Pharm tx of UA/NSTEMI and STEMI ACS Flashcards
about ____ the patient who have a known plaque, have other unknown plaques elsewhere.
1/2
Who is at the highest risk for cardiac event?
Age over 65, with greater than 3 CAD r/f
What are the ACC/AHA recommendations for anti-platelet tx in pt’s with NSTE-ACS: Class I:
ASA
Clopidogrel-if can’t use ASA
Clopidogrel + ASA if early invasive approach not planned
Stop clopidogrel 5-7d before CABG/Surgery
Use a GPIIb/IIIa inhibitor if cardiac cath and PCI planned in next 8 days
What are the ACC/AHA recommendations for anti-platelet tx in pt’s with NSTE-ACS: Class II:
GPIIb/IIIa inhibitor in high-risk pt’s if invasive surgery NOT planned
GPIIb/IIIa inhibitor in pt’s receiving clopidogrel if cardiac cath and PCI planned.
What is the role of ASA in ACS
prevents thrombus from plaque rupture.
Reduces odds of death MI or stroke by 22%
What antiplatelets are used in ACS?
ASA
Thienopyridine or both (oral
GP IIB/IIA inhibitors (IV)
What is the MOA of ASA?
irreversible inhibition of platelet COX and TXA2 formation
What is interesting about the administration of ASA?
Chewing makes them work 50% faster
What is important when dosing ASA and NSAIDS together?
instruct pt’s to take ASA first and NSAID 3 hours later (they compete for receptors)
Major side effect of ASA?
GI bleeding and ulcers
EXTENSIVE hepatic metabolism (major CYP reaction esp for pt’s on PPI’s)
What medication should be used in conjunction with ASA for up to 1 year following coronary stent placement?
Clopidogrel
Why has Clopidogrel taken over for Ticlopidine?
major side effects, and irreversible
When is Prasugrel given?
When PCI is planned
Who is Prasugrel CI’d in?
STroke or TIA within 3 mo. Pt's older than 75 Wt less than 60lbs active bleeding planned surgery hypersensitivity
What is the MOA of Ticagrelor
reversilby inhibits ADP P2Y12 receptors metabolic pathway is CYP3A4
