Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CDM 2 Exam 1 > Lecture 3 - Acute Coronary Symptoms > Flashcards

Lecture 3 - Acute Coronary Symptoms Flashcards

1
Q

cause of ACS?

A

rupture of atherosclerotic plaque with subsequent platelet adherence, activation, and aggregation, and the activation of the clotting cascade.

Ultimately, clot forms composed of fibrin and platelets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Unstable Angina vs NSTEMI

A

UA = not positive for cardiac enzymes, no cell death, ischemia (not infarction)

NSTEMI = positive for cardiac enzymes, death of myocardium (infarction), no ST elevation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

STEMI will be…

A

occlusive thrombus
Fibrin rich

want drugs to dissolve fibrin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

UA/NSTEMI

A

Mural Thrombus

mostly platelets, use anti-platelet drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

TIMI Risk score NSTEMI

A 
Low = 0-2
Medium = 3-4
High = 5-7
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

ACS Non-pharmacologic therapy

A

EKG
Oxygen (O2 < 90%)
Cardiac Enzymes
Bed Rest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

ACS Pharmacologic Therapy

A 
Aspirin 325mg non-ec
Nitrates
Morphine??
Anti-coagulant
Anti-platelet
Statin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Class I recommendation: Nitroglycerin

A

SL = 0.4mg q5min for 3 doses

IV = 5-10mcg/min, titrate up to 75-100 mcg/min

Avoid in pt with hypotension ( SBP < 90) or right ventricular infarcts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Class I recommendation: Morphine

A

2-4mg IV q5-15min until pain relief or ADR

may worsen outcomes in NSTEMI

Monitor BP,HR, RR, naloxone present

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Class I recommendation: Beta-Blockers

A

All pts w/o CI in 1st 24hrs

Oral > IV preferred

CI: Signs of HF, low output state (HR <60, SBP <90)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

CCBs

A

generally 2nd line

wary of SL short acting nifedipine = reflex tachycardia leading to MI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Plavix is…

A

clopidogrel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Effient is…

A

Prasugrel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Brilinta is…

A

ticagrelor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Aspirin info

A

Decreases morbidity/mortality,
DOESNT IMPACT CHEST PAIN

Dosing: 325 mg qd
MOA: irreversibly inhibit COX, inhibiting platelet aggregation

don’t use EC, 81 mg dose preferred for maintenance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Clopidogrel Dosing

A

Dosing: 300-600 mg loading, higher = faster inhibition
Maintenance: 75mg qd

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Clopidogrel interactions

A

Pro drug, CYP450 metabolism

PPIs inhibit CYP450, so co-admin appress to increase risk of reinfarction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Prasugrel info

A

more potent irreversible platelet inhib compared to clopidogrel

approved for pt managed with PCI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Prasugrel Dosing

A

60mg loading dose, continue 10 mg once daily w or w/o food

consider 5mg once daily for pt <60kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Prasugrel considerations

A

don’t start in….

> 75 yr old
previous history of TIA or stroke
likely to undergo CABG, start after
BW < 60kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Ticagrelor MOA

A

reversibly binds to ADP receptor P2Y12

22
Q

Ticagrelor Dosing

A

Loading: 180 mg once w/ Aspirin 325

Maintenance dose: 90 mg bid w/ 81mg aspirin

if on for longer than 12 months, can possibly reduce to 60mg BID

23
Q

Ticagrelor Drug Interactions

A

Carbamazepine,Phenytoin

24
Q

Ticagrelor Adverse effects

A

Dyspnea, dissipates in 2-4 weeks

bleeding

25
Q

Cangrelor (Kengreal) MOA

A

reversibly binds to ADP

26
Q

Cangrelor Dosing

A

Loading: 30mcg/kg IV bolus
Maintenance Dose: 4mcg/kg/min IV for duration of PCI or 2hrs

Doesn’t interact with Ticagrelor, but does with Prasugrel or clopidogrel (load after stoping infusion not during)***

27
Q

GP IIB and IIIA inhibitors are used….

A

adjunctive anti platelet in some cases usually

28
Q

Integrilin (Eptifibatide)

A

Dose has to be loaded, and given by infusion. Has renal dosing

Discontinue infusion with OD

29
Q

Aggrastat (Tirofiban)

A

Dose has to be loaded, and given by infusion. Has renal dosing

Discontinue infusion with OD

30
Q

Xa inhibitor

A

Fondaparinux (Arixtra)

31
Q

Direct thrombin inhibitor

A

Bivalirudin (angiomax)

Dabigatran (Pradaxa)

32
Q

Low molecular weight heparin

A

Enoxaparin (Lovenox)

Dalteparin (Fragmin)

33
Q

Enoxaparin (Lovenox) Dosing

A

1mg/kg q12h (CrCl > 30/min)
1mg/kg q24h (CrCl <30/min)

Usually round to next syringe or next 10mg

34
Q

what to monitor Enoxaparin

A

Scr
Platelets
Anti-factor Xa lvls

35
Q

Fondaparinux (arixtra) info

A

Class 3 rec

Avoid using as solo in PCI, used w/ Heparin

36
Q

Fondaparinux (arixtra) Dosing

A

STEMI: 2.5mg IV Day 1, then 2.5mg subcut q24h
NSTEMI: 2.5mg SQ once daily

caution CrCl 30-50ml/min
**Don’t use if CrCl < 30ml/min

Monitor: Scr, Anti-factor Xa lvls

37
Q

Bivalirudin (Angiomax) info

A

Dosing: IV bolus + IV infusion

Monitor: Scr, can monitor aPTT

Dose adjustment for severe Renal failure

38
Q

NSAID use in ACS?

A

Black box warning

increased risk of mortality, reinfarction, HTN, etc

39
Q

Unstable Angina Clinical Presentation

A
  1. Typical rise and gradual fall (troponin) or more rapid rise/fall (CK-MB) with at least one of the following….
  • Ischemic Symptoms
  • Development of Q waves on ECG
  • ECG changes indicative of ischemia
  • Imaging of myocardium abnormality
40
Q

CK-creatinine phosphokinase info

A

peak at 24 hrs, normalizes in 2 days

41
Q

Troponins info

A

Elevations may persist up to 2 weeks

42
Q

Treating pt presenting with ACS

A
  1. Triage
  2. Asses risk of CV death/ recurrent ischemia
  3. General care (ASA, NTG, Statin…consider O2/BB/Morphine)
  4. Choose invasive or non-invasive initial strategy
  5. select second antiplatelet to add to ASA
  6. choose an anticoagulant agent
43
Q

Statins use

A

High-intensity statin during hospital care

Atorva 40-80* or Rosa 20*-40

consider moderate intensity if >75yr old or not candidate for high intensity

44
Q

Irreversible, nonselective COX-1 Inhib

A

Aspirin

45
Q

Irreversible P2Y12 antagonist

A

Clopidogrel

Prasugrel

46
Q

Reversible P2Y12 antagonist

A

Ticagrelor

Cangrelor

47
Q

GPIIb/IIIa inhibitors

A

Abciximab
Eptifibatide
Tirofiban

48
Q

PAR-1 Antagonist

A

Vorapaxar

49
Q

Enoxaparin Advantage and Disadvantage

A

Advantage:
Lower incidence of HIT
Less monitoring
Twice Daily dosing instead of continuous infusion

Disadvantage:
unsure dosing in obese/renal impairment
longer duration not always wanted
harder to reverse
only in certain syringe sizes
50
Q

Fondaparinux Advantage and Disadvantage

A

Advantage:
once daily dose
No incidence of HIT

Disadvantage:
Lack of reversibility
Catheter thrombosis
Longer duration of action
unsure of universal dosing for all pt
renal dosing CrCL < 30 ml/min
51
Q

Bivalirudin Advantage and Disadvantage

A

Advantages:
no incidence of HIT
may req less use of GPIIb/IIIa inhib

Disadvantages:
lack of reversibility
continuous infusion
not studied in ACS pts w/ conservative management strategy

CDM 2 Exam 1 (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions