SIHD & ACS exam 1 review

Question 1

What is the antiplatelet indication for patients with CCD with no history of stent implantation (secondary prevention)?

Answer 1

low dose aspirin (SAPT)
if CI to ASA then Clopidogrel 75mg
if high risk then DAPT

Question 2

What is the maintenance dose of prasugrel (Effient)?

Answer 2

10 mg daily

Question 3

What is the maintenance dose of ticagrelor (Brilinta)?

Answer 3

90 mg BID

Question 4

What is the maintenance dose of clopidogrel (Plavix)?

Answer 4

75 mg daily

Question 5

Ticagrelor adverse effects?

Answer 5

bleeding, bradycardia, heart block, dyspnea

Question 6

What is the antiplatelet indication for patients with CCD and have had an elective PCI + Stent?

Answer 6

DAPT minimum for 6 months
SAPT indefinetely
if high risk of bleeding, 1-3 months of DAPT may be reasonable; SAPT as a P2Y12 inhibitor until 12 months then switch to aspirin

Question 7

What is the indication for antiplatelet therapy in SIHD CABG (non-emergent)?

Answer 7

DAPT for 12 months
then, SAPT

Question 8

Adverse Effects of nitrates?

Answer 8

headache, hypotension, dizziness, lightheadedness and facial flushing, reflex tachycardia

Question 9

What Beta Blockers are indicated for CCD?

Answer 9

Atenolol (Tenormin), Metoprolol (Lopressor), Propranolol (Inderal)

Question 10

What do non-DHP CCBs do to myocardial contractility?

Answer 10

decrease/reduce (Verapamil more)
which reduces cardiac output

Question 11

What are the adverse effects of DHPs?

Answer 11

peripheral edema, hypotension, flushing, headache, dizziness, maybe some reduced myocardial contractility

Question 12

What is the dosing for the NTG patch?

Answer 12

-once daily
-on for 12-14 hrs then off for 10-12 hrs
on at 7am off @7-9 pm

Question 13

What is the dosing for ISDN tabs?

Answer 13

2-3 times/day
8,12,4 pm
10 mg TID

Question 14

What is the dosing for ISMN tabs?

Answer 14

2 times/day 7 hrs apart
8am & 3 pm(4pm)

Question 15

What is the dosing for ISMN SR tabs?

Answer 15

once daily at 8 am
30 mg

Question 16

What is a negative result for the high sensitivity troponin?

Answer 16

less than 14ng/L

Question 17

What is a negative result for the conventional troponin?

Answer 17

less than 0.05ng/mL

Question 18

What is the dose of morphine for ACS patients?

Answer 18

4-8 mg IV, followed by 2-8mg IV q5-15 mins

Question 19

What is the loading dose of Clopidogrel?

Answer 19

600 mg
-300 mg if using fibrinolytic

Question 20

What is the loading dose of Ticagrelor?

Answer 20

180 mg

Question 21

What is the loading dose of Prasugrel?

Answer 21

60 mg

Question 22

What is the loading dose of Cangrelor?

Answer 22

30mcg/kg followed by 4 mcg/kg/min for 2 hrs

Question 23

What antiplatelets are preferred for ischemia guided therapy?

Answer 23

clopidogrel and ticagrelor

Question 24

What antiplatelets are preferred for early invasive strategy?

Answer 24

ticagrelor or prasugrel

Question 25

What antiplatelets are preferred in STEMI patients on fibrinolytics?

Answer 25

clopidogrel

Question 26

What antiplatelets are preferred in STEMI patients with PCI?

Answer 26

ticagrelor or prasugrel

Question 27

What anticoagulants are indicated for ischemia guided strategy?

Answer 27

UFH, Enoxaparin, Fondaparinux

Question 28

What anticoagulants are indicated for early invasive strategy?

Answer 28

UFH, Bivalirudin, Enoxaparin

Question 29

What anticoagulants are indicated for a STEMI w/fibrinolytics?

Answer 29

UFH, enoxaparin, fondaparinux

Question 30

What anticoagulants are indicated for a STEMI w/a PCI?

Answer 30

UFH, bivalirudin (preferred in high bleeding risk)

Question 31

What are the renal dosing requirements for Enoxaparin?

Answer 31

if CrCl <30mL/min then 1mg/kg q24h

Question 32

What are the renal dosing adjustments for Fondaparinux?

Answer 32

CI if CrCl <30 mL/min

Question 33

What are the renal dosing adjustments for Bivalirudin?

Answer 33

if CrCl <30 mL/min then 1mg/kg/hr
Dialysis 0.25 mg/kg/hr

Question 34

What are the renal dosing adjustments for Unfractionated heparin?

Answer 34

-no renal adjustments

Question 35

What are the contraindications for Prasugrel?

Answer 35

CI in pts with history of TIA/stroke
-not recommended for pats 75+ or less than 60kg