IHD - Scondary Prevention √ Flashcards
What is needed to add Rivaroxaban with aspirin
DAPT (dual Antiplatelet therapy) complete
Rica 2.5 plus aspirin best
when cant we add Rivaroxaban and aspirin to a patients therapy
When they are still on DAPT (aspirin + P2Y12i)
need to wait to consider
Dual Antiplatelet therapy guidelines (PIC)
How long is DAPT therapy for SIHD PCI DES
6 months
DES - drug eluding stent
How long is DAPT therapy for SIHD PCI BMS
1 month
BMS - bare metal stent
How long is DAPT therapy for SIHD CABG
12 months
How long is DAPT therapy for ACS
12 months
When do continue DAPT longer than 12 months
Advanced age
ACS
Multiple MI
Extensive CAD
DM
CKD
LVEF <40%
when do you favor a shorter DAPT time frame
History of Prior bleeding
Oral anticoag therapy
Female sex
Advance age
Low body weight
CKD
DM
Anemia
Chronic NSAID therapy
How long are pts on BB after ACS event
At least 1 year (max 3)
When do you give BB for life after a ACS event
LVEF ≤40% given for life
Which BB do you give after ACS care
Metoprolol
Carvedilol
Would I still give BB to someone with COPD or Asthma
Yes, bc it outweighs the risk
what HR do we titrate BB to?
50-60 BPM
What 5 patients do we give ace or arb to
- LVEF ≤ 40%,
- stable CKD,
- DM,
- HTN,
5.large anterior wall MI with an unknown LVEF
ACEi and ARBS what do we have to worry about
BEWARE OF
Hypotension
Renal failure
Hyperkalemia
What is the guideline for statins after an ASC event
follow the ASCVD guideline for statins
Why do we worry about aldosterone and which drugs do we use
Leads to remodeling and HTN
Use spironolactone or eplerenone
Given in the first 2 weeks
Which patients do we give ARA to
In patients on an ACEi that have LVEF ≤40 with HF symptoms or diabetes
Why spironolactone over eplerenone
Dose is able to be titration by 25mg up or down depending
Eplerenone of over spironolactone
More data
Less Gynecomastia
More selective aldosterone blocker (less binding to progesterone and androgen)
When do we start a SGLT2 vs GLP 1 for post ACS
patients that have HFreF, diabetes or CKD
SGLT2 doses
Dapagliflozin - 10 mg
Empagliflozin - 10 mg
Canagliflozin - 100 mg
what secondary prevention meds do we think about
Nitro
Aspirin
P2Y12
Statin
+/- ACE
+/- ARA
+/- BB
+/- SGLT2
If we are treating with fibrinolysis what P2Y12 do we give
clopidogrel 300mg not 600
what do we look for to see if the clot has been resolved 3 things
- no chest pain
- normal ECG
- arrhythmias
