Acute Coronary Syndromes

Question 1

Drug Treatment for ACS

Answer 1

MONA-GAP-BA

+/- PCI depending on EKG

Question 2

abciximab, eptifivatide, and tirofiban are what

Answer 2

gp2b/3a antagonists

Question 3

clopodogrel, prasugrel, and ticagrelor are what

Answer 3

p2y12 inhibitors

Question 4

which two medications should be avoided acutely

Answer 4

nsaids and IR nigedipine

Question 5

clopidogrel and prasugrel classification and binding to receptor

Answer 5

thienopyridines that irreversibly bind to receptor

Question 6

clopidogrel metabolism

Answer 6

cyp2c19 prodrug; avoid omeprazole and esomeprazole

Question 7

prasugrel contraindication

Answer 7

do not use in patient with hx of stroke/tia due to bleeding risk.

Question 8

max asa maint dose on ticagrelor

Answer 8

<100mg

Question 9

ticagrelor dosing

Answer 9

90mg bid x 1 year, then 60mg bid

Question 10

plavix

Answer 10

clopidogrel

Question 11

when to stop prasugrel and ticagrelor

Answer 11

prasugrel: 7 days prior to elective surgery
ticagrelor: stop 5 days before any surgery

Question 12

effient

Answer 12

prasugrel

Question 13

brilinta

Answer 13

ticagrelor

Question 14

cangrelor administration

Answer 14

via injection, must transition to an oral P2Y12 after PCI

Question 15

prasugrel dispensing

Answer 15

must be dispensed in original container

Question 16

all p2y12 inhibitors have what warning besides bleeding

Answer 16

TTP

Question 17

reopro

Answer 17

abciximab

Question 18

integrilin

Answer 18

eptifibatide

Question 19

activase

Answer 19

alteplase

Question 20

alteplase moa

Answer 20

tissue plasminogen activator (tPA)

Question 21

TNKase

Answer 21

tenecteplase

Question 22

fibrinolutic contraindications

Answer 22

active internal bleeding, history of recent stroke, severe uncontrolled hypertension

Question 23

clopidogrel dosing

Answer 23

75 mg po daily

Question 24

ticagrelor dosing

Answer 24

90mg po bid for 1 year, then 60mg bid

Question 25

main side effect/ contraindication of glycoprotein receptor antagonists

Answer 25

thrombocytopenia

Question 26

When are fibrinolytics used?

Answer 26

STEMI only

Question 27

fibrinolytic moa

Answer 27

convert plasminogen to plasmin

Question 28

When should a PCI be done?

Answer 28

Preferred: 90 minutes

Max: Within 120 minutes (2 hours)

Optimal: 30 minutes

Question 29

Which is the only fibrinolytic that can be used for acute stroke?

Answer 29

Alteplase (different dosing)

Question 30

how long to use asa after MI

Answer 30

indefinetly

Question 31

how long to use a p2y12

Answer 31

at least 12 months (along with asa)

Question 32

how long to use niroglycerin

Answer 32

indefinitely as needed

Question 33

how long to use bb

Answer 33

at least 3 years

Question 34

how long to use ace

Answer 34

indefinetly if ef < 40, HTN, CKD or diabetes

Question 35

how long to use aldosterone antagonist

Answer 35

indefinetly especially if reduced EF but contraindicated in significant renal impairment

Question 36

how long to use statin for

Answer 36

indefinetly, high intensity because this counts as a primary prevention event