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Isbp > atherosclerosis And ACS Treatment > Flashcards

atherosclerosis And ACS Treatment Flashcards

1
Q

How to prevent?

A

Healthy eating, no smoking , manage stress, know LDL and total cholesterol, BP, and exercise

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2
Q

What is primary prevention?

A

Lipid lowering meds, BP control, smoking cessation, diabetes, physical activity, Mediterranean diet

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3
Q

What is secondary prevention?

A

More aggressive dosing of 1’ and +- Aspirin, P2Y12 I., cardiac rehab

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4
Q

2’ prevention: lipid lowering meds?

A

Ezetimibe, evolocumab, alirocumab, anacetrapib

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5
Q

2’ prevention: anti-thrombotic?

A

Rivaroxaban, prasugrel

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6
Q

2’ prevention: anti-inflamm

A

Colchicine and canakinumab

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7
Q

OHBATMANS- meaning?

A

O- oxygen
H-heparin
B- beta blocker
A- antiplatelets
T-thrombolytic
M-morphine
A-angiotensin converting enzyme I. Or aldosterone Antag.
N-nitroglycerin
S-statin

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8
Q

Which drugs from OHBATMAN Is mainly for discharge use?

A

A-angiotensin converting enzyme I. Or aldosterone Antag.
S-statin

*the rest are given based on presentation

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9
Q

What do tPa do?

A

Activates plasminogen to plasmid and binds to fibrin to break it down (degradation)

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10
Q

What is known as natural fibronolytic?

A

Plasmin

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11
Q

Can you benefit if fibrin is hard and give a tpa?

A

No , no benefit-needs to be loose

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12
Q

What is the patho of a clot?

A

Increased clot formations-activates thrombin, leads to fibrin and a clot

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13
Q

What are the two fibrinolytics? (Tissue plasminogen activators)

A

tpa-alteplase
Tnk- tenecteplase

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14
Q

What do thrombolytics do?

A

Reestablish circulation and blood flow

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15
Q

Nitroglycerin is?

A

A strong venal dilator
Decreased preload, ventricular size, and end diastolic pressure
Overall decrease O2 demand

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16
Q

Nitroglycerin at higher doses is?

A

Both arterial and venal dilation

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17
Q

Can you use thrombolytics for stable or unstable angina ?

A

No can cause major bleed

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18
Q

When can you use thrombolytics?

A

For STEMI(full thickness)

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19
Q

Thrombolytics guideline:

A

Use for acute MI in 1st 12 hours
Acute ischemic stroke
Peripheral artery occlusion
Pulmonary embolism
DVT

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20
Q

If no cath lab…?

A

Give thrombolytics

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21
Q

If no PCI (cath lab?

A

Administer fibrinolytic<30 min

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22
Q

If PCI?

A

Fix can do angiogram, or fibrinolytic

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23
Q

Alteplase vs tenecteplase

A

Alteplase has a short half life
Tenecteplase is more fibrin specific and longer duration -less chance of bleeding

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24
Q

Contraindications to thrombolytics?

A

Active bleed, stroke in last 3 months, cerebral hemorrhage
Major surgery within 2 weeks
Peptic ulcer
Head injuries or neoplasm
Uncontrolled HTN >180
Already on anticoagulant

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25
Q

What are the fibrinolytic inhibitors ? Use if patient starts bleeding

A

Amino sprout acid
Tranexamic acid
Inhibits formation of plasmin/ plasminogen

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26
Q

Do not give fibrinolytic if patient is:

A

On aspirin/ nsaids
Renal failure
Thrombocytopenia
VWD
Hemophilia
Platelet >50,000

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27
Q

Nitroglycerin patho?

A

Enhances NO-GTp-cGMP—-dephosphorylates to myosin LC=relaxation

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28
Q

Contraindications to nitroglycerin?

A

Do not take nitrates for 12 hours
Use sildenafil due to shorter half life

29
Q

SE of nitroglycerin ?

A

Tachyphylaxis , headache, syncope, increased HR

30
Q

When is the best time to take nitroglycerin?

A

When the most exertion is used

31
Q

What antiplatelets therapy should be given?

A

DAPT-clopidogrel plus aspirin

32
Q

Moa of clopidogrel?

A

Inhibits activation of platelet by blocking pgy12 receptor

33
Q

Aspirin moa?

A
  1. Decrease thromboxane=increased platelet aggregation and decreased vasoconstriction
  2. Increase prostacyclin=decreased platelet aggregation and vasodilation
34
Q

What is the loading dose for clopidogrel?

A

600 mg
But can use 300mg if person is over 75 years old, already on clopidogrel, history of at risk for bleeding
Then 75 mg qd

35
Q

How long should you take clopidogrel if: stent

A

1 month

36
Q

How long should you take clopidogrel if: drug eluding stent +ACS

A

12 month

37
Q

How long should you take clopidogrel if: CABG

A

Hold for 5-7 days

38
Q

Contraindications for prasugrel?

A

> =75 years old, intracranial hemorrhage, previous stroke, weight <60 kg

*increased risk of bleed

39
Q

Tricagrelor characteristics?

A

Reversible non competitive
No need for bio transformation
Good for surgery
Active metabolite
Downside- dyspnea and BiD dosing

40
Q

What anticoagulants should you use?

A

UFH, fondaparinux, enoxaparin

41
Q

Anticoagulants use how long?

A

48 hours

42
Q

Atorvastatin high dose?

A

40-80

43
Q

Rosuvastatin high dose?

A

20-40

44
Q

Statin contraindications?

A

Pregnancy, myopathy, DDI with 3A4 or fibrates, hepatic dysfunction

45
Q

What bb to use?

A

Selective- metoprolol or carvedilol

46
Q

Contraindication for bb?

A

Cold( poor perfusion, decreased HR(<60) , increase risk of cardiogenic shock , asthma and severe allergies

47
Q

If tachyarrythmia or hypertensive give;

A

Bb

48
Q

Continue bb how long?

A

Indefinitely

49
Q

When to use Ace/ arb?

A

When Ef< 40%

50
Q

Antianginal therapy?

A

Nitrates plus bb
Enhanced activity
Reduces O2 consumption

51
Q

When not to use antianginal therapy?

A

When it is Cocaine induced chest pain

52
Q

What therapy improves mortality?

A

Bb and aspirin

53
Q

First line for all patients is ?

A

Antiplatelets

54
Q

Higher doses of antiplatelets?

A

Do not improve outcomes just increase bleeding

55
Q

Treatment for NSTEMI?

A

Based on TIMI score,
If low-OHBATMAN
if high- carb lab for revasculatization

56
Q

Omeprazole and plavix interaction?

A

Omeprazole metabolizes 2C19 so decreases plavix

57
Q

Put a stent for how long:
ACS?
No ACS just MI?

A

12 months
6 months

58
Q

Heparin vs enoxaprin

A

Heparin has a shorter half life (good)
Enoxaparin has a longer half life

59
Q

Which anticoagulant should you use in HIT?

A

Bivalrudin and fondaparinux or agatroban

60
Q

Heparin dosing?

A

IVPB: 60 units/kg max:4,000U
IV: 12U/kg/ hr max: 1,000 U/ hr for 48 hr until PCI performed

Always use low intensity

61
Q

Enoxaparin dosing?

A

1 dose: 1mg BID/ kg
In other words 1mg\ kg every 12 hours

62
Q

What does timi score tell us?

A

Risk of death, MI, and urgent revascularization by day 14

63
Q

Timi score:

A

0-1: 5%
2: 8%
3: 13%
4: 20%
5: 26%
6-7: 41%

64
Q

Timi score high risk if >=?

A

5

65
Q

Timi score risk factors(1 point)

A

65 or older
CAD
Aspirin use in 7 days
Severe angina
Elevated cardiac marker
ST deviation >= 0.5
Or 3 risk factors for CAD: Dm, HTN,smoker, hyper cholesterol

66
Q

Prasugrel dosing?

A

60 mg loading then 10mg dosing qd

67
Q

Ticagrelor dosing?

A

180 mg loading
Then 90mg BID

68
Q

If can’t do PCI and tpa is contradicted what do you do?

A

Give heparin and aspirin

Isbp (4 decks)

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