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P2 Spring: PHRM 845 > Exam 1: Rogers > Flashcards

Exam 1: Rogers Flashcards

1
Q

what are the risk factors for ACS?

A
  • older age
  • male
    • hx of CAD
  • DM
  • renal insufficiency
  • Prior MI
  • Smoking
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2
Q

what are the signs & symptoms?

A
  1. Retrosternal Chest Pain
    –> Left side (arm and jaw)
  2. N/V
  3. Diaphoresis
  4. SOB
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3
Q

What are the atypical symptoms? (what people as well?)

A
  1. Likely for
    - Elderly, Females, Diabetics, impaired renal function, dementia
  2. Symptoms
    - epigastric pain, indigestion, stabbing or pleuritic pain, inc. dyspnea in the absence of chest pain
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4
Q

What does a STEMI refer to on an ECG?

A

persistent ST elevation and potential Q wave changes

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5
Q

What does an NSTEMI and UA how on an ECG?

A

no ST elevation; could show depression if anything

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6
Q

What test should be done to see if the patient has a STEMI/NSTEMI?

A

Troponin

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7
Q

What is a high troponin level for both tests?

A
  1. High sensitivity
    –> Normal <14 ng/L
  2. Conventional
    –> Normal <0.05 ng/mL
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8
Q

When do you need to check trends?

A
  • repeat every 3-6hrs for the first 12 h
  • repeat will identify pattern
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9
Q

What is the difference bwtn Stable/Unstable angina & STEMI/NSTEMI?

A
  1. Stable
    –> goes away within 20min or less
    –> normal ECG
  2. Unstable
    – normal ECG
    – persistent pain > 20 min
    – normal troponin
  3. STEMI
    – high troponin
    – ST elevation
  4. NSTEMI
    – high troponin
    – no ST elevation
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10
Q

What are some complications of ACS?

A
  1. HF
  2. valvular dysfunction
  3. arrhythmias
  4. bradycardia/HB
  5. shock
  6. death
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11
Q

what is ventricular remodeling mean? How does this happen/what causes it?

A
  1. changes in size, shape, and function on LV after ACS; leading to HF
  2. can happen from activation of RAAS system or increased preload/afterload
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12
Q

what does MONA stand for?

A

Morphine, Oxygen, Nitrate, Aspirin

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13
Q

what is the morphine dose that you would give ?

A

Initial: 4-8mg IV, followed by 2-8mg IV q5-15min

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14
Q

what are side effects of morphine?

A

sedation, respiratory depression, N/V

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15
Q

what do you want to avoid when using morphine and why?

A

NSAID, except aspirin
–> d/c home ones and don’t initiate can inc. MACE

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16
Q

when do you want to use oxygen?

A

when O2 <90%

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17
Q

what nitrate dose do you use or give them?

A

0.3-0.4mg q5min x 3 if continuing

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18
Q

what are side effects of nitrates?

A

HA, hypotension

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19
Q

how long do you have to wait to take a nitrate with tadalafil?

A

48hrs

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20
Q

how long do you have to wait to take sildenafil or vardenafil?

A

24 hr

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21
Q

What is the dose of aspirin you would give for MONA?

A

162-325 chewable for 1 dose

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22
Q

What is a coronary angiography?

A

test that shoots dye in veins to see how they are and if blockages

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23
Q

What are the absolute CIs for fibrinolytics?

A
  1. history of brain bleeds, strokes, any type of active bleed or trauma
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24
Q

what are the relative CIs to fibrinolytics?

A

severe HTN, dementia, any surgery in last 3 weeks or internal bleeding

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25
Q

what reperfusion do you use for a STEMI?

A

PCI or fibrinolytic

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26
Q

When do you use a PCI vs a fibrinolytic for a STEMI?

A
  1. use a PCI unless not at a PCI capable hospital and you are more than 120 min away (do this within 12 hours)
27
Q

how fast do you need to do reperfusion therapy for STEMI?

A

within 30 minutes upon arrival

28
Q

what is the reperfusion therapy for NSTEMI/UA?

A

ischemia guided strategy (med management) or early invasive strategy (PCI)

29
Q

what should the continued regimen be for aspirin? what is a counseling tip?

A

81-325mg; TWF

30
Q

What it the discussion of therapy with a P2Y12 inhibitor for DAPT therapy? is a loading dose needed?

A
  1. loading dose then maintenance
  2. 12 m therapy
31
Q

when would you use cangrelor in therapy?

A

when you did not receive a loading dose; IV given during PCI procedure

32
Q

What is the loading dose and maintenance dose for clopidogrel?

A

loading: 300-600
main: 75 QD

33
Q

What is the loading dose and maintenance dose for prasugrel?

A

load: 60
main: 10 qd

34
Q

What is the loading dose and maintenance dose for ticagrelor?

A

load 180
main 90 bid

35
Q

when is the 600mg dose not preferred for plavix and what would the loading dose be in different age brackets?

A
  • with fibrinolytics
    < or 75 = 300mg
    > 75 = no load dose
36
Q

What could be some reasons to switch to other P2Y12?

A

cost, side effects, not a good response, stroke risk, bleeding risk

37
Q

When using a P2Y12 for an NSTEMI/UA and have the ischemia guided strategy, what is the preferred agents?

A

clopidogrel and ticagrelor

38
Q

When using a P2Y12 for an NSTEMI/UA and have the early invasive stretegy, what is the preferred agents?

A

preference for prasugrel or ticagrelor but any can be used

39
Q

When using a P2Y12 for an STEMI with fibrinolytic strategy, what is the preferred agents?

A

plavix

40
Q

When using a P2Y12 for an STEMI with PCI, what is the preferred agents?

A

ticagrelor or prasugrel preferred

41
Q

what are some minor vs. major risk of bleeding?

A

MINOR:
- bruising
- light nosebleeds
- bleeding gums when flossing
MAJOR:
- blood in urine/stool
- coughing blood
- ongoing bleeding wounds

42
Q

Should aspirin be held before a CABG surgery?

A

no

43
Q

How long should the P2Y12s be held for prior to elective CABG?

A
  • ticag –> 3d
  • clop –> 5d
  • prasu –> 7d
44
Q

how long should a P2Y12 be held for an urgent CABG?

A

24h if possible

45
Q

what are the GP2b/3a inhibitors ?

A

abiciximab, eptifibatide, and tirofiban

46
Q

when would you use a GP2b/3a?

A

in addition to DAPT
- given at same time of PCI and on an individual basis

47
Q

what are the specific reasons you would give a GP2a/3b in STEMI/NSTEMI?

A

NSTEMI: high risk features such as high troponin
STEMI: large thrombus burden
1. not good loading for P2Y12
2. Bail Out
–> during procedure if thrombus develops or low after stenting

48
Q

what is the bolus dose for abciximab?

A

0.25/kg IV

49
Q

what is the bolus dose for eptifibatide

A

180mcg/kg x 2 “ double bolus”

50
Q

what is the bolus dose for tirofiban?

A

25 mcg/kg

51
Q

what GP2a/3bs need renal adjustment? What is the cut off?

A

eptifibatide = < 50
tirofiban = < 60

52
Q

when using UFH what is it administered as and what do you need to keep watch for? ( what values?)

A
  1. continuous infusion
  2. aPTT ot ACT
53
Q

how is enoxaparin eliminated?

A

kidneys and accumulates in renal impairment

54
Q

what is bivalirudin and what have trials shown? (what trials)

A
  1. DTI
  2. not used with GPs except bail out
  3. HEAT– not effective as much for MACE
  4. – BRIGHT and MATRIX as lower bleed risk
55
Q

what is fondaparinux and when should you not use it?

A

factor 10a inhibitor
1. dont use alone for PCI –> high thrombis rates
2. CI in CrCl < 30

56
Q

when should a BB be initiated for ACS?

A

first 24 hrs of ACS

57
Q

when would you not want to start a BB?

A

HR < 50
uncontrolled asthma/ RAD
Risk of shock or low output state

58
Q

what 3 BBs are utilized more in patients with HFrEF? (<40% for reference)

A

metoprolol succinate, carvedilol, bisoprolol

59
Q

when should you give a BB in a person using cocaine?

A

use carvedilol since binds to alpha receptors but initiate when out of system

60
Q

what should you do with a BB in HF?

A

avoid starting new or increasing dose during an acute exacerbation due to inc. risk of pulmonary edema

61
Q

when could you consider a CCV? what type specifically of CCB?

A

non-DHP if pt has recurrent ischemia and CI to BBs (diltiazem or verapamil)

62
Q

what is the theory for a statin in ACS?

A

initiate or be on HIS

63
Q

when should an ace/arb be initiated for different groups?

A
  1. they should get it but if they have HFrEF, CKD, DM they should get it ideally within 24 hours or sooner rather than later
64
Q

when would you not use an ace or arb?

A
  • hypotension/shock
  • acute renal failure
  • angioedema
  • bilateral renal artery stenosis

P2 Spring: PHRM 845 (2 decks)

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