ACS pt3 Flashcards
What is recommended for 12 months following STEMI or NSTEMI/UA?
DAPT: ASA + P2Y12i
What is the onset of action of cangrelor (Kangreal)?
Plate inhibition within 2 minutes
When is cangrelor (Kangreal) used?
Use during PCI when pt did not receive loading dose of P2Y12i
What are the loading and maintenance doses of P2Y12 inhibitors?
The loading dose of clopidogrel is 300-600 mg. What is preferred?
600 mg of clopidogrel
Why is a 600 mg loading dose of clopidogrel preferred?
Results in greater, more rapid, and more reliable plate inhibition vs 300 mg dose
When is a clopidogrel 600 mg loading dose not preferred?
When used with a fibrinolytic:
- fibrinolytic + age >75 = no loading dose
- fibrinolytic + age <=75 = 300 mg LD
Why is the max dose of ASA 81 mg when used w ticagrelor?
- Ticagrelor has greater platelet inhibition vs plavix, therefore higher bleeding risk
- ASA dose higher than 81 mg can increase bleeding risk
What are the SEs of brilinta?
Dyspnea, ventricular pauses
What is prasugrel not recommended for?
Use with ischemia guided therapy (ticagrelor/clopidogrel preferred)
What is prasugrel CI in?
CI in pts w history of TIA/stroke
What are the pt specific factors that lead to prasugrel not being recommended?
- Pts aged >= 75
- <60 kg
- High bleeding risk
DES may not be preferred if pt is unable to tolerate or comply w prolonged course of DAPT. Why?
Associated w higher rate of late stent thrombosis (up to 12 months)
What drug is released from a DES?
Anti-rejection meds
What are minor s/sx of bleeding?
- Bruising
- Light nosebleeds
- Bleeding gums when flossing
What are major s/sx of bleeding?
- Blood in urine
- Blood in stool
- Coughing up blood
- Cut that won’t stop after 10 min of strong pressure
Does ASA need to be held prior to CAGB?
No
How long must ticagrelor be held prior to elective CAGB?
3 days
How long must clopidogrel be held prior to elective CABG?
5 days
How long must prasugrel be held prior to elective CABG?
7 days
How long must P2Y12i be held prior to urgent CABG?
Hold for 24 hours prior, if possible
What are the GP2b/3a inhibitors?
Abciximab, eptifibatide, tirofiban
When is a GP2b/3ai given?
Given at time of PCI
GP2b/3ai use is rare. When is it considered?
- In NSTEMI: high risk features such as positive troponin
- In STEMI: large thrombus burden
- Inadequate P2Y12i loading
- Bailout use if new thrombus forms or low blood after stenting
What is the bolus dose of abciximab (Reopro)?
0.25 mg/kg IV
What is the maintenance dose of abciximab?
0.125 mcg/kg/min; continue up to 12 hours
Any renal adjustments for abciximab?
No
What is the bolus dose of eptifibatide (Integrilin)?
180 mcg/kg IV x 2 (10 min apart)
What is the maintenance dose of eptifibatide?
2 mcg/kg/min; continue up to 18 hours
What is the renal adjustment for eptifibatide?
If CrCl <50 ml/min, lower dose to 1 mcg/kg/min
What is bolus dose of tirofiban (aggrastat)?
25 mcg/kg IV
What is maintenance dose of tirofiban?
0.15 mcg/kg/min; continue up to 18 hours
What is renal adjustment for tirofiban?
If CrCl <60 ml/min, lower dose to 0.075 mcg/kg/min
What are general CI for GP2b/3a inhibitors?
- Active bleeding
- Hx of hemorrhagic stroke
- Severe uncontrolled HTN (SBP >180 or DBP >110)
- Major surgery within 6 weeks
- Dialysis
