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Therapeutics 2 > Acute Coronary Syndromes > Flashcards

Acute Coronary Syndromes Flashcards

1
Q

What is a Type I Acute Coronary Syndrome (ACS)?

A

vascular occlusion ischemia (blockage)

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2
Q

What is a Type II Acute Coronary Syndrome (ACS)?

A

demand ischemia, “overworking” (wall tension, heart rate, contractility)

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3
Q

What are the indicators of unstable angina?

A

no ST elevation and no biomarkers

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4
Q

What are the indicators of NSTEMI?

A

no ST elevation(usually) with biomarkers

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5
Q

What are the indicators of STEMI?

A

ST elevation and maybe biomarkers

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6
Q

What are the cardiac biomarkers?

A

TROPONIN, myoglobin, creatine kinase(CK)

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7
Q

Describe NSTEMI vs STEMI

A

-NSTEMI= ST depression, white clots, partial coronary occlusion, reperfusion, not urgent
-STEMI= ST elevation, red clots, total coronary occlusion, reperfusion urgently needed

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8
Q

What is the PQEST of Angina?

A

-Precipitating factors= pain at rest with NO exertion
-Palliative measures= rest and nitrates won’t relieve pain
-Quality of pain= crushing chest tightness
-Region of pain= substernal (right in the middle)
-Radiation of pain= arms, jaw, neck, abdomen, or back
-Severity of pain= 8-10/10
-Temporal pattern= > 20 minutes

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9
Q

What does MONA stand for?

A

-Morphine
-Oxygen
-Nitroglycerin
-Aspirin

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10
Q

What is the concern with morphine for initial treatment of acute coronary syndromes?

A

studies showed increased death and length of hospitalizations so not generally given unless symptoms persist despite therapy

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11
Q

When would oxygen be considered for acute coronary syndromes (ACS) pt?

A

SaO2 < 90%

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12
Q

What is the MOA of Nitroglycerin?

A

increased nitric oxide release resulting in venous dilation and arterial dilation (decrease afterload= decrease BP= decrease demand and coronary vasodilation = increased coronary supply)

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13
Q

What is the indication of Nitroglycerin?

A

-SL preferred for acute angina
-IV preferred for unstable refractory angina

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14
Q

What drug should every patient with ACS receive once admitted to the hospital?

A

aspirin

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15
Q

What is the benefit of Aspirin in ACS pt?

A

reduce death, MI, or stroke by up to 50%

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16
Q

What dose of Aspirin should be given to pt initially upon admittance into the hospital for ACS?

A

160-325mg chewed and swallowed

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17
Q

What does THROMBINS2 stand for?

A

-Thienopyridine
-Heparin
-RAAS
-Oxygen
-Morphine
-Beta blocker
-Intervention (PCI)
-Nitroglycerin
-Statin
-Salicylate (aspirin)

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18
Q

Describe TIMI:

A

used to score patients to assist on deciding whether a pt is a candidate for percutaneous coronary intervention (PCI) aka “cardiac catheterization”

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19
Q

How does the point system work for TIMI?

A

one point for each of the following risk factor predictors:
-age > 65
-3 or more CAD risk factors
- > 50% stenosis of major coronary artery
-ST segment elevation
-2+ angina episodes in past 24h
-ASA used within past 7 days
-elevated biomarkers

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20
Q

What pt would be a candidate for early invasive therapy (PCI)?

A

-TIMI score > 3
-recurrent angina/ischemia with low activity
-elevated troponin levels
-new ST depression on EKG
-angina/ischemia + HF
-hemodynamic instability
-sustained ventricular tachycardia

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21
Q

Describe Coronary Patency

A

dye is injected into coronary artery and blood flow is assessed (angiogram/angiography) and is graded:
-3= normal
-2= moderate
-1= minimal
-0= none

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22
Q

What are examples of percutaneous coronary intervention (PCI)?

A

-balloon angioplasty
-cardiac stenting

23
Q

What is the MOA of P2Y12 Inhibitors?

A

prevent platelet aggregation by irreversibly blocking P2Y12 component of the ADP receptor -> preventing platelet activation

24
Q

What drugs are P2Y12 Inhibitors?

A

-clopidogrel
-prasugrel
-ticagrelor
-cangrelor

25
Q

What should be given to pt before PCI?

A

aspirin 162-325mg and P2Y12 Inhibitor ASAP

26
Q

What drugs should be given to pt after PCI?

A

-aspirin 81mg INDEFINITELY
-P2Y12 inhibitor should be given for at least 12 months if not on oral anticoagulant

27
Q

What are the benefits of Prasugrel?

A

-more potent antiplatelet effects
-not limited by genetic polymorphisms
-reduction in ischemic outcomes (w/ PCI)

28
Q

What are the limitations of Prasugrel?

A

-not indicated for “medically treated”
-higher life-threatening bleed rates
-CONTRAINDICATED in previous stroke or TIA

29
Q

What drugs are Glycoprotein IIb/IIIa Inhibitors?

A

tirofiban and eptifibatide

30
Q

What are the benefits of using Glycoprotein IIb/IIIa inhibitors in ACS?

A

reduce risk of death, reduce revascularization, reduce major adverse cardiac events

31
Q

What are the adverse effects of Glycoprotein IIb/IIIa Inhibitors?

A

-thrombocytopenia
-occult bleeding
-hypotension
-chest pain

32
Q

What is the place in ACS therapy of Glycoprotein IIb/IIIa Inhibitor?

A

-combined with anticoagulation (heparin), but not given with bivalitudin
-generally reserved for higher risk patients with high troponin
-in NSTEMI/STEMI: adjunct when P2Y12 inhibitor therapy is not adequate

33
Q

What are the contraindications of Glycoprotein IIb/IIIa Inhibitors?

A

-thrombocytopenia
-active bleed
-stroke within 2 years

34
Q

What are the monitoring parameters for Unfractionated Heparin (UFH)?

A

-activated clotting time in cath lab
-activated partial thromboplastin time (aPTT) every 6 hours when medically managing (1.5-2x control (roughly 50-65 sec)

35
Q

What is the duration of therapy of Unfractionated Heparin (UFH)?

A

-PCI: discontinue after procedure is completed
-medical management: 2-5 days

35
Q

What is the unique use of Enoxaparin?

A

STEMI with a fibrinolytic

36
Q

What are the indications of Bivalirudin?

A

-preferred over heparin + GPIIb/IIIa inhibitor in PCI STEMI patients at high risk for bleeding
-in patients with heparin induced thrombocytopenia

37
Q

What are non-anticoagulant/antiplatelet therapy for ACS medication management?

A

-beta blocker
-ACEI
-statin
-aldosterone blockers

38
Q

When should a beta blocker be started for ACS?

A

ASAP or with 24h

39
Q

What is the benefit of using beta blockers in ACS?

A

decreases myocardial O2 demand (decrease HR, decrease contractility, decrease BP)

40
Q

How long should beta blockers be used after ACS event?

A

3 years

41
Q

What is the goal HR using beta blockers for ACS?

A

50-60bpm

42
Q

What are the contraindications of beta blockers?

A

-SBP < 90mmHg
-HR < 50 bpm
-acute heart failure
-heart block

43
Q

What is the benefit of using an ACEI for ACS?

A

-prevent venticular remodeling
-reduce venticular dilation after infarction
-reduce venticular hypertrophy
-reduce arrhythmias
-improve LV function

44
Q

What patients should receive an ACEi in ACS?

A

all, but especially if evidence of HFrEF

45
Q

What is the indication of Aldosterone blocker, Eplerenone?

A

patients with MI in past 10 days and HFrEF < 40%

46
Q

What is the adverse effect of Aldosterone blocker, Eplerenone?

A

hyperkalemia

47
Q

What statin should patients be given post ACS event?

A

high intensity statin

48
Q

When should a CCB be considered for ACS?

A

if BB is contraindicated but DO NOT use in HF because CCB of choice is verapamil and diltiazem

49
Q

Which fibrinolytic is most fibrin specific?

A

tenecteplase

50
Q

What are the adverse effects of fibrinolytics?

A

-occult bleeding= check all stools, avoid unnecessary sticks
-ICH (brain bleed)
-hypotension

51
Q

When should PCI be preformed once admitted?

A

60-90 mins

52
Q

When should fibrinolytics be administered once admitted?

A

30 mins

Therapeutics 2 (13 decks)

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