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PHRM 845 Therapeutics > ACS Rogers Parts 3-5 (Not done) > Flashcards

ACS Rogers Parts 3-5 (Not done) Flashcards

1
Q

true or false: we are unlikely to use a GPIIb/IIIa inhibitor in STEMI treatment

A

false (unlikely to use in UA/NSTEMI)

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2
Q

clopidogrel loading dose range

A

300-600 mg

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3
Q

how long does platelet inhibition take with cangrelor?

A

within 2 minutes

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4
Q

what medication is used during PCI when pt did not receive a loading dose P2Y12 inhibitor?

A

cangrelor

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5
Q

ticagrelor loading dose

A

180 mg

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6
Q

ticagrelor maintenance dose

A

90 mg bid

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7
Q

prasugrel loading dose

A

60 mg

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8
Q

prasugrel maintenance dose

A

10 mg daily

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9
Q

cangrelor loading dose

A

30 mcg/kg, followed by 4 mcg/kg/min x 2 hours

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10
Q

is there a maintenance dose for cangrelor?

A

no, use an oral agent

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11
Q

a 600 mg loading dose is preferred for clopidogrel, except in what circumstance?

A

when using fibrinolytic

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12
Q

clopidogrel loading dose for pt on a fibrinolytic + age > 75

A

no loading dose (due to inc risk of bleeding)

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13
Q

clopidogrel loading dose when using fibrinolytic + age of 75 or less

A

300 mg

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14
Q

CI for prasugrel

A

history of TIA/stroke

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15
Q

true or false: ticagrelor is NOT recommended in pts 75 or older, < 60 kg, or bleeding risk

A

false (Prasugrel, not ticagrelor)

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16
Q

what CYP metabolizes clopidogrel?

A

CYP2C19

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17
Q

how long do we need to hold aspirin, ticagrelor, clopidogrel, and prasugrel before CABG?

A

aspirin -> doesn’t need to be held
ticagrelor -> 3 days
clopidogrel -> 5 days
prasugrel -> 7 days

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18
Q

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

A

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)

19
Q

true or false: GPIIb/IIIa inhibitors are usually given before PCI

A

false (given during PCI)

20
Q

what is “bail out” therapy for GPIIb/IIIa inhibitors?

A

use during procedure if a thrombus develops or low blood after stenting (basically if there are thrombus complications during PCI)

21
Q

which GPIIb/IIIa inhibitor is not renally adjusted?

a. abciximab
b. eptifibatide
c. tirofiban

A

a. abciximab

22
Q

gold standard for diagnosis of HIT

A

serotonin release assay (SRA)

23
Q

enoxaparin is eliminated by _______

A

kidneys (accumulates in renal impairment)

24
Q

bivalirudin is not used together with GPIIb/IIIa inhibitors, except in what case?

A

bail out

25
Q

true or false: fondaparinux cannot be used in pts with a history of HIT

A

false

26
Q

true or false: fondaparinux can be used alone for PCI

A

false

27
Q

fondaparinux is CI in CrCl < _____ mL/min

A

< 30

28
Q

dosing for enoxaparin if CrCl < 30

A

1 mg/kg q24h

29
Q

dosing for bivalirudin if CrCl < 30

A

1 mg/kg/hr

30
Q

dosing for bivalirudin if pt is on dialysis

A

0.25 mg/kg/hr

31
Q

for ischemia guided strategy for UA/NSTEMI, which of the following is not used?

a. UFH
b. bivalirudin
c. enoxaparin
d. fondaparinux

A

b. bivalirudin

(a is 48 hours; c and d are for duration of hospital stay/up to 8 days)

32
Q

for early invasive strategy of UA/NSTEMI, which of the following is not ideally used?

a. UFH
b. bivalirudin
c. enoxaparin
d. fondaparinux

A

d. fondaparinux

(the others can be used until PCI, fondaparinux is not ideal, don’t use alone for PCI)

33
Q

for fibrinolytic therapy for STEMI, which of the following is not used?

a. UFH
b. bivalirudin
c. enoxaparin
d. fondaparinux

A

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)

34
Q

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

a, b

(used until PCI, bivalirudin preferred in high bleeding risk)

35
Q

maintenance dose for UFH

A

12 units/kg/hr infusion titrate to aPTT target (no maintenance dose during PCI)

36
Q

metoprolol tartrate starting dose

A

25-50 mg Q6-12h

37
Q

target dose for metoprolol tartrate and succinate

A

tartrate 100 mg bid
succinate 200 mg bid

38
Q

what are the cardioselective beta blockers that we should know? (4 of them on chart; lecture 5, slide 10)

A

atenolol, metoprolol, bisoprolol, nebivolol

39
Q

use sustained-release metoprolol succinate, carvedilol, or bisoprolol in pts with what condition?

A

HFrEF

40
Q

for diabetes pts, a beta blocker can mask the symptoms of hypoglycemia, but it will not mask a _____ _____

A

cold sweat

41
Q

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)

A

c. D/C diltiazem and start carvedilol 6.25 mg bid

(dilitazem is CI in HFrEF)

42
Q

how many sprays are needed to prime Nitrolingual?

A

5 sprays

43
Q

how many sprays are needed to prime Nitromist?

A

10 sprays

PHRM 845 Therapeutics (34 decks)

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