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CRT > E3: Unstable Angina + NSTEMI > Flashcards

E3: Unstable Angina + NSTEMI Flashcards

1
Q

What does OSNAAP stand for in the Acute treatment of ACS?

A

O: oxygen
S: Statin
N: Nitroglycerin
A: Aspirin
A: Anticoagulation
P: P2Y12 Inhibitor

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2
Q

In what situations would we use medical management rather than PCI in acute ACS?

A
  1. Old/ Frail
  2. Dialysis (contrast DI)
  3. No Institutional PCI capability.
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3
Q

Who should get OSNAAP therapy?

A

All Acute ACS Events.

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4
Q

During an ACS event, what strength statin should the patient be initiated on?

A

High Intensity statin.

Rosuvastatin: 20-40 mg
Atorvastatin: 40-80 mg.

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5
Q

Why are statins beneficial during an acute ACS event if their primary indication is for LDL lowering capabilities?

A

Pleotropic Effects:
Antiplatelet + Plaque stabilization.

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6
Q

Should all patients presenting with acute ACS receive nitroglycerin?

A

No, only if they are experiencing chest pain.

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7
Q

What is the dosing frequency for sublingual nitroglycerin in acute ACS?

A
  1. SL nitroglycerin every 5 minutes for a maximum of 3 doses.

Then the patient should be assessed for possible IV NTG use.

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8
Q

In what situations would we utilize IV NTG?

A

The patient has already maximized oral NTG. (3 doses 15 minutes)
and they have one of the following conditions:
1. Persistent Ischemia
2. HF
3. Hypertension.

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9
Q

What is the primary contraindication of NTG?

A

Recent use of a PDE5 inhibitor.
These include Sildenafil, Tadalafil, and Avanavil.

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10
Q

NTG can not be used for _____ hours after sildenfil or avandifil.

A

24 hours.

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11
Q

NTG can not be used for ___ hours after tadalafil.

A

48 hours.

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12
Q

Should all patients presenting with acute unstable angina/NSTEMI receive aspirin?

A

Yes

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13
Q

What is the loading dose of aspirin in acute ACS therapy?

A

162-365 mg.
This should be chewable aspirin only.

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14
Q

In an acute ACS event, IV fractionated heparin should be used until _________.

A

48 hours of treatment or a PCI has occurred.

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15
Q

In an acute ACS event, SQ enoxaparin should be used until __________.

A

The entire duration of the hospitalization or until PCI is performed.

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16
Q

In unstable angina, what is the loading dose of clopidogrel?

A

600 mg

17
Q

In unstable angina, what is the maintenance dose of clopidogrel and for how long.

A

75 mg QD for 1-6 months.

18
Q

In unstable angina what is the loading dose of ticagrelor?

A

180 mg

19
Q

In unstable angina, what is the maintenance dose of ticagrelor?

A

90 mg BID for 1-6 months.

20
Q

In unstable angina, what is the preferred P2Y12 inhibitor per OSNAAP.

A

Ticagrelor.

21
Q

When should prasugrel be utilized for unstable angina?

A

After coronary visualization has occurred. (PCI)

22
Q

In unstable angina, what is the loading dose of prasugrel?

A

60 mg

23
Q

In unstable angina, what is the maintenance dose of prasugrel?

A

10 mg QD

24
Q

This P2Y12 inhibitor should not be used for medical management due to the increased risk of intracranial bleeding. (it is reserved for patients who have undergone PCI)

A

Prasugrel.

25
Q

Aggrastat is a __________, and the generic name is ______.

A

GIIB/IIIa Inhibitor
Tirofiban

26
Q

Integrilin is a __________, and the generic name is ______.

A

GIIB/IIIa Inhibitor
Eptifibatide

27
Q

Reopro is a __________, and the generic name is ______.

A

GIIB/IIIa Inhibitor
Abciximab

28
Q

This class of drugs are indicated in unstable angina for cardiac catheterization with significant clot burden.

A

GIIB/IIIa Inhibitors.
Tirofiban, Eptifiban, Abciximab

29
Q

This class of drugs blocks the binding site of fibrinogen, preventing clot stabilization.

A

GIIB/IIIa Inhibitors
Tirofiban, Eptifiban, Abciximab

30
Q

What is something we should watch out for when using GIIB/IIIa inhibitors.

A

Increased Bleeding risk, especially with Aspirin, P2Y12 inhibitor or anticoagulant.

31
Q

What acronym do we use for the long-term treatment following an unstable angina hospitalization?

A

SNAP-BAM

32
Q

What does SNAP-BAM stand for.

A
  1. Statin
  2. Nitroglycerin
  3. Aspirin
  4. P2Y12 Inhibitor
  5. Beta Blocker
  6. ACEi/ARB
  7. Mineralocorticoid Receptor Blocker.
33
Q

How long should beta-blockers be on board following an unstable angina hospitalization?

A

1-3 years.

34
Q

What patients should be initiated on a beta-blocker on discharge following an unstable angina hospitalization?

A

All patients
(we would only hold for signs of acute heart failure.)

35
Q

Which Beta-Blockers have proven CV mortality benefit in HFrEF?

A
  1. Bisoprolol
  2. Carvedilol
  3. Metoprolol Succinate XL
36
Q

What patients should be initiated on an ACEi/ARB upon discharge following an unstable angina hospitalization?

A

1.All patients with an ejection fraction <40%.

AND

  1. All patients with diabetes, hypertension, or CKD.

Note, the HOPE trial shows data to suggest all patients should be initiated on an ACEi/ARB. However, if the patient has a normal EF and low BP. Beta-blocker therapy is preferred due to proven mortality benefit.

37
Q

Upon discharge following an unstable angina hospitalization, when should mineralocorticoid receptor antagonist be used.

A

In all patients with an ejection fraction <40% who are already on both an ACEi/ARB and a Beta-blocker.

38
Q

Eplerenone and Spironolactone are of the what drug class?

A

Mineralocorticoid Receptor Antagonist.

39
Q

When are MRAs contraindicated?

A
  1. SCr (2.5+ in men, 2.0 in women)
  2. K+ (Above 5 mEq/L)

CRT (16 decks)

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