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NAPLEX - OUR cards > Acute Coronary Syndromes (ACS) > Flashcards

Acute Coronary Syndromes (ACS) Flashcards

1
Q

ACS definition

A

sudden, reduced blood flow causing an imbalance between oxygen supply and demand of the heart

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2
Q

ACS conditions

A

non-ST segment elevation acute coronary syndromes (NSTE-ACS) - unstable angina and NSTEMI
ST-elevated myocardial infarction (STEMI)

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3
Q

Classic symptoms of ACS

A 
chest pain (can be radiating to arms, neck, back, jaw)
severe dyspnea
diaphoresis
syncope 
palpitations
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4
Q

Pts that may not experience classic ACS symptoms

A

women
elderly
diabetics

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5
Q

ACS risk factors

A 
Men > 45, women > 55
1st degree relative with early ACS event (Men < 55, women < 65)
smoking
HTN
Dyslipidemia
diabetes
CAD/angina
lack of exercise
excessive alcohol
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6
Q

ACS diagnosis/workup

A

ECG asap
Cardiac enzymes (troponins) asap and 3-6 hrs after onset of symptoms
CK-MB and myoglobin (less sensitive)

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7
Q

What conditions will cardiac enzymes be positive?

A

NSTEMI and STEMI

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8
Q

Drug treatment options for ACS (acronym)

A 
MONA-GAP-BA
Morphine
Oxygen
Nitrates
ASA

GPIIb/IIIa antagonist
anticoagulants
P2Y12 inhibitors

Beta blockers
ACE inhibitors

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9
Q

Morphine’s role in ACS

A

arterial/venous dilation –> decr oxygen demand

pain relief

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10
Q

When to use oxygen

A

use if SaO2 < 90% or in respiratory distress

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11
Q

When to not use NTG

A

SBP < 90, HR < 50

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12
Q

What aspirin should be used for 1st dose?

A

Non-enteric coated, chewable 325 mg

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13
Q

What are the preferred beta blocker in ACS and when should it be admin?

A

Beta-1 selective w/o ISA (metoprolol, bisoprolol, etc)

w/in 24 hrs

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14
Q

Meds to avoid in acute setting of ACS

A

NSAIDs

IR nifedipine

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15
Q

P2Y12 inhibitors that are prodrugs and irreversibile

A

clopidogrel

prasugrel

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16
Q

Loading dose for clopidogrel

A

300-600 mg (600 for PCI)

do not give load dose if pt recieved firbrinolytics for STEMI and is > 75 y/o

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17
Q

Clopidogrel is metabolized by….

A

CYP2C19

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18
Q

How many days should Plavix be stopped prior to most surgeries?

A

5 days

19
Q

Rare but serious adverse effects associated with Plavix

A

thrombotic thrombocytopenic purpura (TTP)

20
Q

Plavix side effects

A

bleeding, pruritis

21
Q

Prasugrel contraindications

A

serious bleeding

hx of TIA/stroke

22
Q

Stop prasugrel how many days before surgery?

A

7 days

23
Q

Prasugrel loading dose

A

60 mg (before or up to 1 hr after PCI)

24
Q

Prasugrel maintenance dose

A

10 mg daily

5 mg daily (< 60 kg)

25
Q

Prasugrel age cut-off

A

75 years or older; not recommended unless high risk

26
Q

ticagrelor loading dose

A

180 mg

27
Q

ticagrelor maintenance dose

A

90 mg BID x 1yr, can give 60 mg BID after that

28
Q

Stop ticagrelor how many days prior to surgery?

A

5 days

29
Q

Max dose of ASA w/ ticagrelor

A

100 mg of ASA

?100 mg will decrease effectiveness of ticagrelor

30
Q

ticagrelor side effects

A

bleeding, dyspnea (>10%), incr SCr, incr uric acid

31
Q

Cangrelor use…

A

adjunct to PCI to decrease risk of periprocedural MI
IV infusion
transition to oral agent immediately after PCI (use Load dose)

32
Q

Ticagrelor metabolism

A

CYP3A4

33
Q

GPIIb/IIIa receptor antagonist

A

ReoPro
Integrillin
Aggrastat

34
Q

Reopro

A

Abciximab
only use ACS with PCI
must be filtered
platelet function returns 24-48 hrs after d/c

35
Q

Integrillin

A

Eptifibatide
can’t be used in pts on dialysis
incr incidence of thrombocytopenia
platelet function returns -4-8 hrs after d/c

36
Q

Aggrastat

A

Tirofiban

platelet function returns 4-8 hrs after d/c

37
Q

When would you use fibrionolytics?

A

In STEMI pts where PCI cannot be performed
PCI must be performed w/in 90 mins of ED arrival
fibrinolytics must be given w/in 30 mins of ED arrival

38
Q

Alteplase info

A

Activase
Given as “accelerated infusion”
> 67 kg = 100 mg IV over 1.5 hrs, 3 different admins
< 67 kg = 15 mg bolus, then weight based

39
Q

Tenecteplase

A 
TNKase
SIngle IV bolus 
<60 kg = 30 mg
60-69 = 35 mg
70-79 = 40 mg 
80-89 = 45 mg
>= 90 kg = 50 mg
40
Q

Reteplase

A

Retavase

10 units x 1, 10 units 30 mins later

41
Q

Vorapaxar

A 
Zontiivty 
used with ASA and/or clopidogrel
Protease-activated receptor 1 antagonist
2.08 mg daily 
CYP 3A4 substrate
42
Q

What NSAID should be used in pts with ACS?

A

Naproxen (less CV risk)

43
Q

Dual antiplatelet therapy duration

A

usually 12 months or more for PCI

44
Q

DUration of beta blocker therapy for ACS

A

3 years

indefinitely if HF/angina/ HTN management

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