ACS pt 3

Question 1

how long for dual antiplatelet therapy in ACS?

Answer 1

12 months

Question 2

when to use cangrelor

Answer 2

when pt did not get loading dose P2Y12 prior to PCI

Question 3

cangrelor dosing

Answer 3

load: 30 mcg/kg then 4 mcg/kg/min x 2 hours

Question 4

when to use 300 mg loading dose of clopidogrel?

Answer 4

fibrinolytic
if 75+ and on fibrinolytic: no loading

Question 5

clopidogrel is activated by what enzyme?

Answer 5

CYP2C19

Question 6

which P2Y12 has lowest inhibition of platelet aggregation?

Answer 6

clopidogrel

Question 7

which drug is max dose of ASA 81 mg

Answer 7

ticagrelor

Question 8

ticagrelor side effects

Answer 8

dsypnea nad ventricular pauses

Question 9

prasugrel contraindications and reccomendations against

Answer 9

TIA/stroke
avoid: 75+, <60 kg, high bleed risk

Question 10

prasugrel is activated by what enzyme?

Answer 10

CYP3A4 and 2B6

Question 11

ischemia guided therapy preferred agents?

Answer 11

clopidogrel or ticagrelor

Question 12

early invasive strategy preferred agents?

Answer 12

ticagrelor, prasugrel

Question 13

fibrinolytic preferred agent?

Answer 13

clopidogrel

Question 14

PCI preferred agents?

Answer 14

ticagrelor or prasugrel

Question 15

when is a drug eluting stent not preferred?

Answer 15

if pt can’t comply with DAPT

Question 16

when to hold P2Y12 inhibitors prior to elective CABG?

Answer 16

ASA - no hold requirement
ticagrelor - 3 days
clopidogrel - 5 days
prasugrel - 7 days

Question 17

when to hold P2Y12 inhibitors prior to urgent CABG?

Answer 17

24 hours if possible

Question 18

GP IIb/IIIa inhibitors

Answer 18

abciximab, eptifibatide, tirofiban

Question 19

when are GP IIb/IIIa inhibitors given?

Answer 19

at time of PCI, only when large thrombus burden or bail out thrombus develops during procedure

Question 20

abciximab bolus/main dose

Answer 20

bolus: 0.25 mg/kg
main: 0.125 mg/kg/min for 12 hours

Question 21

eptifibatide bolus/main dose

Answer 21

bolus: 180 mcg/kg IV x 2 (10 mins apart)
main: 2 mcg/kg/min
CrCl < 50 1 mcg

Question 22

tirofiban bolus/main dose

Answer 22

bolus: 25 mcg/kg
main: 0.15 mcg/kg/min
CrCl < 60 0.075 mcg/kg/min