MI/ACS III

Question 1

Secondary Prevention: First Steps

Answer 1

-Aspirin 81 mg PO QD

-Rivaroxaban 2.5 mg PO BID
*wait until DAPT complete then add riva to aspirin if desired

-Ticagrelor first, then Prasugrel, then Clopidogrel

Question 2

Duration of tx after ACS event

Answer 2

12 months (can be more)
-for DAPT, aspirin, GREL

Question 3

Beta Blockers

Answer 3

-Give for at least 1 year (up to 3) for all pts if no CI
-Give indefinitely in pts with LV dysfunction (EF < 40%)
-Metoprolol or Carvedilol most common

Question 4

ACEI/ARB (and CI)

Answer 4

-All pts with LVEF of < 40%, CKD, DM, HTN, large anterior wall MI
-Reasonable to use in all other MI pts

AVOID in hypotension, renal failure, hyperkalemia

Question 5

Antihyperlipidemic drugs

Answer 5

-Lipid panel within 24 hours
-Post ACS pts are in clinical ASCVD group
-Get high intensity statin
= A 48, R 24

Question 6

Aldosterone (when to use)

Answer 6

Considered in:
-in first 2 weeks following an MI in patients already receiving an ACEi who have an EF ≤ 40% and either HF sx or diabetes
-spironolactone 25 or eplerenone 25
-E has less gynecomastia

Question 7

Diabetes Drugs

Answer 7

only if Post MI w/ reduced ejection fraction heart failure (HFrEF), CKD, DM

JUST MI = no

SGLTi
-Dapa 10
-Empa 10
-Cana 100

GLIP1RA
-Sema 2.4 sq weekly

Question 8

P2Y12 choice for primary PCI

Answer 8

-Not clopidogrel bc of genetic variability, don’t risk it

-Look at contras for Tica and Pras

-NO for Pras: < 60 kg, 75+, TIA/Stroke hx

-NO for Tica: ICH, caution in LD/COPD