Acute Coronary Syndrome Flashcards
How does ACS develop?
plaque building up (atherosclerosis) in the coronary arteries of the heart. Plaque can break off an reduce blood flow (ischemia)
Risk factors of ACS
Age: men > 45 years, women > 55 years
Family history
Smoking
HTN
Known CAD
DLD
Diabetes
Chronic Stable Angina (SIHD)
Lack of exercise
Excessive Alcohol
A patient comes in with chest pain radiating down the arms and back. ECG found ST segment elevation and troponin levels were 10. What would be this patient’s diagnosis and treatment?
STEMI (full blockage)
**patient NEEDS a PCI if it can be done within 90 minutes of arrival to the hospital or 120 minutes of ambulance
Morphine
Oxygen
Nitrate
Aspirin
GP 11b/ IIIa antagonist
Anticoagulants
P2Y12 inhibitors
Beta blockers
ACE inhibitors
Mechanism of nitrates for ACS
Antianginal
dilate the coronary artiers and improve collateral blood flow
- decrease preload
and reduce chest pain
Mechanism of beta blockers for ACS
Antianginal
decrease BP and HR
Negative inotropic (decrease contractility)
increase long-term survival!
***beta -1 selective is preferred
Mechanism of ACE inhibitors for ACS
prevent cardiac remodeling
decrease preload and afterload
What medications should you avoid in an acute setting of ACS?
NSAIDs
IR Nifedipine
***have an increase risk of mortality!
Aspirin MOA
irreversibly inhibits COX-1 and 2 to decrease the production of thromboxane A2 (an inducer of platelet aggregation)
Effient MOA
Prasugrel
P2Y12 inhibitor prevents ADP mediated activated of GPIIb/IIIa receptor complex for platelet aggregation
Brillinta MOA
Ticagrelor
P2Y12 inhibitor prevents ADP mediated activated of GPIIb/IIIa receptor complex for platelet aggregation
What enzymes are involved in Plavix metabolism and activation?
ACTIVATION by CYP2C19
inhibitors = decrease efficacy
—– test for poor metabolizers
***do not use with esomeprazole or omeprazole!!!!
Plavix SE
CI: serious internal bleeding
Warning: bleeding risk (stop 5 days before surgery), do NOT use with esomeprazole or omeprazole, Thrombotic Thrombocytopenix Purpura
Effient SE
***dispense in the original container to protect from moisture
BW: fatal bleeding, patients >/= 75 years old
CI: serious bleed, history of TIA or stroke, CABG
**stop 7 days before surgery
SE: thrombotic thrombocytopenic purpura
Brillinta SE
Ticagrelor
BW: fatal bleeding
Warning: serious bleed, history of ICH, avoid in CABG
SE: thrombotic thrombocytopenic purpura
**stop 5 days before surgery
***DO NOT exceed ASA dose of 100 mg === decreases effectiveness of ticagrelor
What time frame is appropriate for ACS treatment with fibrinolytic?
within 30 minutes of hospital arrival
