Acute Coronary Syndrome part 2 Flashcards
see chart of slide 4/5
ok
who is the early invasive strategy used for in nstemi/ua, waht does it involve
angiography and maybe revascularization wihtin 24 hours
indicated for high risk patients (timi>2) or other high risk factors
who may be referred for cabg
high risk patients with multivessel disease
ischemia guided strategy drugs
initiate dapt and anticoagulant
- asa
- p2y12
- anticoagulant - ufh,lmwh
whats the adjunct pharmacotherapy in nstemi/ua
continue dapt anticoagulant discontinued adter pci beta blocker acei statin nitrates prn
early invasive strategy in nstemi/ua drugs
asa
p2y12 loading dose
anticoagulant
consider GPIIb/IIIa inhibitors in high risk patients
who is the ischemia guided strategy used for
patients with low risk factors just get medical management
may be referred for revascularization if ischemia worsens or new high risk occurs
what is the dapt therapy in nstemi/ua
how long
if underwent early invasive with pci should recieve same dapt as stemi
with ischemia strategy use asa plus ticagrelor or clopidogrel
all for 1 year
what was the result of the cure trial for clopidogrel and asa vs asa alone
clopidogrel + asa in us/nstemi patients reduces the risk in cv outcomes
some increase in major bleeding
high risk benefit patients derive most benefit
what was the result of the plato trial in ticegrelor +asa vs clopidogrel + asa
ticagrelor high risk reduction
no sig increase in major bleed
still fine to use clopidegrel in low risk patients
what timi score would you recommend early invasive
4 and up
glycoprotein 2b/3a receptor antagonist moa
block binding of fibrinogen to GPIIb/IIIa receptor on platelet surface inhibiting platelet aggregation
examples of glycoprotein recrpto antagonists
abciximab
eptifibatide
tirofiban
what does glycoprotein ra do in patients with ua/acs who undergo pci
reduce death/mi
improved outcomes with anticoagulants
prevent progression to mi and death
enoxparin dosing
1mg/kg sc q12h until pci or hospital discharge
advantages of lmwh
easier to give
no monitoring
disadvantage of lmwh
long acting
renal elimination
unfractionated heparin dosing
60 units/kg load then 12 units/kg/hr infusion
titrate to aptt 1.5-2x control
until pci or 48 hours
monitoring for ufh
signs of bleeding
Hbg
platelets
moa of fondaparinuz anticoagulant
indirect acting factor Xa inhibitor
dose of fondaparinux and when we would use it
2.5mg sc daily until pci or discharge
has a lower rate of major bleeding so in patients at a higher risk of bleeding
what are hte goals of adjunct therapy
reduce the risk of short term and long term complications associated with acs
slow progression of coronary heart disease and minimize the future cv events and other morbidities
improve mortality and restore quality of life
what is the cumulative relative risk reduction if all asa, bb, statins, and acei used as secondary prevention
75%
does omega 3 reduce cv risk
no evidence to stop but no evidence of protective effects
do antioxidants, folic acid, vit b6, vitb12 prevent heart disease
no not recommended
drugs to avoid post mi
nsaids (couple days ok)
hormone therapy in postmenopausal women increases cv risk
why should you avoid beta blockers in cocaine users
risk of potentiating coronary spasm
