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Phar 505 > Acute Coronary Syndrome 2 > Flashcards

Acute Coronary Syndrome 2 Flashcards

1
Q

What are the choices for fibronyltics drugs

A

Alteplase, Reteplase, and tenecteplase

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2
Q

What is the huge adverse effect of fibronyltics, what are risk factors that increase this adverse effect

A

Bleeding/ Intercranial hemorrhage (Stroke), age greater than 65, weight greater than 70 kg, uncontrolled HTN

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3
Q

What are the ABSOLUTE contraindications of fibronylytics

A

Active bleeding, previous intracranial hemorrhage, ischemic stroke within 3 months, recent head trauma, recent intracranial or intraspinal surgery within 2 months, BP greater than 220/110 mmHG, known bleeding disorder

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4
Q

What are the relative contraindications for fibrinolytics

A

Recent truama/surgery (less than 2 weeks ago), history of GI/GU surgery (less than 6 months ago), Active peptic ulcer disease, BP greater than 180/100, Concomitant prescription with oral anticoagulants

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5
Q

What is the gold standard to diagnose CAD, how is it done

A

Angiogram: Catheter advanced via the femoral or radial artery to coronary arteries where opaque contrast is injected to visualize coronary arteries

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6
Q

What is percutaneous coronary interventions

A

Procedure used to treat narrowing of the coronary arteries of the heart found coronary artery disease

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7
Q

T/F: Primary PCI is the preferred option for STEMI and an early invasive strategy for NSTEMI

A

True

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8
Q

What are two stent types

A

Bare metal stent, Drug-eluting stent

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9
Q

T/F: When stents are used to push aide plaques the coagulation casacade activates

A

True

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10
Q

What are the two risk groups for NSTEMI patients

A

Low risk or Intermediate-High risk

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11
Q

T/F: All patients who have an MI, whether STEMI or NSTEMI, will be put on a P2Y12 inhibitor

A

True

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12
Q

If a patient who has NSTEMI is given a noninvasive strategy which P2Y12 inhibitor should be given

A

Clopidogrel or Ticagrelor

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13
Q

If a patient who has STEMI is given a fibrinolytic or nonprimary PCI instead of a primary PCI what P2Y12 inhibitor should be given

A

Clopidogrel

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14
Q

If a patient who has STEMI and is high risk receives a primary PCI (diabetes) what P2Y12 inhibitor should be given

A

Prasugrel or ticagrelor

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15
Q

If a patient has received an invasive strategy or primary PCI and is at higher bleeding risk what P2Y12 inhibitor should be given

A

Clopidogrel

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16
Q

If a patient has received an invasive strategy or primary PCI what P2Y12 inhibitor should be taken if they have unknown coronary antatomy and/or high likelihood of eventual nonurgent Cornorary Artery Bypass Graft Surgery

A

Ticagrelor

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17
Q

If a patient has received an invasive strategy or primary PCI what P2Y12 inhibitor should be taken if the patient weighs less than 60 kg, older than 75, history of transient ischemic attack or stroke

A

Ticagrelor or Clopridogrel (Avoid prasugrel)

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18
Q

For all ACS indications what is dual antiplatelet therapy, duration

A

P2Y12 inhibitor and Asprin, At least 12 months or longer

19
Q

T/F: If a patients receives a fibronolytic the dual antiplatelet therapy should only be done for 7 days

A

False: If a patient recieves a fibrinolytic instead of a PCI they should take dual antiplatelet for 14 days

20
Q

T/F: Dual antiplatelet therapy should be stopped 5-7 days from a Coronary Arterty Bypass Graft surgery

A

True

21
Q

Using what PY12 limits asprin use to less than 100 mg per day

A

Ticagrelor

22
Q

When would a glycoprotein IIb/IIIa inhibitor be added to antiplatelet therapy

A

ACS undergoing PCI at intermediate-high risk

23
Q

When are glycoprotein IIb/IIa inhibitors not be recommended

A

Bivalirudin use, adjunct to thrombolytic therapy

24
Q

What is a precaution a patient might have before using glycoprotein IIb/IIIa inhibitors

A

CrCl less than 30 ml/min

25
Q

If a patient has a STEMI what anticoagulants will be used, what order are they considered in

A

Unfractionated Heparin, bivalirudin, Low molecular weight Heparin

26
Q

If a patient has a NSTEMI and is low risk what anticoagulants will be used, what order will they be used in

A

Fondaprainux, low molecular weight Heparin, unfractionated Heparin

27
Q

If a patient has a NSTEMI and is high risk what anticoagulants will be used, what can switched to during a PCI

A

Unfractionated Heparin or Low molecular weight Heparin, bivalirudin

28
Q

What patients are selected for Heparin

A

Before/during PCI, Intermediate to High risk ACS, Receiving a fibronolytic

29
Q

What is the duration of Heparin use

A

24-48 hours or shortly after PCI

30
Q

What is weight-based (initial/empiric) dosing for heparin

A

60 units/kg (capped at 4000 units) IVP followed by 12 units/kg (capped at 1000 units/hr)

31
Q

T/F: Bilavrudin is usually only for patients with managed PCI and should not be used in patients with NO PCI planned

A

True

32
Q

How long should bivalirudin use be-

A

Until PCI is complete but can be used up to 72 hours after PCI

33
Q

When should alternatives to LMWH be considered, what should it be switched with

A

High bleeding risk (fondaparinux), Renal insufficiency (heparin), obesity (heparin or fondaparinux

34
Q

What is the approved LMWH

A

Enoxaprin 1mg/kg SC every 12 hours

35
Q

T/F: Fondaparinux is preferred in patients treated with conservative strategy (non-invasive) and/or a high risk of bleeding

A

True

36
Q

When should alternatives to fondaparinux be considered

A

Catheters/PCI performed (cause catheter thrombosis), CrCl less than 30 ml/min, weight less than 50 kg

37
Q

T/F: All patients with ACS should recieve a high-intensity statin (Atorvastatin 80 mg or Rosuvastatin 40)

A

True

38
Q

When would ACEs or ARBs be considered in ACS treatment, when are they started

A

Post-MI with low LVEF (less than 40%), All patients with MI/prior to hospital discharge

39
Q

When would Eplerenone be considered in ACS treatment

A

Post-MI with low LVEF (less than 40%) and Diabetes or symptomatic Heart Failure

40
Q

T/F: Eplerenon is contraindicated if the patient has CrCl less than 30

A

True

41
Q

Within the first 24 hours what drug classes should be started as early as possible, how long

A

Asprin, Beta-blocker, Statin/ Aspirin and Beta blocker is indefinite, Beta-blocker at least a year possibly up to3 years

42
Q

What drug should be evaluated for after 12 months

A

PY12 inhibitors

43
Q

What drugs should be avoided due to ACS drug use

A

NASIDs and hormone replacement therapy

44
Q

What is the order for bleeding risk in anticoagulants

A

Fondaparinux. LMWH, Heparin

Phar 505 (33 decks)

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