Exam 1 - Sowinski (Ischemia) Flashcards
Typical Clinical Presentation for SIHD (stable angina) (acronym)
PQRST Precipitating factors Pallative Measures Quality of Pain Region/Radiation Severity of Pain Timing/Temporal Pattern
what typically precipitates stable angina pectoris
exertion - walking gardening, ADOL
what typically relieves SIHD
rest and or SL NTG
what type of pain is it for SIHD
squeezing, heaviness, tightening
where is the pain for SIHD
substernal
ECG findings with typical Angina
ST-Segment DEPRESSION
ONLY DURING THE EVENT THO
Guidelines for Angina (acronym)
ABCDE A - aspirin/antiplatelets/antianginals/ B - beta blockers, blood pressure C - Cholesterol and Cigarettes D - Diet and Diabetes E - Exercise and Education
If someone has vasospastic angina — what do you for managing their anginal episodes?
NO BETA BLOCKERS!!
If BP > 140/90 – give CCB
if BP < 140/90 — give Nitrate
what drugs are P2Y12 inhibitors
Ticlodipine, clopidogrel, prasugrel, ticagrelor, canegrelor
Aspirin at too high of doses is an issue because?
it will start blocking COX-2 and puts patient at actually a HIGHER thrombotic risk (we end up blocking some vasodilation)
which P2Y12 inhibitor needs CYP450 to activate it?
Clopidogrel
Prasugrel to a lesser extent
ADEs for Clopidogrel
Bleeding, Diarrhea, Rash
ADEs for Prasugrel
Bleeding, Diarrhea, Rash
ADEs for Ticagrelor
Bleeding, Bradycardia, DYSPNEA!, Heartblock
PRIMARY PREVENTION - Anti-Platelet Therapy:
who gets it?
if 50 - 59 with > 10% CVD risk
and…
if 60 - 69 with > 10% CVD risk
aka 50 - 59 w/ CVD risk >10%
what are the 3 categories of secondary prevention of anti-platelet therapy in CAD
SIHD w/ no stent or SIHD with elective PCI + stent or SIHD and CABG
Secondary Prevention w/ antiplatelets for SIHD with NO STENT: what do they do?
Aspirin 81 mg QD FOR LIFE
or
Clopidogrel 75 mg/day IF absolute contraindication/significant intolerance
2 types of stents
Drug eluting or Bare metal stent
What are the two common (aka 2ng gens used today) drug eluting stents (DES)
Everolimus and Zotarolimus
For SIHD pts getting an elective PCI: how do they utilize antiplatelets
They will do DAPT (dual antiplatelet therapy)
ASA 325 prior to PCI - then 81 mg QD for life
AND
Clopidogrel (300 - 600 mg before PCI) THEN 75 mg/day for either min. 6 mos (DrugElutingStent) or min. 1 month (BareMetalStent) – if major bleeding/high risk stop at 3 mos
*traditional to do clopidogrel for 12 mos
For SIHD pts: if Pt gets a CABG what do they do for secondary prevention with antiplatelts
they do ASA 81 mg/day for life and clopidogrel 75 mg/day ~ 12 mos
(IF they had a PCI/stent before - they RESTART the 12 mos timeline after the CABG)
why do DES need longer time on clopidogrel rather than the BMS
DES take longer to heal… (but in long run better than a BMS)
if pt on DAPT (because of Stent/CABG) what do you do if they need non-cardiac surgery?
cant really stop DAPT…. defer the surgery as long as possible (6 mos to a year!!) only done if it is a life threatening surgery
if pt on DAPT (because of Stent/CABG) why do a PPI
if high risk - use a PPI
if pt on DAPT (because of Stent/CABG) what do you do if pt requires anticoagulation?
use clopidogrel because it is less risky for pts that may have A.Fib, DVT, or PE prevention needs
if pt on DAPT (because of Stent/CABG) when would you use Ticagrelor/Prasugrel?
if pt cant do clopidogrel for some reason
if pt on DAPT (because of Stent/CABG) - what is risk scoring used for?
risk scoring helps you see how long they should be on DAPT -
if overall score is > 2 - then ok/benfit vs risk is ok for prolonged therapy
if overall score is < 2 —- unfavorable benefit vs risk for prolonger therapy
ACEI are good for preventing ACS and death because.... they stabilize \_\_\_\_\_\_\_\_ improve \_\_\_\_\_\_ function inhibit \_\_\_\_\_\_\_ cell growth decrease \_\_\_\_\_\_\_\_ migration and possible \_\_\_\_\_\_ properties
stabilize PLAQUE improve ET function inhibit VSM cell growth decrease MACROPHAGE migration Anti-Ox properties