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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
Q

What are the two procedures that are possible in NSTEMI/UA

A

Ischemia guided therapy
Early invasive strategy (PCI)

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26
Q

What drugs are preferred for ischemia guided therapy in NSTEMI/UA

A

CLopidogrel or ticagrelor

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27
Q

what drugs are preferred for PCI in NSTEMI/UA

A

Ticagrelor/prasgurel

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28
Q

WHat are the two possible procedures for STEMI

A

Fibrinolytic
PCI

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29
Q

What drugs are preferred for fibriolytic therapy in STEMI

A

clopidogrel

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30
Q

What drugs are preferred for PCI therapy in STEMI

A

ticagrelor or prasgurel

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31
Q

What kin of drugs are released from drug eluting stents

A

Anti rejection drugs

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32
Q

DES (drug eluting stents) may not be preferred in which case

A

If patient can not tolerate or comply with a prolonged course of DAPT

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33
Q

Why are DES not preferred if patient can not comply with prolonged DAPT

A

DES are associated with late stent thrombosis as bare metal stents are a big risk early on and not late

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34
Q

duration to take ticagrelor

A

take 12 hours apartW

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35
Q

when to contact doctor for ticagrelor

A

If increased SOB

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36
Q

MInor s and s of bleeding and major s and s of bleeding

A

minor- nose bleed, gum bleeding
major- blood in urine, cough and stool

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37
Q

Does aspirin need to be held prior to CABG

A

No

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38
Q

SHould P2Y12s be held before CABG

A

Yes

39
Q

How many days before CABG should P2Y12s be held

A

Ticagrelor- 3 days
Clopidogrel- 5 days
Prasgurel- 7 days

40
Q

How man hours before urgent CABG should P2Y12s be held

A

24 hours

41
Q

What P2y12 should be avoided in emergency

A

Clopidogrel (due to need to convert to active form)

42
Q

Prasgurel contraindicated in

A

history of stroke

43
Q

Can we combine two P2Y12 inhibitors

A

No

44
Q

What are some GPIIBIIIA inhibitors

A

Abiciximab, eptifibatide, tirofiban

45
Q

WHen to use GPIIBIIIA in NSTEMI

A

high risk features such as positive troponin

46
Q

When to use GPIIBIIIA in STEMI

A

large thrombus burden
inadequate P2Y12 inhibitor loading
BAIL OUT

47
Q

What are factor Xa inhibitors

A

UFH
LMWH
Pentasaccharides

48
Q

Factor IIa inhibitors

A

indirect- UFH, LMWH
Direct- DTI

49
Q

intrinsic pathway factors

A

factor IX
Factor VIII

50
Q

Extrinsic pathway factors

A

Factor VIII
TF

51
Q

What kind of activity does UFH have

A

Anti Xa and Anti IIa

52
Q

HIT caused by

A

formation of antibodies that activate platelets

53
Q

screening tests available if HIT suspected

A

ELISA
Serotonin release assay (SRA)- gold standard

54
Q

Is UFH that only anticoag that can cause HIT

A

No, LMWH can also cause them in some very rare cases

55
Q

can a patient with a history of HIT be rechallenged with UFH or LMWH

A

No, patients should not be rechallenged

56
Q

does UFH have slow or fast onset? half lide? ROA?

A

fast onset
short t1/2
administered as continous infusion

57
Q

WHat factor Xa inhibitor is preferred in birth

A

enoxaparin

58
Q

name a LMWH drug

A

Enoxaparin

59
Q

Does enoxaparin have more antiXa or anti IIa compared to UFH

A

higher anti Xa

60
Q

do we routinely check anti xa levels for patients on enoxaparin

A

no, unless patient is severely over or under weight

61
Q

name a DTI

A

bivalirudin

62
Q

bivalirudin brand

A

Angiomax

63
Q

Can we use bivalirudin with GPIIBIIIA inhibitors

A

no except for bail out

64
Q

what kind of drug is fondaparinux

A

Factor Xa inhibitor

65
Q

Can fondaparinux be used in patients with a history of HIT

A

yes

66
Q

Do not use fondaparinux alone for PCI T/F

A

true

67
Q

if a patient is already on fondaparinux and needs a PCI, what do we do?

A

Need to give UFH or bivalirudin also

68
Q

Fondaparinux CI

A

Crcl<30

69
Q

UFH bolus dose

A

60 units/kg IV (max 4000units)
50-100 units/kg during PCI

70
Q

UFH maintenance dose

A

12 units/kg.hr
no maintenance during PCI

71
Q

Enoxaprin bolus dose

A

30 mg IV

72
Q

Enoxaparin maintenance dose

A

1 mg/kg sq 12H

1st dose 15 min after bolus

if >75 y/o reduce to 0.75 mg sc q 12H

73
Q

Bivalirudin bolus dose

A

0.75 mg/kg IV

74
Q

Bivalidurin maintenance dose

A

1.75 mg/kg/hr infusion

75
Q

fondaparinux bolus dose

A

2.5 mg IV

76
Q

fondaparinux maintenance

A

2.5 mg sq 24h

77
Q

renal dosing for UFH

A

no change

78
Q

enoxaparin <30 CRCL dosing

A

1 mg/kg q 24h

79
Q

bivalirudin <30 CrCl dosing

A

1 mg/kg/hr

80
Q

bivalirudin dialysis dosing

A

0.25 mg/kg/hr

81
Q

fondaparinux CrCl<30 dosing

A

contraindicated

82
Q

UA/NSTEMI reperfusion therapy

A

ischemia guided strategy
early invasive strategy

83
Q

STEMI reperfusion therapy

A

fibrinoytic
PCI

84
Q

what is the only drug that we do not use for ischemia guided strategy

A

bivalirudin

85
Q

Drugs we use for ischemia guided strategy with duration

A

UFH (48hrs)
Enoxaparin (duration of hospital stay up to 8 days)
Fondaparinux (duration of hospital stay up to 8 days)

86
Q

Drugs to use for early invasive strategy and drugs to avoid

A

UFH, Bivalirudin and enoxaparin (until PCI)
fondaparinux not ideal

87
Q

drugs to use for fibrinolytic and drugs to avoid (duration include)

A

UFH (48 hrs)
enoxaparin and fondaparinux- (duration of hospital stay upto 8 days)
bivalirudin (8 days)

88
Q

drugs to use and avoid in PCI (duration included)

A

UFH- yes (until PCI)
Bivalirudin- yes (until PCI, preferred in high bleeding risk)
Enoxaparin and fondaparinux - no

89
Q

CrCL formula

A

72*Scr

x 0.85 for females

90
Q

loading dose for psy12 inhibitors

A

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
Q

P2y12 inhibitor maintenance dose

A

ticagrelor-90 mg BID
Prasgurel- 10 mg QD
CLopidogrel- 75 mg daily

for 1 year

92
Q

if patient has PCI what are options for drugs

A

UFH or bivalirudin

93
Q

is PCI preferred over fibrinolyticw

A

yes

Therapeutics (38 decks)

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