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Therapy year 3- sem 2 > IHD - Early Managment of ACS (STEMI NSTEMI, UNSTABLE ANGINA) > Flashcards

IHD - Early Managment of ACS (STEMI NSTEMI, UNSTABLE ANGINA) Flashcards

1
Q

ACS Subtypes
- myocardial damage
- biochemical marker realease?

A

UA
- transient partial blockage does not result in myocardial damage, no biochemical markers released

NSTEMI
- similar to UA however myocardial cell damage does occur and release of biomarkers

STEMI
- fully occlusive clot, myocardial damage and release of biochemical markers

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2
Q

what is a big diagnosis factor medication wise for ACS?

A

no relief from SL nitroglycerin

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3
Q

ECG elements

P wave

QRS wave

T wave

A

p wave
- atrial depolarization

QRS wave
- ventricular depolarization

T wave
- ventricular polarization

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4
Q

when shoudl eck be done? what can it tell us?

A

done within 10 minutes of arrival to ER with ischemic chest pain

can show:
STEMI - St elevation, Q wave can show previous completed STEMI

NSTEMI - ST depression or T wave inversion (indicates ongoing ischmia)

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5
Q

what are some lab findings we should be aware of?

A

biochemical markers can be release when there is myocardial cell death

Biochemical markers:
- Troponin, CK, and MB (for myocardial necrosis)

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6
Q

if STEMi detected what drugs?

A

fibronoltyics

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7
Q

ACS diagnosis:

SX
ECG Changes
Cardiac biomarkers

for UA, NSTEMI, and STEMI

A

UA
- SX: yes
- ECG changes: none
- cardaic biomarkers: none

NSTEMI
- SX: yes
ECG changesL T wave inversion, ST depression, no cahnge
- Cardiac biomarkers increase Troponin, CK and MB

STEMI
- SX: yes
-ECG: ST segemnt elevation
- - Cardiac biomarkers increase Troponin, CK and MB

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8
Q

acaute mangemnt goal of STEMI

A

iniitial goal is reperfusion

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9
Q

P2Y12 agents

A

prasugrel, ticagrel, cangrel, clopdirogrel

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10
Q

thrombolysis agents and MOA

A
  • alteplase or tissue plasminogen activator (tPA)
  • Reteplase (rTA)
  • Tenecteplase (TNK)

MOA: convernt plasminogen to plasmin whihc helps in cell lysis

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11
Q

antipltent agents

A

ASA, prasugrel, ticagrel, cangrel, clopdirogrel

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12
Q

anticoagulants for STEMI

A

UFH, LMWH, bivalirudin

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13
Q

treatment guideline for STEMI

A

ST segemnt elevation - intial supportive care - if more then 120 minutes fibrionoltics otherwise PCI - then initiate antiplatlet therpay - initaie anticoagulant therpy

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14
Q

what is rpefered for STEMi PCI or thrombolysis?

A

PCI preferedd

however more then 120 minutes we do thrombolysis

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15
Q

why do we use antiplatlets and anticoagulants

A

prevent further clot formation

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16
Q

Thrombolytics
- reperfusion time
- failure rate
- re occlusion rate
- when can we give (timeframe)

A
  • reperfusion time : 45- 60 plus minutes
  • failure rate : 16-40% of time
  • re occlusion rate : 15-15%
  • when can we give (timeframe) : 12 hours of onset of sx (preferred 3 hours to give it)
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17
Q

can we give thrombolytics in the following?
- preg
- dementia
- uncontrolled HTN
- hemorrhagic stroke
- active bleed
- elevated CRP

A

NO

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18
Q

Thrombolytics ADE

A

bleeding - including hemorrhagic stroke

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19
Q

Rsik factors with thrombolytics

A
  • older age
  • female sex
  • low body weight (less then 70 kg female less then 80 kh male)
  • prior stroke
  • HTN ( Bp above 160/95)
20
Q

ASA loading dose and maintenace dose

A

loading : 162-325 mg chewed for 1 dose

maintenace : 81 mg / day

21
Q

What are the antiplatlet pro-drugs

A

clopidrogrel and prasugrel

22
Q

how is clopidrogrel and ticagrelor metabolised?

A

via hepatic means

23
Q

what antiplatelet has the fastest and most reliable pharmacokinetics profile?

A

prasugrel

24
Q

when is ticagrelor contraindiacted?

A
  • hx intrcranial hemorhage
  • severe haptic impairment
  • concomitant string CYP 3A4 inhibtitors (ketoconazole, clairthromycin, ritonavir, and atazanavir)
25
Q

anticoagualnte option for therpay?

  • whihc need weight or renal adjustment?
  • monitoring
A

UFH
- weight bsae
- no renal
- moniot aPTT

LMWH
- weight based
- renal needed
- Moniotirng ??

Fondapurineux
- Ci if less then 30mL/min

Bivalirubin
- direct thrombin inhibtor
- aprroved for during PCI for STEMI alos for patients with HIT

26
Q

are fibrionolytics used for NSTEMI?

A

no

27
Q

if fibrinolytics use what agent do we recommend for antiplattelt?

A

clopidrogrel

28
Q

if we experience a NSTEMI what agents do we use for antiplataent?

A

ticagrelor and clopidrogrel

29
Q

for patients undergo a PCI what antiplatelt agents do we recommend?

A

ticagrelor > clopidrogrel

30
Q

if we have an elective PCI what’s the follow up for anti-platett agents look like

A

typical 6 months with clopdrogrel and ASA

31
Q

if we have ACS what standard antiplatelt therpay

A

ASA with either ticagrelor or pasgruel preffered over clopidrgrel

32
Q

if having a CABG when should ASA, CLopidrgorel, and ticagrelor be stopped?

A

ASA- not stopped

Clopidrogel - 2-7 days before surgery

Ticagrelor - 2-3 days before surgery

33
Q

if we don’t have ACS what antiplatelet can we use post-CABG?

A

ASA and clopdidrogrel

34
Q

post ACS what meds should we have/consider

A
  1. low dose ASA
  2. P2Y12 inhibitor
  3. Bete blocker
  4. Statin - high intensity
  5. ACEi or ARB
  6. aldosterone antagonist (MRA if DM or lvef less 40%)
  7. SGLT2i or GLP-1 RA
35
Q

if we have an ACS but don’t require revascularization what drugs are preferred in terms of anti-platelet

A

ticagrelor > clopidrogrel > prasugrel

36
Q

how long should clopidrgrel be continued post

  • STEMI
  • NSTEMI
  • ASA allergy
A
  • STEMI - 14 days to 1 year (lytic only)
  • NSTEMI - 3 months to 1 year (could go longer if medically indicated)
  • ASA allergy - indefintiley
37
Q

how long should ticagrelor be continued post

  • NSTEMI
A

3 months to 1 year unless medically needed for longer

38
Q

when are B blockers CI ?

if reduced LVEF?

A
  • hypo
  • severe LV failure
  • severe COPD

if reduced LVEF continue indefineitly

39
Q

all meds dosing

A

to traget dose or max tolerated dose

40
Q

what statins are recolmmended?

A

atorvastatin(80 mg) and rosuvation (20 or 40 mg)

41
Q

why are ACEi /ARB so important

A

prevent reinfarction

  • prevent development of HF with recent ACS, esp for those with reduced LVF
42
Q

ACEi ending, ARB ending

A

-pril

-tan

43
Q

what adtange do SGLT2i and GLP-1 RA provide

A

Good for:

  • ACCVD and DM
  • CKD
  • HF
44
Q

when are MRA’s used?

A

used within first two weeks post MI for patients already on ACEi and with LVEF of less then 40 % or HF symtpoms or DM

45
Q

risk of MRA’s

A

hyperkalamia

46
Q

additional consideration for patients (3)

A
  • LA nitrate (for chest pain)
  • D/C NSAIDS (except ASA)
  • avouid homrone replecemnt theroay

Therapy year 3- sem 2 (9 decks)

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