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P2 Therapeutics > CAD/ACS > Flashcards

CAD/ACS Flashcards

1
Q

_________ is the outward symptom of ischemia

A

angina

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2
Q

What is PQRST?

A

P - precipitating factors/palliative measures
Q - quality and quantity of pain
R - region and radiation
S - severity of pain
T - timing and temporal pattern

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3
Q

What does patient have to take before elective PCI procedure?

A

ASA
P2Y12 inhibitor loading dose (i.e. Plavix 300mg)

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4
Q

What does patient take after elective PCI procedure and for how long? (LOW RISK OF BLEEDING)

A

DAPT: minimum 6 months
SAPT: indefinitely

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5
Q

What does patient take after elective PCI procedure and for how long? (HIGH RISK OF BLEEDING)

A

DAPT: 1-3 months (ASA, Plavix)
SAPT: P2Y12i until 12 months (Plavix)
SAPT: indefinitely (ASA)

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6
Q

Nitrates cause ____________ which decreases _________

A

venodilation, preload
(dilate veins (before heart) less blood flow to heart)

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7
Q

Two EKG findings during NSTEMI

A

-ST depression
-T wave inversion

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8
Q

Troponin is released from ________ _________

A

necrotic myocytes

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9
Q

Higher sensitivity troponin > __________ is considered abnormal

A

> 14 ng/L

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10
Q

Conventional troponin > __________ is considered abnormal

A

> 0.05 ng/mL

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11
Q

UA and NSTEMI will often be treated the same way, although UA does not lead to detectable levels of _____________

A

troponin

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12
Q

___________ remodeling may occur after an ACS

A

ventricular

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13
Q

What factors are involved with ventricular remodeling? (2)

A
  1. activation of RAAS
  2. hemodynamic factors (increase in preload and afterload)
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14
Q

Ventricular remodeling can lead to what?

A

Heart failure

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15
Q

What does MACE usually include?

A

Stroke
MI
Cardiovascular death

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16
Q

Precipitating factors of an ACS

A
  1. Recent exercise
  2. Extreme weather - hot or cold
  3. Large meal
  4. Fright/anger
  5. Sex
  6. Walking against wind
  7. Smoking
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17
Q

Define ACS

A

acute myocardial ischemia resulting from an imbalance between oxygen demand + supply

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18
Q

Reperfusion strategies for UA/NSTEMI

A

Early invasive strategy vs ischemia-guided strategy

(no fibrinolytic)

19
Q

Reperfusion strategies for STEMI

A

PCI or fibrinolytics

20
Q

Patients must receive what four things immediately upon arrival to the hospital (for ACS)?

A

M: Morphine
O: Oxygen
N: Nitroglycerin
A: Aspirin

21
Q

What is the initial dose of morphine upon arriving to the hospital?

A

4-8mg IV, followed by 2-8mg q5-15 mins

22
Q

Maintain an O2 saturation > _______% upon arriving to the hospital

A

> 90%

23
Q

SL NTG dose upon arriving to the hospital

A

0.3-0.4mg q5min x 3

24
Q

IV NTG dose upon arriving to the hospital

A

10 mcg/min, then titrate by 5mcg/min q5min
(max: 200mcg/min)

25
Q

What formulation of NTG is not recommended for ACS due to a slower onset of action?

A

Transdermal

26
Q

Tolerance to nitrates develops after > _______ hours of continuous use

A

> 24 hours

27
Q

nitrates should not be taken within 24 hours of taking which PDE inhibitors?

A

sildenafil
vardenafil

28
Q

nitrates should not be taken within 48 hours of taking which PDE inhibitor?

A

tadalafil

29
Q

aspirin dose upon arriving to the hospital

A

162-325mg chewable aspirin (1 dose)
*given to all patients w/o contraindications ASAP

30
Q

What is coronary angiography?

A

A heart catheter that shows which arteries in the heart have blockages

31
Q

Fibrinolytics mechanism of action

A

Convert plasminogen to plasmin, which breaks down fibrin (fibrin holds clot together)

32
Q

Which fibrinolytic is weight-based?

A

Tenecteplase

33
Q

If fibrinolytic therapy is preferred for a STEMI patient, what is the “door-to-needle” time?

A

within 30 mins of hospital arrival

34
Q

If PCI is preferred for a STEMI patient, what is the “door-to-balloon” time?

A

within 90 mins of hospital arrival

35
Q

For NSTEMI/UA patients, what does ischemic-guided reperfusion therapy mean?

A

treatment with medications
no heart-catheterization

36
Q

For NSTEMI/UA patients, what does early invasive reperfusion therapy mean?

A

coronary angiography +/- revascularization
(preferred for high-risk patients)

37
Q

Metoprolol and carvedilol are __________ metabolized

A

Hepatically

38
Q

Metoprolol and atenolol are dosed _______ daily

A

once

39
Q

Antiplatelet therapy durations after CABG

A

DAPT - 12 months
SAPT - indefinitely

40
Q

Antiplatelet therapy durations post-ACS

A

DAPT - 12 months
SAPT - indefinitely

41
Q

prasugrel loading and maintenance dosing

A

LD: 60 mg
MD: 10 mg

42
Q

ticagrelor loading and maintenance dosing

A

LD: 180 mg
MD: 90 mg BID

43
Q

Prasugrel is contraindicated in patients with a previous __________

A

stroke

44
Q

Aspirin dose must be < _________ mg when taken with ticagrelor

A

< 100mg

P2 Therapeutics (18 decks)

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