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Therapeutics > lecture 5 > Flashcards

lecture 5 Flashcards

1
Q

Name antiplatelet drugs

A

Aspirin
Psy12 inhibitors
GPIIBIIIA inhibitors

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2
Q

Aspirin dose when pt presents to hospital

A

162-325 mg upon presentation and 81 mg indefinitely

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3
Q

name P2y12 inhibitor drugs

A

Clopidogrel, ticagrelor, prasgurel (cangrelor is an IV option)

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4
Q

how long is DAPT recommended for in STEMI or NSTEMI/UA patients

A

12 months

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5
Q

How fast does cangrelor IV work

A

2 mins

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6
Q

WHen to use cangrelor

A

Use during PCI when patient did not receive loading dose p2y12 inhibitor

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7
Q

Clopidogrel generic

A

plavix

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8
Q

clopidogrel loading and maintenance dose

A

loading- 300-600 mg
maintenance- 75 mg daily

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9
Q

Ticagrelor generic

A

Brilinta

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10
Q

Ticagrelor loading and maintenance dose

A

loading- 180 mg
Maintenance- 90 mg BID

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11
Q

Prasgurel generic

A

Effient

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12
Q

Prasgurel loading and maintenance dose

A

loading- 60 mg
maintenance- 10 mg

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13
Q

cangrelor loading and maintenance dose

A

loading- 30 mcg/kg, followed by
4 mcg/kg/min x 2 hours

maintenance- use an oral agent

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14
Q

preferred loading dose of clopidogrel

A

600 mg loading dose preferred because it results in greater, more rapid and more reliable platelet inhibition compared to 300 mg

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15
Q

600 mg loading dose of clopidogrel preferred except

A

when using fibrinolytic

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16
Q

times when clopidogrel is not given at 600 mg

A

fibrinolytic+age>75= no loading dose
fibrinolytic+age<or = 75 =300 mg loading dose

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17
Q

which psy12 is a prodrug? what is it metabolized by?

A

clopidogrel. metabolized by CYP2C19
(prasgurel is also a prodrug)

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18
Q

which has greater pletelet aggregtion inhibition ticagrelor or clopidogrel

A

Ticagrelor

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19
Q

Considerations when taking tidagrelor

A

Max dose of Aspirin is 81 mg.

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20
Q

Side effects of ticagrelor

A

Dyspnea and ventricular pauses

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21
Q

prasgurel is not recommended in patients that are

A

> 75 yo, <60 kg or high bleeding risk

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22
Q

reason to switch from clopidogrel to ticagrelor or prasgurel

A

Inadequate response (genetics/CV event)

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23
Q

Reason to switch from ticagrelor to clopidogrel

A

Bleeding, cost, dyspnea, adherence

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24
Q

Reason to switch from prasgurel to clopidogrel

A

Bleeding, cost, stroke

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25
What are the two procedures that are possible in NSTEMI/UA
Ischemia guided therapy Early invasive strategy (PCI)
26
What drugs are preferred for ischemia guided therapy in NSTEMI/UA
CLopidogrel or ticagrelor
27
what drugs are preferred for PCI in NSTEMI/UA
Ticagrelor/prasgurel
28
WHat are the two possible procedures for STEMI
Fibrinolytic PCI
29
What drugs are preferred for fibriolytic therapy in STEMI
clopidogrel
30
What drugs are preferred for PCI therapy in STEMI
ticagrelor or prasgurel
31
What kin of drugs are released from drug eluting stents
Anti rejection drugs
32
DES (drug eluting stents) may not be preferred in which case
If patient can not tolerate or comply with a prolonged course of DAPT
33
Why are DES not preferred if patient can not comply with prolonged DAPT
DES are associated with late stent thrombosis as bare metal stents are a big risk early on and not late
34
duration to take ticagrelor
take 12 hours apartW
35
when to contact doctor for ticagrelor
If increased SOB
36
MInor s and s of bleeding and major s and s of bleeding
minor- nose bleed, gum bleeding major- blood in urine, cough and stool
37
Does aspirin need to be held prior to CABG
No
38
SHould P2Y12s be held before CABG
Yes
39
How many days before CABG should P2Y12s be held
Ticagrelor- 3 days Clopidogrel- 5 days Prasgurel- 7 days
40
How man hours before urgent CABG should P2Y12s be held
24 hours
41
What P2y12 should be avoided in emergency
Clopidogrel (due to need to convert to active form)
42
Prasgurel contraindicated in
history of stroke
43
Can we combine two P2Y12 inhibitors
No
44
What are some GPIIBIIIA inhibitors
Abiciximab, eptifibatide, tirofiban
45
WHen to use GPIIBIIIA in NSTEMI
high risk features such as positive troponin
46
When to use GPIIBIIIA in STEMI
large thrombus burden inadequate P2Y12 inhibitor loading BAIL OUT
47
What are factor Xa inhibitors
UFH LMWH Pentasaccharides
48
Factor IIa inhibitors
indirect- UFH, LMWH Direct- DTI
49
intrinsic pathway factors
factor IX Factor VIII
50
Extrinsic pathway factors
Factor VIII TF
51
What kind of activity does UFH have
Anti Xa and Anti IIa
52
HIT caused by
formation of antibodies that activate platelets
53
screening tests available if HIT suspected
ELISA Serotonin release assay (SRA)- gold standard
54
Is UFH that only anticoag that can cause HIT
No, LMWH can also cause them in some very rare cases
55
can a patient with a history of HIT be rechallenged with UFH or LMWH
No, patients should not be rechallenged
56
does UFH have slow or fast onset? half lide? ROA?
fast onset short t1/2 administered as continous infusion
57
WHat factor Xa inhibitor is preferred in birth
enoxaparin
58
name a LMWH drug
Enoxaparin
59
Does enoxaparin have more antiXa or anti IIa compared to UFH
higher anti Xa
60
do we routinely check anti xa levels for patients on enoxaparin
no, unless patient is severely over or under weight
61
name a DTI
bivalirudin
62
bivalirudin brand
Angiomax
63
Can we use bivalirudin with GPIIBIIIA inhibitors
no except for bail out
64
what kind of drug is fondaparinux
Factor Xa inhibitor
65
Can fondaparinux be used in patients with a history of HIT
yes
66
Do not use fondaparinux alone for PCI T/F
true
67
if a patient is already on fondaparinux and needs a PCI, what do we do?
Need to give UFH or bivalirudin also
68
Fondaparinux CI
Crcl<30
69
UFH bolus dose
60 units/kg IV (max 4000units) 50-100 units/kg during PCI
70
UFH maintenance dose
12 units/kg.hr no maintenance during PCI
71
Enoxaprin bolus dose
30 mg IV
72
Enoxaparin maintenance dose
1 mg/kg sq 12H 1st dose 15 min after bolus if >75 y/o reduce to 0.75 mg sc q 12H
73
Bivalirudin bolus dose
0.75 mg/kg IV
74
Bivalidurin maintenance dose
1.75 mg/kg/hr infusion
75
fondaparinux bolus dose
2.5 mg IV
76
fondaparinux maintenance
2.5 mg sq 24h
77
renal dosing for UFH
no change
78
enoxaparin <30 CRCL dosing
1 mg/kg q 24h
79
bivalirudin <30 CrCl dosing
1 mg/kg/hr
80
bivalirudin dialysis dosing
0.25 mg/kg/hr
81
fondaparinux CrCl<30 dosing
contraindicated
82
UA/NSTEMI reperfusion therapy
ischemia guided strategy early invasive strategy
83
STEMI reperfusion therapy
fibrinoytic PCI
84
what is the only drug that we do not use for ischemia guided strategy
bivalirudin
85
Drugs we use for ischemia guided strategy with duration
UFH (48hrs) Enoxaparin (duration of hospital stay up to 8 days) Fondaparinux (duration of hospital stay up to 8 days)
86
Drugs to use for early invasive strategy and drugs to avoid
UFH, Bivalirudin and enoxaparin (until PCI) fondaparinux not ideal
87
drugs to use for fibrinolytic and drugs to avoid (duration include)
UFH (48 hrs) enoxaparin and fondaparinux- (duration of hospital stay upto 8 days) bivalirudin (8 days)
88
drugs to use and avoid in PCI (duration included)
UFH- yes (until PCI) Bivalirudin- yes (until PCI, preferred in high bleeding risk) Enoxaparin and fondaparinux - no
89
CrCL formula
(140-age)xIBW -------------------- 72*Scr x 0.85 for females
90
loading dose for psy12 inhibitors
ticagrelor- 180 mg x 1 (preferred with PCI) Prasgurel- 60 mg x 1 (preferred with PCI) clopidogrel- 600 mg x 1 Clopidogrel 300 mg x 1 (preferred with fibrinolytic)
91
P2y12 inhibitor maintenance dose
ticagrelor-90 mg BID Prasgurel- 10 mg QD CLopidogrel- 75 mg daily for 1 year
92
if patient has PCI what are options for drugs
UFH or bivalirudin
93
is PCI preferred over fibrinolyticw
yes

Therapeutics (38 decks)

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