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PHRM 845 > ACS pt3 > Flashcards

ACS pt3 Flashcards

1
Q

What is recommended for 12 months following STEMI or NSTEMI/UA?

A

DAPT: ASA + P2Y12i

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2
Q

What is the onset of action of cangrelor (Kangreal)?

A

Plate inhibition within 2 minutes

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3
Q

When is cangrelor (Kangreal) used?

A

Use during PCI when pt did not receive loading dose of P2Y12i

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4
Q

What are the loading and maintenance doses of P2Y12 inhibitors?

A
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5
Q

The loading dose of clopidogrel is 300-600 mg. What is preferred?

A

600 mg of clopidogrel

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6
Q

Why is a 600 mg loading dose of clopidogrel preferred?

A

Results in greater, more rapid, and more reliable plate inhibition vs 300 mg dose

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7
Q

When is a clopidogrel 600 mg loading dose not preferred?

A

When used with a fibrinolytic:
- fibrinolytic + age >75 = no loading dose
- fibrinolytic + age <=75 = 300 mg LD

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8
Q

Why is the max dose of ASA 81 mg when used w ticagrelor?

A
  • Ticagrelor has greater platelet inhibition vs plavix, therefore higher bleeding risk
  • ASA dose higher than 81 mg can increase bleeding risk
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9
Q

What are the SEs of brilinta?

A

Dyspnea, ventricular pauses

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10
Q

What is prasugrel not recommended for?

A

Use with ischemia guided therapy (ticagrelor/clopidogrel preferred)

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11
Q

What is prasugrel CI in?

A

CI in pts w history of TIA/stroke

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12
Q

What are the pt specific factors that lead to prasugrel not being recommended?

A
  • Pts aged >= 75
  • <60 kg
  • High bleeding risk
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13
Q

DES may not be preferred if pt is unable to tolerate or comply w prolonged course of DAPT. Why?

A

Associated w higher rate of late stent thrombosis (up to 12 months)

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14
Q

What drug is released from a DES?

A

Anti-rejection meds

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15
Q

What are minor s/sx of bleeding?

A
  • Bruising
  • Light nosebleeds
  • Bleeding gums when flossing
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16
Q

What are major s/sx of bleeding?

A
  • Blood in urine
  • Blood in stool
  • Coughing up blood
  • Cut that won’t stop after 10 min of strong pressure
17
Q

Does ASA need to be held prior to CAGB?

A

No

18
Q

How long must ticagrelor be held prior to elective CAGB?

A

3 days

19
Q

How long must clopidogrel be held prior to elective CABG?

A

5 days

20
Q

How long must prasugrel be held prior to elective CABG?

A

7 days

21
Q

How long must P2Y12i be held prior to urgent CABG?

A

Hold for 24 hours prior, if possible

22
Q

What are the GP2b/3a inhibitors?

A

Abciximab, eptifibatide, tirofiban

23
Q

When is a GP2b/3ai given?

A

Given at time of PCI

24
Q

GP2b/3ai use is rare. When is it considered?

A
  • 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
25
Q

What is the bolus dose of abciximab (Reopro)?

A

0.25 mg/kg IV

26
Q

What is the maintenance dose of abciximab?

A

0.125 mcg/kg/min; continue up to 12 hours

27
Q

Any renal adjustments for abciximab?

A

No

28
Q

What is the bolus dose of eptifibatide (Integrilin)?

A

180 mcg/kg IV x 2 (10 min apart)

29
Q

What is the maintenance dose of eptifibatide?

A

2 mcg/kg/min; continue up to 18 hours

30
Q

What is the renal adjustment for eptifibatide?

A

If CrCl <50 ml/min, lower dose to 1 mcg/kg/min

31
Q

What is bolus dose of tirofiban (aggrastat)?

A

25 mcg/kg IV

32
Q

What is maintenance dose of tirofiban?

A

0.15 mcg/kg/min; continue up to 18 hours

33
Q

What is renal adjustment for tirofiban?

A

If CrCl <60 ml/min, lower dose to 0.075 mcg/kg/min

34
Q

What are general CI for GP2b/3a inhibitors?

A
  • Active bleeding
  • Hx of hemorrhagic stroke
  • Severe uncontrolled HTN (SBP >180 or DBP >110)
  • Major surgery within 6 weeks
  • Dialysis

PHRM 845 (48 decks)

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