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Therapeutics I > SIHD > Flashcards

SIHD Flashcards

1
Q

What are the therapeutic goals?

A
  1. Prolong life
  2. Reduce symptoms of angina
  3. Improve quality of life
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2
Q

What are the resting HR goal of SIDH?

A

Lower to 50-60bpm and Exercise of less than 100bom

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3
Q

How do treat SIDH with risk factor mods?

A
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4
Q

How do you treat SIDH with management of angina?

A
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5
Q

What are the benefits of rivaroxaban with SIDH?

A

Rivaroxaban 2.5 mg twice daily added to low-dose aspirin

24% relative reduction in CV death, MI, and stroke in one large trial

Increase in bleed events

Polyvascular disease, heart failure, diabetes mellitus, or at least moderate renal insufficiency

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6
Q

What are short term goals of ACS?

A
  1. Early restoration of blood flow to the infarct-related artery to prevent infarct expansion
  2. Prevention of death and MI
  3. Prevention of coronary artery reocclusion
  4. Relief of ischemic chest discomfort
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7
Q

What are long term goals of ACS?

A
  1. Control of CAD risk factors
  2. Prevention of additional MACE (reinfarction, stroke, and HF)
  3. Improvement in quality of life
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8
Q

What ACS acute supportive care?

A

Morphine
Oxygen
Nitroglycerin
Aspirin

Thienopyridine
Herparin
RAAS
Oxygen
Morphine
Beta-blocker
Intervention
Nitroglycerin
S2 Statin & Salicylate

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9
Q

What is morphine used for?

A

Reducing pain may decrease sympathetic tone and reduce HR, BP, and some opitates

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10
Q

What is O2 used for in ACS?

A

Too much O2 generates ROS and cell death, only add O2 <90%

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11
Q

What is Nitroglycerin used for in ACS?

A

Vasodilator and increases O2 supply but may also mask worsening symptoms or cause hypotension and worsen ischemia

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12
Q

What is aspirin used for in ACS>

A

Antiplatelet agent prevents additional thrombosis

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13
Q

What are the treatment options for STEMI?

A
  1. Percutaneous coronary intervention
  2. Fibrinolytic therapy
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14
Q

What are we looking for in PCI for ACS?

A

GOld standard

Goal within 90min of presentation

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15
Q

When would we use fibrinolytic therapy?

A

Patients unable to receive PCI within 120 min

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16
Q

What drugs are used in fibrinolytic therapy? MOA?

A

Alteplase, reteplase, or tenecteplase

Increase plasmin → breakdown of fibrin

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17
Q

How should you administer fibrinolytic therapy?

A
  1. Give within 30 minutes of arrival if PCI is not available
  2. Patients should also receive DAPT with aspirin and clopidogrel loading doses and anticoagulation in conjunction to fibrinolytic agents
  3. Following administration and stabilization (3-24 hours), transfer to a PCI-capable facility
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18
Q

Dosing of Altelase?

A
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19
Q

Dosing of Reteplase?

A
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20
Q

Dosing of TNKase?

A
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21
Q

Indications for STEMI?

A
  1. Symptoms of acute coronary syndrome with an onset within 12 hours of first medical contact
  2. ST-segment elevation of 1 mm or greater in two contiguous leads or new left bundle branch block on a 12-lead ECG
  3. Anticipated that primary PCI cannot be performed within 120 minutes of first medical contact
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22
Q

How do you treat STEMI?

A
23
Q

What are the diagnose options for NSTEMI?

A
  1. Early invasive
  2. Ischemia guided
24
Q

What is early invasive?

A
  1. Diagnostic angiography
  2. PCI or CABG
25
Q

What is ischemia-guided?

A

Medication management

26
Q

What is the invasive strategy with NSTE-ACS?

A
27
Q

What are the ischemia-guided strategy?

A
  1. DAPT
  2. Anticoagulation
28
Q

What is DAPT meds?

A
  1. ASA
  2. Clopidogrel or Ticagrelor
29
Q

What is the anticoagulation meds?

A
  1. UFH
  2. SC LMWH
  3. SC Fondaparinux
30
Q

What is the secondary prevention of ACS?

A
  1. Aspirin
  2. P2Y12 I
  3. Beta blocker
  4. High intesity statin
  5. ACEI/ARB
  6. Aldosterone antagonist
31
Q

Commonly used beta blocker for ACS?

A

Metoprolol and carvedilol

32
Q

How should you follow up with secondary prevention?

A
33
Q

Apirin and Oral P2Y12 Inhibitors for SIHD and ACS?

A
  1. With SIHD undergoing PCI, a loading dose of clopidogrel, followed by daily dosing
  2. With ACS undergoing PCI, it is reasonable to use ticagrelor or prasugrel in preference to clopidogrel to reduce ischemic events
34
Q

Heparin, Low-Molecular-Weight Heparin, and Bivalirudin (Anticoagulants) recommendations?

A

IV heparin and bivalirudin have stronger recommendations
Argatroban is an option for pts with hx of HIT
In patients that received therapeutic enoxaparin <8 hours prior to PCI, do not use anticoagulation
If <12 hours from enoxaparin, do not use UFH

35
Q

How do you dose PCI w/in 24 hr of fibrinolytic?

A

Loading dose of 300 mg of clopidogrel, followed by daily dosing

Patients <75 years of age undergoing PCI within 24 hours after fibrinolytic therapy, ticagrelor may be a reasonable alternative to clopidogrel

36
Q

What are the components of CABG?

A
  1. Insulin Infusion and Other Measures to Reduce Sternal Wound Infection
  2. Antiplatelet Therapy
  3. Beta Blockers and Amiodarone
37
Q

What are the elective CABG?

A
  1. If taking ASA daily → continue
  2. If taking a P2Y12i → discontinue clopidogrel for 5 days, ticagrelor for 3 days, and prasugrel for 7 days before
38
Q

What is urgent CABG?

A

Clopidogrel and ticagrelor should be discontinued for at least 24hours before surgery

39
Q

PHARMACOTHERAPY IN PATIENTS AFTER REVASCULARIZATION

A
  1. Antiplatelet
    PCI → DAPT
    CABG
  2. Beta blocker
    If PCI was for SIHD, do not continue beta blocker after revascularization
    Post ACS, beta blockers should be initiated within 24 hours of the event
40
Q

What are the mechanism of PCI restenosis?

A
41
Q

What is the purpose for re-endothelialization?

A

Prevents thrombosis

Occurs in 2 to 4 weeks after BMS, but later in DES

42
Q

What is the treatment for DAPT after PCI?

A
43
Q

What are the anti platelet therpay?

A
44
Q

What is DAT?

A

P2Y12 I
OAC

45
Q

What is TAT?

A

DAPT
OAC

46
Q

What do you look for when evaluating a patient?

A
  1. Ischemic risk
  2. Bleeding risk
47
Q

What are the dangers of triple therapy?

A

Increased bleeding risk

48
Q

If the instance of using triple therapy was do you use?

A
  1. NOAC instead of warfarin
  2. Clopidogrel as antiplatelet
  3. Drop aspirin as soon as feasible
49
Q

What are the screening tools for SIHD?

A

Seattle Angina Questionnaire
CCS Angina Grading Scale

50
Q

What are montitoring of SIHD?

A

Every 1 to 2 months until goals are achieved, then every 6 to 12 months

51
Q

What is considered SIHD improvement?

A
  1. Number of angina episodes
  2. Weekly SL NTG use
  3. Exercise capacity
  4. Duration of exertion needed to induce angina
  5. Ability to engage in activité they want to do
52
Q

What is considered ACS short term improvement?

A
  1. Restoration or preservation of coronary blood flow
  2. Symptom relief
  3. Prevention of MACE
53
Q

What is considered ACS long term improvement?

A
  1. Functional capacity
  2. Continued focus on risk reduction
  3. Development of adverse effects
  4. Medication adherence
54
Q
A

Therapeutics I (32 decks)

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