <60 kg, high bleed risk
prasugrel is activated by what enzyme?
CYP3A4 and 2B6
ischemia guided therapy preferred agents?
clopidogrel or ticagrelor
early invasive strategy preferred agents?
ticagrelor, prasugrel
fibrinolytic preferred agent?
clopidogrel
PCI preferred agents?
ticagrelor or prasugrel
when is a drug eluting stent not preferred?
if pt can’t comply with DAPT
when to hold P2Y12 inhibitors prior to elective CABG?
ASA - no hold requirement
ticagrelor - 3 days
clopidogrel - 5 days
prasugrel - 7 days
when to hold P2Y12 inhibitors prior to urgent CABG?
24 hours if possible
GP IIb/IIIa inhibitors
abciximab, eptifibatide, tirofiban
when are GP IIb/IIIa inhibitors given?
at time of PCI, only when large thrombus burden or bail out thrombus develops during procedure
abciximab bolus/main dose
bolus: 0.25 mg/kg
main: 0.125 mg/kg/min for 12 hours
eptifibatide bolus/main dose
bolus: 180 mcg/kg IV x 2 (10 mins apart)
main: 2 mcg/kg/min
CrCl < 50 1 mcg
tirofiban bolus/main dose
bolus: 25 mcg/kg
main: 0.15 mcg/kg/min
CrCl < 60 0.075 mcg/kg/min
