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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?

24
Q

when is ticagrelor contraindiacted?

A
  • hx intrcranial hemorhage
  • severe haptic impairment
  • concomitant string CYP 3A4 inhibtitors (ketoconazole, clairthromycin, ritonavir, and atazanavir)
25
anticoagualnte option for therpay? - whihc need weight or renal adjustment? - monitoring
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
are fibrionolytics used for NSTEMI?
no
27
if fibrinolytics use what agent do we recommend for antiplattelt?
clopidrogrel
28
if we experience a NSTEMI what agents do we use for antiplataent?
ticagrelor and clopidrogrel
29
for patients undergo a PCI what antiplatelt agents do we recommend?
ticagrelor > clopidrogrel
30
if we have an elective PCI what's the follow up for anti-platett agents look like
typical 6 months with clopdrogrel and ASA
31
if we have ACS what standard antiplatelt therpay
ASA with either ticagrelor or pasgruel preffered over clopidrgrel
32
if having a CABG when should ASA, CLopidrgorel, and ticagrelor be stopped?
ASA- not stopped Clopidrogel - 2-7 days before surgery Ticagrelor - 2-3 days before surgery
33
if we don't have ACS what antiplatelet can we use post-CABG?
ASA and clopdidrogrel
34
post ACS what meds should we have/consider
1. low dose ASA 2. P2Y12 inhibitor 3. Bete blocker 3. Statin - high intensity 4. ACEi or ARB 5. aldosterone antagonist (MRA if DM or lvef less 40%) 6. SGLT2i or GLP-1 RA
35
if we have an ACS but don't require revascularization what drugs are preferred in terms of anti-platelet
ticagrelor > clopidrogrel > prasugrel
36
how long should clopidrgrel be continued post - STEMI - NSTEMI - ASA allergy
- STEMI - 14 days to 1 year (lytic only) - NSTEMI - 3 months to 1 year (could go longer if medically indicated) - ASA allergy - indefintiley
37
how long should ticagrelor be continued post - NSTEMI
3 months to 1 year unless medically needed for longer
38
when are B blockers CI ? if reduced LVEF?
- hypo - severe LV failure - severe COPD if reduced LVEF continue indefineitly
39
all meds dosing
to traget dose or max tolerated dose
40
what statins are recolmmended?
atorvastatin(80 mg) and rosuvation (20 or 40 mg)
41
why are ACEi /ARB so important
prevent reinfarction - prevent development of HF with recent ACS, esp for those with reduced LVF
42
ACEi ending, ARB ending
-pril -tan
43
what adtange do SGLT2i and GLP-1 RA provide
Good for: - ACCVD and DM - CKD - HF
44
when are MRA's used?
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
risk of MRA's
hyperkalamia
46
additional consideration for patients (3)
- 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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