ACSFC

Question 1

Classic signs and sx of ACS

Answer 1

chest pain, diaphoresis, N/V, numbness/tingling sensation, SOB, dyspnea. Pain is not relieved by NTG spray or SL

Question 2

Diagnosis: UA/NSTEMI/STEMI

Answer 2

UA: Chest pain (10/10) crushing chest pain
NSTEMI: Chest pain & + biomarkers Troponin I or T, CK-MB
STEMI: Chest pain, + biomarkers, ECG changes (1mm ST elevations

Question 3

Treatment of UA/NSTEMI and STEMI

Answer 3

UA/ NSTEMI: MONA + GAP-BA
STEMI: MONA + GAP-BA + thrombolytics

Question 4

Risk factors for ACS

Answer 4

Age men >45 women >55 or early hysterectomy
Family hx of coronary events B4 age 55 in men and 65 in women. Smoking, HTN, hyperlipidemia, diabetes, chronic angina, known CAD

Question 5

what does MONA + GAP-BA stand for?

Answer 5

Pre hospital care: Morphine
Oxygen
Nitrates
Aspirin
ER care: Glycoprotein IIb/IIIa inhibitors
Anticoagulants
P2Y12 inhibitors
Beta Blocker
ACEIs

Question 6

Morphine

Answer 6

decreases O2 demand; vasodilator. used for chest discomfort. dosed 2-5mg IV PRN. s/e bradycardia, hypotension, respiratory depression, sedation.

Question 7

Oxygen

Answer 7

give in pts O2 sat <90%. if cyanosis or respiratory distress

Question 8

Nitrates, what types? when Do not use?

Answer 8

Acute SL or spray. take 1 dose if not better call 911. hospital IV drip to decrease chest pain. do not use if SBP <50

Question 9

Aspirin

Answer 9

325mg chew if EC. Take indefinitely if tolerated but 81 mg dose

Question 10

integrilin

Answer 10

eptifibatide

Question 11

ReoPro

Answer 11

abciximab

Question 12

Glycoprotein IIb/IIIa inhibitors MOA & CI

Answer 12

reversibly block platelet aggregation on binding site of fibrongen, von willibrand factor. , preventing thrombosis. C.I. active internal bleeding, uncontrolled BP S/E: Bleeding, thrombocytopenia esp abciximab), hypotension. Administration: Do not shake vial upon reconstitution.

Question 13

Abciximab (Reopro) CI: w/ administration what should u do? when does plt function return to normal after d/c

Answer 13

C.I. w/ hx of CVA w/in 2 years. hypersensitivity to murine proteins, and thrombocytopenia. Must filter with administration. Platelet fxn returns in 24-48hrs after d/c abciximab

Question 14

Eptifibatide (Integrilin)
CI:
what CrCL to reduce dose

Answer 14

CI in hx of stroke with 30 days or any hx of hemorrhagic stroke, renal dysfunction-reduce infusion rate by 50% in pts Crcl <50ml/min

Question 15

Tirofiban (Aggrastat)

Answer 15

CI in hx of stroke with 30 days or any hx of hemorrhagic stroke, renal dysfunction-reduce infusion rate by 50% in pts Crcl <30ml/min

Question 16

P2Y12 inhibitors MOA, lifespan of drugs? which one has fast onset and offset? lifespan of drugs
which one has fast onset and offset

Answer 16

inhibit platelet activation and aggregation on the ADP receptors on platelets. Clopidogel and Prasugrel are prodrugs and have irreversible binding to the receptor. Lifespan of platelet is 7-10days Ticagrelor had reversible binding and faster on and off set

Question 17

Clopidogrel (Plavix)
dose
bbw
adr
when d/c in pts doing cabg?

Answer 17

LD: 300-600mg MD: 75mg d BBW: poor metabolizers of 2C19 allele b/c PRODRUG*. S/E- bleeding, TTP (rash), bruising. Do not start in pts likely to undergo CABG. D/C 5 days prior to any major surgery

Question 18

Prasugrel (Effient)
do not use in what age
why not use in that age
when do you start givign after a pci has been given.

Answer 18

LD: 60mg MD: 10mg, 5mg 75 unless they have DM or MI. D/C 7 days prior to major surgery. if PCI, give dose no later than 1 hr

Question 19

Ticagrelor (Brilinta)

Answer 19

LD: 180mg/d MD: 90mg bid. use w/ ASA 75-100mg. BBW: sever fatal bleeding. S/E bleeding, dyspnea. D/C 5 days prior to major surgery. MD of ASA above 100mg reduce effectiveness of ticagrelor-only 81 mg. used for just ACS pts

Question 20

When do you use BB and CCB

Answer 20

use within the 1st 24hrs to prevent cardiac remodeling

Question 21

When to use thrombolytics per guidelines?

Answer 21

*when you can’t perform PCI w/in 90 mins.
use thrombolytics within 12 hrs from sx onset.Door to balloon time should be <30mins (thrombolytics) if at a hospital. but thrombolytics should be beneficial as long as under 12 hrs of symptom onset.

Question 22

Thrombolytics MOA

Answer 22

cause fibrinolysis by binding to fibrin in a thrombus (clot) and convertingp entrapped plasminogen to plasmin.

Question 23

Thrombolytics

Answer 23

Alteplase (t-PA)
Reteplase (r-PA
Tenecteplase (TNKase)
Streptokinase (Streptase)
S/E intercranial bleeding, hypotension, fever, bleeding

Question 24

Medications to avoid with ACS

Answer 24

NSAIDs, IR DHP (nifedipine) should not be used in the absence of b-blockers. IV fibinolytics is not indicated in pts w/o ST-segment elevation

Question 25

What drugs should you avoid with clopidogrel?

Answer 25

cimetidine, azole antifungals, omeprazole, fluoxetine, fluvoxamine etc

Question 26

What drugs should be continued when pt goes for CABG?

Answer 26

ASA, UFH

Question 27

What drugs should be discontinued when pt goes for CABG?

Answer 27

Clopogrel and ticagrelor 5 days b4 and Prasagel 7 days B4. if enoxaparin: 12-24hrs B4, if fonda: 24hrs b4, if bivalirudin 3 hrs b4

Question 28

Long term meds for status post MI?aspirin- bare metal stent, sirolimus eluting stent, and paclitaxel eluting stent.

Answer 28

ASA indefinitely 81mg, if stent placement use ASA 325mg: 1mos bare metal stent, 3 mos sirolimus- eluting stent, 6mos w/ paclitaxel-eluting.

Plavix 75mg or effient 10mg for at least 1mon and up to 12 mos to 15 mos if drug eluting stentstent.

NTG SL or spray, BB d, ACE-I < 40%, statin, warfarin, tylenol for pain relief.

Question 29

acs cause

Answer 29

imbalance b/w oxy demand and supply due to athersclorosis–> infarction. this causes release of markers:

Question 30

what markers are released after infarketion

Answer 30

troponin I or T and CK and Myocardial band (MB).

Question 31

morphine moa

Answer 31

arteriolar and venous dilation , prompts a decrease in o2 demand and pain relief.

Question 32

morphine adr

Answer 32

hypotension bradycardia, n/v/ resp depression

Question 33

GAP-BA

Answer 33

1. GP II/III receptor antagonist
   Anticoagulant
   P2y12 inhinitors (plavix, prasugrel)
   Beta blockers
   Ace inhibitors

Question 34

glycoprotein II/II antag for who

Answer 34

those doing an intervention PCI or stent

Question 35

which agents are glycoprotein

Answer 35

abciximab, eptifibatide, tirofab
**rmr eptifibatidde seen in the cath lab at slu

Question 36

what are p2y12 inhibitors

Answer 36

clopidogrel or prasugrel (ticagrelor) - for all pts loading dose followed by maintenance dose unless undergoing cabg

Question 37

medications to avoid is acs

Answer 37

nsaids including cox2
dhp clacium cahannel blockers
iv fibrinolytic therpay is not indicated.

Question 38

prasugrel for who

Answer 38

reduction of thrombotic events in pts with ACS who have DONE A PCI

Question 39

ticagrelo drug interaction what common drugs

Answer 39

simvastatin dont use more than 40 mg.

Question 40

STEMI diagnosis

Answer 40

chest pain > 20 mins, shows ST elevation on ECG, toponin T or I elevation/CK MB elevation

Question 41

fibrinolytics CI

Answer 41

History of CVA-
recent intracranial or intraspinal surgery w/in last 3 months
intracranial neoplasm
ischemic stroke w/in 3 months!!
aortic dissection
uncontrolled htn
careful if***SBP> 185

Question 42

fibrinolytics side effects

Answer 42

bleeding, hypotension, intracranial hemorrage, fever*** thats why intracranial neoplasm and htn stuff are CI!!

Question 43

plavix how often take

Answer 43

once daily

Question 44

if you are using aspirin, clopidogrel and warfarin all three agents then maintain INR at

Answer 44

2-2.5
you would add on warfarin if afib or IF pt has LV thrombus.