Acute care in cardiology Flashcards
Do you reperfuse immediately for a STEMI heart attack?
Yes. PCI (percutaneous coronary intervention) is preferred to lytic therapy. FMC (first medical contact) to device <90 mins. Fibrinolytic therapy is indicated for patient with STEMI in whom PCI cannot be performed. Within 120 min or in someone not agreeable to PCI. Door to needle time <30 min.
How do you risk stratify for NSTE-ACS?
Treated with an early invasive strategy or an ischemia-guided strategy. Early invasive is revascularization. Ischemia guided is lower risk (TIMI 0-1 or GRACE <109).
What is a lower risk GRACE score?
<109.
What is MONA-B therapy?
Morphine, Oxygen, Nitroglycerine (caution in RV failure), Aspirin (ASA chew and swallow non-enteric coated 162-325 mg X 1 dose ASAP) and Beta blocker (oral preferred w/i 24 hours if no contra indication (HF, low-output state, risk for cardiogenic shock, or other contraindications to beta blockade). Aspirin and Beta blocker reduce mortality (THAT’S IT).
How to determine P2Y12 inhibitor in ACS?
Clopidogrel and Ticagrelor for all of them. Can use prasugrel in NSTE-ACS invasive and STEMI Primary PCI for patients who are not at risk for bleeding complications and who don’t have a history of TIA or stroke.
Which P2Y12 is reversible?
Ticagrelor
Which P2Y12 has a different binding site?
Ticagrelor
Which P2Y12 has the slowest onset?
Clopidogrel, peak onset doses are about 6 hours for 300 mg dose and 600 mg load is 2 hours.
How are the P2Y12’s metabolized?
2C19 for clopidogrel, 3A4 for ticagrelor, prasugrel is multiple pathways.
What are the surgery hold times for the P2Y12 antagonists?
5 days for clopidogrel and ticagrelor, 7 days for prasugrel.
What is the dose adjustment for prasugrel?
5 mg if <60 KG
What is the frequency of the P2Y12s?
Once daily for prasugrel and clopidogrel, twice daily for ticagrelor.
What is the dose adjustment for ticagrelor?
60mg BID after 1 year
What drug has an issue with non responders for the P2Y12 drug class?
CYP2C19 in non-responders.
When are GPIs good?
They are IV agents that are greatest benefit when added to aspiring therapy in those with highest risk features (+ troponin). The reduce the incidence of composite ischemic events and may increase risk of bleeding. Most studies they are combined with UFH and most data gathered before routine P2Y12 use.
