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Therapeutics 601 > W5 Topics (Exam 3) > Flashcards

W5 Topics (Exam 3) Flashcards

1
Q

race and sex most likely to develop CAD

A

black men

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2
Q

non-modifiable CAD risk factors

A

male > 45y/o
female >55y/o
family history of premature CAD event (M <55y/o, F <65y/o)

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3
Q

modifiable CAD risk factors

A

smoking, HTN, dyslipidemia, DM, obestity, lack of exercise

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4
Q

CAD progression

A

plaque buildup - vessels vasodilate to make-up for buildup - O2 demand inc above baseline and vessels cannot dilate further - demand > supply = ischemia and angina

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5
Q

Ischemic Heart Disease has 2 subsets:

A

Stable and Unstable IHD

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6
Q

Unstable IHD has 3 subsets

A

Unstable angina
NSTEMI
STEMI
all are ACS (acute coronary syndrome)

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7
Q

Stable Angina

A

chronic angina, precipitated by activity/upset and relieved at rest

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8
Q

Unstable Angina

A

inc freq/duration of angina @ lower level of activity/at rest

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9
Q

NSTEMI

A

myocardial necrosis as a result of poor blood supply (from acute thrombosis)
NO ECG changes

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10
Q

STEMI

A

same as NSTEMI but with ECG changes

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11
Q

cardiac enzymes signaling myocardial necrosis

A

troponin (most specific)

CK, CKMB (less specific, rise quickly)

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12
Q

angina quality

A

pressure, crushing, burning, tightness (acute)

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13
Q

angina location

A

substernal (can radiate to neck, jaw, shoulder, chest, arm, upper abdomen)

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14
Q

angina duration

A

0.5-20min

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15
Q

angina precipitating factors

A

exercise, cold weather, stress, postprandial

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16
Q

angina relieving factors

A

rest, SL nitroglycerin

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17
Q

typical angina

A

follows angina characteristics

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18
Q

atypical angina

A

meets only 2 of criteria

women/older adults/DM have a special presentation (anxiety, SOB, weakness, indigestion)

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19
Q

non-cardiac chest pain

A

does not meet/meets one criteria for angina

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20
Q

treatment of Stable IHD

A

Moderate/high statin
Aspirin 81mg
Clopidogrel if aspirin CI’d
both aspirin and Clopidogrel if high-risk

(dec risk of developing unstable ihd)

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21
Q

treatment of angina (chest pain)

A

just improves QOL, does not dec risk of SIHD

1: SL nitro prn
2: beta blocker (SL nitro doesnt work/ >1 anginal episode/day)
3: CCB/long acting nitrate
4: Ranolazine

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22
Q

CCB for anginal chest pain: Non-DHP v DHP

A

both dec O2 demand

avoid Non-DHP if on beta-blocker, HFrEF, severe LV dysfunction

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23
Q

long acting nitrate for angina

A

PO isosorbide mono/dinitrate or nitroglycerin patch

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24
Q

Ranolazine for angina

A

500mg BID

no effect on BP/HR

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25
Q

Unstable angina/STEMI strategies

A

medical management or early invasive (immediate cardiac catheterization)
OHSNAAP

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26
Q

O (in STEMI and NSTEMI treatment)

A

Oxygen, only if O2 sat <90%

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27
Q

S (in STEMI and NSTEMI treatment)

A

Statin (high intensity!)
atorvastatin 40-80
rosuvastatin 20-40

28
Q

N (in STEMI and NSTEMI treatment)

A

Nitroglycerin
SL q5min up to 3 times
IV if no response to SL
CI’d within 24hr of Sildenafil/Avanafil and 48hr of Tadalafil

29
Q

A (in STEMI and NSTEMI treatment)

A

Aspirin

LD give asap: non-enteric coated, chewable aspirin (324 or 325mg)

30
Q

A (2) (in STEMI and NSTEMI treatment)

A

Anticoagulants
IV unfractionated heparin for 48hr/ until PCI performed
OR
SQ enoxaparin for duration of hospital visit/until PCI performed

31
Q

P (in NSTEMI treatment)

A

P2Y12 inhibitor
LD: Ticagrelor 180mg, Clopidogrel 600mg

MD: (for 12mon) Ticagrelor 90mg BID Clopidogrel 75mg QD

ticagrelor PREFERRED
only use Prasugrel if PCI

32
Q

longterm treatment of ACS

A

SNAP + BAM

33
Q

B (in long-term STEMI and NSTEMI treatment)

A

beta-blocker unless pt has signs of acute HF (fluid overload/tachycardia)

use SR metoprolol succinate, carvedilol, bisprolol in pt with EF <40%

34
Q

A (in long-term STEMI and NSTEMI treatment)

A

ACEi/ARB

all pt should receive

35
Q

M (in long-term STEMI and NSTEMI treatment)

A

MRAs (Spironolactone or Eplerenone)
for pt with EF < 40% who are on ACEi/ARB or beta blocker
CI’d if pt: SCr >2.5mg/dL Males or >2.0mg/dL in Females
K > 5.0mg/dL

36
Q

P (in STEMI treatment)

A

LD: same as NSTEMI (Clopidogrel, Ticagrelor)

BUT Prasugrel 60mg can be used only after visualization of coronary anatomy
Ticagrelor and Prasugrel preferred over Clopidogrel

37
Q

Platelet Patho

A

Adhesion, Activation, Aggregation

38
Q

Adhesion

A

platelets adhere to exposed collagen and Von Willebrand Factor

39
Q

Activation

A

release activating factors and GP IIb/IIIa receptors on platelet surface

40
Q

Aggregation

A

cross-linking of platelets via GP IIb/IIIa receptor-fibrinogen binding; stabilize fibrin clot

41
Q

P2Y12 inhibitors

A

inhibit ADP platelet activation
PO: clopidogrel, prasugrel, ticagrelor
IV: cangrelor

42
Q

P2Y12 inhibitors recommendations

A
  • given for 1 yr to pt who receive a stent

- clopidogrel/ticagrelor + aspirin for 12mon to ALL ACS pt

43
Q

Clopidogrel characteristics

A

P2Y12 inhibitor

  • irreversible binding to ADP receptor
  • longer time to inhibit platelets 2-6hr 3-40%
44
Q

Prasugrel characteristics

A

irreversible binding to ADP receptor

quick platelet inhibition 30min 60-70%

45
Q

Ticagrelor characteristics

A

reversible, allosteric binding to ADP receptor

quick platelet inhibition 30min 60-70%

46
Q

Clopidogrel dosing

A

LD: 300-600mg medical management, 600mg PCI, 300mg STEMI w thrombolytic
MD: 75mg QD

47
Q

Prasugrel dosing

A

N/A for medical management and STEMI w thrombolytic
LD: 60mg PCI
MD: 10mg QD PCI

48
Q

Ticagrelor dosing

A

LD: 180mg medical management and PCI
MD: 90mg BID and 60 after 1yr medical management and PCI
N/A for STEMI w thrombolytic

49
Q

Cangrelor

A

IV platelet inhibitor
onset within 2min, normal platelet activity 1-1.5hr after discont
*give to pt who have NOT been treated with a P2Y12 inhibitor or GP IIb/IIIa inhibitor

50
Q

GP IIb/IIIa inhibitors

A

Abciximab, Eptifibatide, Tirofiban

51
Q

GP IIb/IIIa inhibitors characteristics

A

IV agents, block aggregation step
-administer at time of PCI (pt with NSTE-ACS not pre-treated with P2Y12i and pt with STEMI/ACS who were pre-treated with P2Y12i

52
Q

anticoagulation therapy

A

unfractionated heparin (UFH)
Low MW heparin (Enoxaparin)
Bivalirudin
Fondaparinux

53
Q

anticoagulation therapy key points

A
  • pt must be fully anticoagulated at time of PCI (dec risk of thrombus formation)
  • discont anticoag when PCI complete
  • Bivalirudin only option in pt with early invasive strategy
  • Do not use GP IIa/IIIb with bivalirudin (inc bleed risk)
54
Q

Bivalirudin anticoag key point

A

only use in pt with planned early invasive strategy

55
Q

Fondaparinux anticoag key point

A

contraindicated if CrCl <30ml/min

56
Q

Intermittent claudication (PAD)

A

pain when walking, relieved with rest (severe have pain at rest)

57
Q

Ulceration/infection/skin necrosis (PAD)

A

pt with DM and smokers at highest risk

58
Q

Acute Arterial Occlusion

A

medical emergency! requires immediate revascularization to prevent limb loss

59
Q

if pain is at buttocks, hips, thighs

A

blockage at aorta and iliac artery

60
Q

if pain is at thigh/calf

A

blockage at femoral artery

61
Q

if pain is at calf, ankle, foot

A

blockage at popliteal or tibial artery

62
Q

ABI 1-1.4

A

normal

63
Q

ABI 0.8-0.9

A

some PAD

64
Q

ABI 0.5-0.8

A

moderate PAD

65
Q

ABI <0.5

A

severe PAD

66
Q

Acute Limb Ischemia (from PAD) treatment

A

immediate admin of heparin, revascularize immediately in 1 of 3 ways

  • thrombolytics (local admin to occlusion site)
  • endovascular (balloon stenting, thrombectomy)
  • surgical (thrombectomy, bypass surgery, amputation if cannot revascularize)
67
Q

Longterm PAD treatment

A
  • aspirin with symptomatic PAD *+clopidogrel after revascularization
  • antiplatelet therapy if asymptomatic
  • statin for ALL
  • ACEi/ARB if HTN
  • Cilostazol if intermittent claudication (symptoms)

Therapeutics 601 (2 decks)

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