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Naplex 2025 > Acute Coronary Syndrome > Flashcards

Acute Coronary Syndrome Flashcards

1
Q

What is the cause of Acute Coronary Syndromes [ACS]?

A
  • Plaque build up [atherosclerosis] where the plaque breaks off making a clot that reduces blood flow [ischemia]
  • This causes the imbalence of oxygen supply and demand
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2
Q

What are some of the risk factors for ACS?

A
  • Age: Men > 45y & Women > 55y
  • Family Hx
  • Smoking
  • Hypertension
  • Known CAD
  • Dyslipiedmia
  • Diabetes
  • Chronic Stable Angina
  • Lack of exercise
  • Excessive Alcohol
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3
Q

What are some of the signs and symptoms for ACS?

A
  • Chest Pain [pressure/squeezing] that last > 10 mins (can go into arm, neck, jaw, back…)
  • Dyspnea, Diaphoresis, Fainting
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4
Q

What is something that someone should do if they are experiencing chest pain?

Drug?

A
  • Take NTG; 1 dose every 5 mins up to 3 doses
  • If giving a second dose call 911
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5
Q

What are the 2 diagnosis of ACS?

A
  • STEMI
  • NSTEMI or UA
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6
Q

What is the first thing that should be done when a medical person shows up?

A
  • 12 lead ECG within 10 mins
  • If having MI [NSTEMI or STEMI] then go to hospital for PCI
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7
Q

What are some of the biochemical markers that we look for when we thing someone has ACS?

Cardiac Enzymes

A
  • Troponins I and T
  • Should be gotten at presentation and 3-6 hours after

CK-MB and Myoglobin are less sensitive but still good to watch

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8
Q

What is a PCI?

A
  • Putting a small balloon into the coronary artery to open the artery and increase blood flow
  • A stent is put into it to hold ot open
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9
Q

What is the “door to balloon” and “door to needle”?

When treating a STEMI

A
  • Door to Balloon: PCI is preferred within 90 minutes of getting to hospital OR 120 mins if seen by medical person first
  • Door to Needle: When PCI cant happen within 120 mins then fibrinolytic used within 30 mins
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10
Q

What are the drug combos that are used for the treatment of ACS?

A
  • Antianginal [decrease oxygen demand]
  • Anticoagulant [prevents clots]
  • Antiplatelets [prevents clots]
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11
Q

What is MONA-GAP-BA?

A
  • M: Morphine
  • O: Oxygen
  • N: Nirates
  • A: Aspirin
  • G: GPIIb/IIa
  • A: Anticoags
  • P: P2Y12
  • B: Beta Blockers
  • A: ACEi
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12
Q

What is important to know about Nitrates when it comes to giving MONVA-GAP-BA for someone?

A
  • Antianginal: dilates coronary arteries = decreased blood flow = decreased chect pain
  • SL NTG 0.4mg given every 5mins x3 doses
  • DO NOT give IV if SBP < 90
  • PDE5-i are contraindicated
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13
Q

What is important to know about Asipirin when its related to MONA-GAP-BA?

A
  • Antiplatelet
  • Give non-enteric coated aspirin [chewable] immediately
  • Maintainacne give 81mg forever
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14
Q

What is important to know about GPIIb/IIIa antagonists when it is realted to MONA-GAP-BA?

A
  • Antiplatelet
  • Drugs are Abciximab, Eptifibate, Triofiban
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15
Q

What is important to know about Anticoagulants when it is related to MONA-GAP-BA?

A
  • Inhibit clotting factor
  • LMWH [Exnoaparin], UFH, Bivalirudin [preferred in STEMI]
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16
Q

What is important to know about P2Y12 Inhibitors in MONA-GAP-BA?

A
  • Antiplatelet
  • Clopidogrel, Prasugrel, Ticagrelor
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17
Q

What is important to know about Beta Blockers in relation to MONA-GAP-BA

A
  • Antiangial: Decrease HR, BP, Contractility
  • Oral, Low Dose BB [B1 w/o ISA] started within 24h
18
Q

What is important to know about ACEi in relation to MONA-GAP-BA?

A
  • Blocks production of Ang II
  • Oral started within 24h and continued forever
19
Q

What are some of the durgs you should avoid in an acute setting on ACS?

A
  • NSAIDS
  • Nifedipine IR [increase mortality]
20
Q

What are the Antiplatelet drugs that are used ACS and what is there MOA?

A
  • Aspirin: irreversibly inhibtis COX 1&2 decreasing TXA2
  • P2Y12: binds to ADP P2Y12 preventinh GPIIb/IIIa
  • GPIIb/IIIa: blocks GPIIb/IIIa stoping activation
  • Protease-activated Receptor 1: binds to PAR-1 preventing platelet aggregation
21
Q

What are the P2Y12 Inhibitors that are used for ACS?

A
  • Clopidogrel [Plavix]
  • Prasugrel [Effient]
  • Ticagrelor [Brillinta]
22
Q

What is the difference between the P2Y12 Inhibitors?

Clopid & Pras Vs Ticag

A
  • Clopidogrel & Prasugrel are prodrugs that have IRREVERSBLE in binding
  • Ticagrelor is no a prodrug and is reversilbe
23
Q

What is the boxed warning for Clopidogrel?

A
  • Prodrug so it depends on 2C19 to version [Poor Metabolizers have increased cardio events]

`

24
Q

What are the contraindications for Clopidigrel?

A
  • Serious Bleeding
25
Q

What are the warnings for Clopidogrel?

A
  • Bleeding; stop 5 days before surgery
  • DO NOT use with Omprazole or Esomprazole
26
Q

What are the Boxed Warnings for Prasugrel?

A
  • BLEEDING [not for >75yo]
  • DO NOT start if doing a CABG; stop 7 days before surgery
27
Q

What is something important to note about dispensing Prasugrel?

A
  • MUST be in orginial container
28
Q

What are the contraindications for Prasugrel?

A
  • Serious bleeding, Hx of TIA or Stroke
29
Q

What is important to note about the dosing for Ticagreolr?

A
  • MD: 90mg PO BID for 1 year THEN 60mg BID
30
Q

What is the boxed warning for Ticagrelor>

A
  • After initial aspirin dose fo 162-325mg, DO NOT exceed more that 100 because it decreases efficacy of ticagrelor
  • AVOID in CABG; stop 5 days before surgery
31
Q

What are the contraindications for Ticagrelor?

A
  • Serious Bleeding Risk
32
Q

What is important to know about Cangrelor?

A
  • Injectable
  • Go to one of the ORAL ones after PCI
33
Q

What are the GPIIb/IIIa Antagonists that are used?

A
  • Eptifibatide
  • Tirofiban
  • Abiciximab

Eptifibatide and Tiroban are reverible blockers and are used for Medical Mangament or PCI +/- stent

Abicixiamb is not available

34
Q

What are the contraindications for the GPIIb/IIIa Antagonists

A
  • Thrombocytopenia, Hx of bleeding, Stroke within last 30 days
35
Q

What are the side effects for GPIIb/IIIa Antagonists

A
  • Bleeding, Thrombocytopeina
36
Q

What are the fibrinolytics used for?

A
  • “Clot Breakdown” by binding to fibrin and converting Plasminogen into plasmin
  • ONLY for STEMI
37
Q

When should a fibrinolyitc be used?

A
  • within 30 mins of getting to hospital if PCI is < 120 mins [Door to Needle]
38
Q

What are the Fibrinolytics that are used?

A
  • Altaplase [Activase]
  • Tenectiplase [TNKase]
  • Reteplase
39
Q

What are the contraindications for the fibrinolytics?

A
  • Active internal bleeding, Hx of stroke, Severe uncontrolled HTN
40
Q

What are the side effects of Fibrinolytics?

A
  • Bleeding [including Intracranial hemorrhage]
41
Q

What are some other notes for Fibrinolytics?

-

A
  • Alteplase contraindications and dosing are different for stroke
42
Q

What are some of the drugs that are used indefinitely in secondary prevention of ACS?

A
  • Aspirin [81mg]
  • Beta Blockers [normally 3y unless HF or HTN]
  • NTG [SL Tab or TL Spray]
  • ACEi [EF < 40%, HTN, CKD, Diabetes]
  • Statins [High Intensity]
  • Aldosterone Antagonist [EF < 40%, HF, Diabetes]

Naplex 2025 (10 decks)

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