Acute Coronary Syndromes (ACS) Post-intervention

Question 1

What are the goals of therapy?

Answer 1

prevent complications and death
prevent coronary artery reinfarction
relieve ischemic chest pain/discomfort
heart rate 55-60 bpm

Question 2

Non-Pharm therapies

Answer 2

Weight loss
healthy diet
smoking cessation
cardiac rehabilitation

Question 3

If patient has HTN

Answer 3

treat appropriately. Add ACE-I 1st line therapy

Question 4

If patient has HLD

Answer 4

treat appropriately. Add high intensity statin 1st line

Question 5

If patient has diabetes

Answer 5

treat appropriately

Question 6

if patient is physically inactive/sedentary lifestyle

Answer 6

encourage regular aerobic physical activity

Question 7

if patient uses tobacco/cigarette smoking

Answer 7

encourage smoking cessation

Question 8

if patient is on medications that may adversely affect FLP (see patient history)

Answer 8

facilitate therapeutic substitution if appropriate

Question 9

If patient intake alcohol excessively

Answer 9

limit to 1 daily drink for women and 2 for men

Question 10

if patient has poor nutrition

Answer 10

TLC diet, Mediterranean diet

Question 11

If patient is overweight/obese

Answer 11

encourage safe and healthy weight loss

Question 12

if patient is stressed

Answer 12

encourage stress relieving activities

Question 13

Pharm therapies

Answer 13

anti-anginal therapies
anti-platelet therapies
and additional therapies for mortality reduction

Question 14

Anti-anginal therapies

Answer 14

all patients should be on at least one long-acting agent to prevent chest pain, preferably one proven to reduce mortality

Question 15

Beta-blockers (BB)

Answer 15

Efficacy: reduces recurrent ischemia, infarct size, risk reinfarction, and occurrence of ventricular arrhythmias. decrease mortality and morbidity
Indication: all patients

Question 16

Nitrates

Answer 16

Efficacy: improves exercise tolerance, increases time to angina onset, and reduces angina symptoms. provides no reduction in death. no change in mortality, but decreases morbidity
Indication: Short acting NTG- all patients PRN use
Long acting NTG- ongoing ischemia despite optimal use of Beta-blocker

Question 17

Calcium Channel Blocker (CCB)

Answer 17

Efficacy: improves exercise tolerance and increases time to onset of angina. provides no reduction in death. no change in mortality, but decreases morbidity
Indication: patients w/ongoing ischemia despite optimal use of BB. patients w/contraindications to BB

Question 18

Aspirin

Answer 18

Efficacy: reduces risk of death, recurrent MI and stroke. decreases mortality
Indication: all patients. preferably enteric coated 81 mg

Question 19

P2Y12 receptor inhibitors

Answer 19

Efficacy: decreases the rate of stent thrombosis, myocardial infarction, stroke, and CV death. decreases mortality. Prasugrel reduces MI and stent thrombosis, but increase in bleeding compared to clopidogrel. net harm in patients w/history of cerebrovascular events. no benefit is patients > 75 yo or

Question 20

Angiotensin converting enzyme inhibitors (ACE-I)

Answer 20

Efficacy: reduces death, reinfarction, stroke, and prevents progression of HF. decreases mortality.
Indication: HTN, DM, LVD, and CKD

Question 21

Angiotensin receptor blockers (ARB)

Answer 21

Efficacy: reduces death, reinfarction, stroke, and prevents progression of HF. decreases mortality.
Indication: HTN, DM, LVD, and CKD or unable to take ACE-I

Question 22

Statins

Answer 22

Efficacy: reduces death and MI. decreases mortality.
Indication: all patients. high intensity recommended in patients less than or equal to 75 yo. moderate intensity recommended in patients > 75 yo

Question 23

C
B
A
N
A
N
A
S

Answer 23

CCB
BB
ACE-I
NTG (SHORT)
ASPIRIN (81 MG)
NTG (LONG)
ANTIPLATELET AGENT
STATIN