Acute Coronary Syndrome 2 Flashcards
What are the choices for fibronyltics drugs
Alteplase, Reteplase, and tenecteplase
What is the huge adverse effect of fibronyltics, what are risk factors that increase this adverse effect
Bleeding/ Intercranial hemorrhage (Stroke), age greater than 65, weight greater than 70 kg, uncontrolled HTN
What are the ABSOLUTE contraindications of fibronylytics
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
What are the relative contraindications for fibrinolytics
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
What is the gold standard to diagnose CAD, how is it done
Angiogram: Catheter advanced via the femoral or radial artery to coronary arteries where opaque contrast is injected to visualize coronary arteries
What is percutaneous coronary interventions
Procedure used to treat narrowing of the coronary arteries of the heart found coronary artery disease
T/F: Primary PCI is the preferred option for STEMI and an early invasive strategy for NSTEMI
True
What are two stent types
Bare metal stent, Drug-eluting stent
T/F: When stents are used to push aide plaques the coagulation casacade activates
True
What are the two risk groups for NSTEMI patients
Low risk or Intermediate-High risk
T/F: All patients who have an MI, whether STEMI or NSTEMI, will be put on a P2Y12 inhibitor
True
If a patient who has NSTEMI is given a noninvasive strategy which P2Y12 inhibitor should be given
Clopidogrel or Ticagrelor
If a patient who has STEMI is given a fibrinolytic or nonprimary PCI instead of a primary PCI what P2Y12 inhibitor should be given
Clopidogrel
If a patient who has STEMI and is high risk receives a primary PCI (diabetes) what P2Y12 inhibitor should be given
Prasugrel or ticagrelor
If a patient has received an invasive strategy or primary PCI and is at higher bleeding risk what P2Y12 inhibitor should be given
Clopidogrel
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
Ticagrelor
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
Ticagrelor or Clopridogrel (Avoid prasugrel)
For all ACS indications what is dual antiplatelet therapy, duration
P2Y12 inhibitor and Asprin, At least 12 months or longer
T/F: If a patients receives a fibronolytic the dual antiplatelet therapy should only be done for 7 days
False: If a patient recieves a fibrinolytic instead of a PCI they should take dual antiplatelet for 14 days
T/F: Dual antiplatelet therapy should be stopped 5-7 days from a Coronary Arterty Bypass Graft surgery
True
Using what PY12 limits asprin use to less than 100 mg per day
Ticagrelor
When would a glycoprotein IIb/IIIa inhibitor be added to antiplatelet therapy
ACS undergoing PCI at intermediate-high risk
When are glycoprotein IIb/IIa inhibitors not be recommended
Bivalirudin use, adjunct to thrombolytic therapy
What is a precaution a patient might have before using glycoprotein IIb/IIIa inhibitors
CrCl less than 30 ml/min
If a patient has a STEMI what anticoagulants will be used, what order are they considered in
Unfractionated Heparin, bivalirudin, Low molecular weight Heparin
If a patient has a NSTEMI and is low risk what anticoagulants will be used, what order will they be used in
Fondaprainux, low molecular weight Heparin, unfractionated Heparin
If a patient has a NSTEMI and is high risk what anticoagulants will be used, what can switched to during a PCI
Unfractionated Heparin or Low molecular weight Heparin, bivalirudin
What patients are selected for Heparin
Before/during PCI, Intermediate to High risk ACS, Receiving a fibronolytic
What is the duration of Heparin use
24-48 hours or shortly after PCI
What is weight-based (initial/empiric) dosing for heparin
60 units/kg (capped at 4000 units) IVP followed by 12 units/kg (capped at 1000 units/hr)
T/F: Bilavrudin is usually only for patients with managed PCI and should not be used in patients with NO PCI planned
True
How long should bivalirudin use be-
Until PCI is complete but can be used up to 72 hours after PCI
When should alternatives to LMWH be considered, what should it be switched with
High bleeding risk (fondaparinux), Renal insufficiency (heparin), obesity (heparin or fondaparinux
What is the approved LMWH
Enoxaprin 1mg/kg SC every 12 hours
T/F: Fondaparinux is preferred in patients treated with conservative strategy (non-invasive) and/or a high risk of bleeding
True
When should alternatives to fondaparinux be considered
Catheters/PCI performed (cause catheter thrombosis), CrCl less than 30 ml/min, weight less than 50 kg
T/F: All patients with ACS should recieve a high-intensity statin (Atorvastatin 80 mg or Rosuvastatin 40)
True
When would ACEs or ARBs be considered in ACS treatment, when are they started
Post-MI with low LVEF (less than 40%), All patients with MI/prior to hospital discharge
When would Eplerenone be considered in ACS treatment
Post-MI with low LVEF (less than 40%) and Diabetes or symptomatic Heart Failure
T/F: Eplerenon is contraindicated if the patient has CrCl less than 30
True
Within the first 24 hours what drug classes should be started as early as possible, how long
Asprin, Beta-blocker, Statin/ Aspirin and Beta blocker is indefinite, Beta-blocker at least a year possibly up to3 years
What drug should be evaluated for after 12 months
PY12 inhibitors
What drugs should be avoided due to ACS drug use
NASIDs and hormone replacement therapy
What is the order for bleeding risk in anticoagulants
Fondaparinux. LMWH, Heparin
