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MTM Board Certification > Cardio- ACS > Flashcards

Cardio- ACS Flashcards

1
Q

What does ACS stand for?

A

Acute Coronary Syndrome

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2
Q

What are the 3 types of ACS?

A

STEMI
Non-STEMI
Unstable Angina

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3
Q

Which ACS involves troponin bio markers in addition to elevated ST?

A

STEMI

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4
Q

T/F: Non-STEMI includes bio-markers.

A

True

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5
Q

List 3 types of ACS event in order of most severe to least severe.

A

STEMI
NON-STEMI
Unstable Angina

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6
Q

Name UN-modifable ACS risk factors.

A
  • Age
    Men > 45 years , Women > 55 years
  • Family History
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7
Q

Name 6 MODIFABLE ACS risk factors.

A
  1. smoking
  2. DM
  3. HTN
  4. HLD
  5. Obesity/lack of physical activity
  6. Use of stimulants (cocaine, methamphetamines)
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8
Q

What is treatment of choice for STEMI and it’s associated time frame.

A

PCI (Percutaneous Coronary Intevention) which much be iniated within 12-24 hours of event.
Given with heparin based products (lovenox/heparin

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9
Q

What is the treatment of choice for NSTEMI/Unstablet Angina?

A

PCI (if within time window) followed by Antiplatelet + Statin + ACE/ARB & BB if appropriate.

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10
Q

What is an alternative tx for STEMI?

A

Fibrinolytics
- Tenecteplase, Alteplase, Streptokinase

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11
Q

Which Fibrinolytic has the best safety profile?

A

Tenecteplase (similiar to Alteplase)

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12
Q

Fibrinolytics Contraindications?

A

Significant internal bleeding
- intracranial hemorrhage
- GI bleed
- Uncontrolled, unresponsive HTN (>180/110)

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13
Q

How long is antiplatelet tx recommend after ACS event?

A

Generally 12 months following stent placement.

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14
Q

Plavix (P2Y12 inhibitor) Caveats?

A

CYP2C19 Prodrug
- Rapid Cyp2C19 metabolizers will have increased bleeding risk
- Poor Cyp2C19 metabolizers will have increased risk of stroke

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15
Q

What medication inhibits CYP2C19?

A

Omeprazole
Note: recommend pantoprazole

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16
Q

Which CYP2C19 has a higher bleeding risk in elderly with low weight?

A

Prasugrel
Boxed warning: for patients 75 years or older
Note: More potent than Plavix and avoids 2C19 pathway

17
Q

Which CYP2C19 agent should be avoided in patients with gout?

A

Ticagrelor due to increased uric acid
Note: do not take with ASA doses >100 mg

18
Q

What is the target LDL goal for ACS patients?

A

<70 mg/dl for highest risk patients

19
Q

Name a STATIN alternative?

A

Ezetimibe

20
Q

What medication can be added to STATIN therapy when LDL is not optimal (< 70 mg/dL)?

A

Zetia or PCSK-9 inhibitors

21
Q

Classic Medications on Hospital Discharge for ACS patients?

A
  • ASA
  • PY212 inhibitor
  • ACE/ARB
  • Beta-blocker
    -Statin

MTM Board Certification (4 decks)

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