ACS Rogers Parts 3-5 (Not done) Flashcards
true or false: we are unlikely to use a GPIIb/IIIa inhibitor in STEMI treatment
false (unlikely to use in UA/NSTEMI)
clopidogrel loading dose range
300-600 mg
how long does platelet inhibition take with cangrelor?
within 2 minutes
what medication is used during PCI when pt did not receive a loading dose P2Y12 inhibitor?
cangrelor
ticagrelor loading dose
180 mg
ticagrelor maintenance dose
90 mg bid
prasugrel loading dose
60 mg
prasugrel maintenance dose
10 mg daily
cangrelor loading dose
30 mcg/kg, followed by 4 mcg/kg/min x 2 hours
is there a maintenance dose for cangrelor?
no, use an oral agent
a 600 mg loading dose is preferred for clopidogrel, except in what circumstance?
when using fibrinolytic
clopidogrel loading dose for pt on a fibrinolytic + age > 75
no loading dose (due to inc risk of bleeding)
clopidogrel loading dose when using fibrinolytic + age of 75 or less
300 mg
CI for prasugrel
history of TIA/stroke
true or false: ticagrelor is NOT recommended in pts 75 or older, < 60 kg, or bleeding risk
false (Prasugrel, not ticagrelor)
what CYP metabolizes clopidogrel?
CYP2C19
how long do we need to hold aspirin, ticagrelor, clopidogrel, and prasugrel before CABG?
aspirin -> doesn’t need to be held
ticagrelor -> 3 days
clopidogrel -> 5 days
prasugrel -> 7 days
Patient is a 71 year old male that arrives at the ER via ambulance. He had crushing pain in his chest for 15 minutes that relieved when the EMT administered nitroglycerin. ECG performed in ambulance shows normal sinus rhythm (NSR) with no S or T wave abnormalities. High sensitivity troponin drawn in the ER is 2300ng/L. Patient takes clopidogrel 75mg daily at home for ischemic stroke 3 years ago (took this morning). Which of the following is the best initial antiplatelet recommendation?
a. ASA 325mg x1
b. Clopidogrel 600mg x 1
c. ASA 325mg x 1 and ticagrelor 180mg x 1
d. ASA 325mg x 1 and prasugrel 90mg x 1
c. ASA 325mg x 1 and ticagrelor 180mg x 1
(a. needs loading dose of P2Y12, b. needs aspirin, d. prasugrel is CI in ischemic stroke and wrong loading dose)
true or false: GPIIb/IIIa inhibitors are usually given before PCI
false (given during PCI)
what is “bail out” therapy for GPIIb/IIIa inhibitors?
use during procedure if a thrombus develops or low blood after stenting (basically if there are thrombus complications during PCI)
which GPIIb/IIIa inhibitor is not renally adjusted?
a. abciximab
b. eptifibatide
c. tirofiban
a. abciximab
gold standard for diagnosis of HIT
serotonin release assay (SRA)
enoxaparin is eliminated by _______
kidneys (accumulates in renal impairment)
bivalirudin is not used together with GPIIb/IIIa inhibitors, except in what case?
bail out
true or false: fondaparinux cannot be used in pts with a history of HIT
false
true or false: fondaparinux can be used alone for PCI
false
fondaparinux is CI in CrCl < _____ mL/min
< 30
dosing for enoxaparin if CrCl < 30
1 mg/kg q24h
dosing for bivalirudin if CrCl < 30
1 mg/kg/hr
dosing for bivalirudin if pt is on dialysis
0.25 mg/kg/hr
for ischemia guided strategy for UA/NSTEMI, which of the following is not used?
a. UFH
b. bivalirudin
c. enoxaparin
d. fondaparinux
b. bivalirudin
(a is 48 hours; c and d are for duration of hospital stay/up to 8 days)
for early invasive strategy of UA/NSTEMI, which of the following is not ideally used?
a. UFH
b. bivalirudin
c. enoxaparin
d. fondaparinux
d. fondaparinux
(the others can be used until PCI, fondaparinux is not ideal, don’t use alone for PCI)
for fibrinolytic therapy for STEMI, which of the following is not used?
a. UFH
b. bivalirudin
c. enoxaparin
d. fondaparinux
b. bivalirudin
(can be considered for HIT; a is used for 48 hours; c and d for duration of hospital stay up to 8 days)
which of the following do we give for pt who is getting a PCI for a STEMI? SELECT ALL THAT APPLY?
a. UFH
b. bivalirudin
c. enoxaparin
d. fondaparinux
a, b
(used until PCI, bivalirudin preferred in high bleeding risk)
maintenance dose for UFH
12 units/kg/hr infusion titrate to aPTT target (no maintenance dose during PCI)
metoprolol tartrate starting dose
25-50 mg Q6-12h
target dose for metoprolol tartrate and succinate
tartrate 100 mg bid
succinate 200 mg bid
what are the cardioselective beta blockers that we should know? (4 of them on chart; lecture 5, slide 10)
atenolol, metoprolol, bisoprolol, nebivolol
use sustained-release metoprolol succinate, carvedilol, or bisoprolol in pts with what condition?
HFrEF
for diabetes pts, a beta blocker can mask the symptoms of hypoglycemia, but it will not mask a _____ _____
cold sweat
Patient is an 82 year old female that presented with NSTEMI and received a drug-eluting stent (LAD) several hours ago. Temp 37.2, BP is 125/71, HR 67bpm, RR 16, O2 sat 96% on room air. EF = 35%. Patient has no edema in extremities. Patient was on diltiazem 120mg daily prior to admission.
Which of the following would you recommend?
a. Continue diltiazem 120mg daily
b. Continue diltiazem 120mg daily and add carvedilol 6.25mg bid
c. D/C diltiazem and start carvedilol 6.25mg bid
d. D/C diltiazem (BP too low to start a BB at this time)
c. D/C diltiazem and start carvedilol 6.25 mg bid
(dilitazem is CI in HFrEF)
how many sprays are needed to prime Nitrolingual?
5 sprays
how many sprays are needed to prime Nitromist?
10 sprays
