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Flashcards in ACSFC Deck (44)
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1
Q

Classic signs and sx of ACS

A

chest pain, diaphoresis, N/V, numbness/tingling sensation, SOB, dyspnea. Pain is not relieved by NTG spray or SL

2
Q

Diagnosis: UA/NSTEMI/STEMI

A

UA: Chest pain (10/10) crushing chest pain
NSTEMI: Chest pain & + biomarkers Troponin I or T, CK-MB
STEMI: Chest pain, + biomarkers, ECG changes (1mm ST elevations

3
Q

Treatment of UA/NSTEMI and STEMI

A

UA/ NSTEMI: MONA + GAP-BA
STEMI: MONA + GAP-BA + thrombolytics

4
Q

Risk factors for ACS

A

Age men >45 women >55 or early hysterectomy
Family hx of coronary events B4 age 55 in men and 65 in women. Smoking, HTN, hyperlipidemia, diabetes, chronic angina, known CAD

5
Q

what does MONA + GAP-BA stand for?

A

Pre hospital care: Morphine
Oxygen
Nitrates
Aspirin
ER care: Glycoprotein IIb/IIIa inhibitors
Anticoagulants
P2Y12 inhibitors
Beta Blocker
ACEIs

6
Q

Morphine

A

decreases O2 demand; vasodilator. used for chest discomfort. dosed 2-5mg IV PRN. s/e bradycardia, hypotension, respiratory depression, sedation.

7
Q

Oxygen

A

give in pts O2 sat <90%. if cyanosis or respiratory distress

8
Q

Nitrates, what types? when Do not use?

A

Acute SL or spray. take 1 dose if not better call 911. hospital IV drip to decrease chest pain. do not use if SBP <50

9
Q

Aspirin

A

325mg chew if EC. Take indefinitely if tolerated but 81 mg dose

10
Q

integrilin

A

eptifibatide

11
Q

ReoPro

A

abciximab

12
Q

Glycoprotein IIb/IIIa inhibitors MOA & CI

A

reversibly block platelet aggregation on binding site of fibrongen, von willibrand factor. , preventing thrombosis. C.I. active internal bleeding, uncontrolled BP S/E: Bleeding, thrombocytopenia esp abciximab), hypotension. Administration: Do not shake vial upon reconstitution.

13
Q

Abciximab (Reopro) CI: w/ administration what should u do? when does plt function return to normal after d/c

A

C.I. w/ hx of CVA w/in 2 years. hypersensitivity to murine proteins, and thrombocytopenia. Must filter with administration. Platelet fxn returns in 24-48hrs after d/c abciximab

14
Q

Eptifibatide (Integrilin)
CI:
what CrCL to reduce dose

A

CI in hx of stroke with 30 days or any hx of hemorrhagic stroke, renal dysfunction-reduce infusion rate by 50% in pts Crcl <50ml/min

15
Q

Tirofiban (Aggrastat)

A

CI in hx of stroke with 30 days or any hx of hemorrhagic stroke, renal dysfunction-reduce infusion rate by 50% in pts Crcl <30ml/min

16
Q

P2Y12 inhibitors MOA, lifespan of drugs? which one has fast onset and offset? lifespan of drugs
which one has fast onset and offset

A

inhibit platelet activation and aggregation on the ADP receptors on platelets. Clopidogel and Prasugrel are prodrugs and have irreversible binding to the receptor. Lifespan of platelet is 7-10days Ticagrelor had reversible binding and faster on and off set

17
Q

Clopidogrel (Plavix)
dose
bbw
adr
when d/c in pts doing cabg?

A

LD: 300-600mg MD: 75mg d BBW: poor metabolizers of 2C19 allele b/c PRODRUG*. S/E- bleeding, TTP (rash), bruising. Do not start in pts likely to undergo CABG. D/C 5 days prior to any major surgery

18
Q

Prasugrel (Effient)
do not use in what age
why not use in that age
when do you start givign after a pci has been given.

A

LD: 60mg MD: 10mg, 5mg 75 unless they have DM or MI. D/C 7 days prior to major surgery. if PCI, give dose no later than 1 hr

19
Q

Ticagrelor (Brilinta)

A

LD: 180mg/d MD: 90mg bid. use w/ ASA 75-100mg. BBW: sever fatal bleeding. S/E bleeding, dyspnea. D/C 5 days prior to major surgery. MD of ASA above 100mg reduce effectiveness of ticagrelor-only 81 mg. used for just ACS pts

20
Q

When do you use BB and CCB

A

use within the 1st 24hrs to prevent cardiac remodeling

21
Q

When to use thrombolytics per guidelines?

A

*when you can’t perform PCI w/in 90 mins.
use thrombolytics within 12 hrs from sx onset.Door to balloon time should be <30mins (thrombolytics) if at a hospital. but thrombolytics should be beneficial as long as under 12 hrs of symptom onset.

22
Q

Thrombolytics MOA

A

cause fibrinolysis by binding to fibrin in a thrombus (clot) and convertingp entrapped plasminogen to plasmin.

23
Q

Thrombolytics

A

Alteplase (t-PA)
Reteplase (r-PA
Tenecteplase (TNKase)
Streptokinase (Streptase)
S/E intercranial bleeding, hypotension, fever, bleeding

24
Q

Medications to avoid with ACS

A

NSAIDs, IR DHP (nifedipine) should not be used in the absence of b-blockers. IV fibinolytics is not indicated in pts w/o ST-segment elevation

25
Q

What drugs should you avoid with clopidogrel?

A

cimetidine, azole antifungals, omeprazole, fluoxetine, fluvoxamine etc

26
Q

What drugs should be continued when pt goes for CABG?

A

ASA, UFH

27
Q

What drugs should be discontinued when pt goes for CABG?

A

Clopogrel and ticagrelor 5 days b4 and Prasagel 7 days B4. if enoxaparin: 12-24hrs B4, if fonda: 24hrs b4, if bivalirudin 3 hrs b4

28
Q

Long term meds for status post MI?aspirin- bare metal stent, sirolimus eluting stent, and paclitaxel eluting stent.

A

ASA indefinitely 81mg, if stent placement use ASA 325mg: 1mos bare metal stent, 3 mos sirolimus- eluting stent, 6mos w/ paclitaxel-eluting.

Plavix 75mg or effient 10mg for at least 1mon and up to 12 mos to 15 mos if drug eluting stentstent.

NTG SL or spray, BB d, ACE-I < 40%, statin, warfarin, tylenol for pain relief.

29
Q

acs cause

A

imbalance b/w oxy demand and supply due to athersclorosis–> infarction. this causes release of markers:

30
Q

what markers are released after infarketion

A

troponin I or T and CK and Myocardial band (MB).

31
Q

morphine moa

A

arteriolar and venous dilation , prompts a decrease in o2 demand and pain relief.

32
Q

morphine adr

A

hypotension bradycardia, n/v/ resp depression

33
Q

GAP-BA

A
  1. GP II/III receptor antagonist
    Anticoagulant
    P2y12 inhinitors (plavix, prasugrel)
    Beta blockers
    Ace inhibitors
34
Q

glycoprotein II/II antag for who

A

those doing an intervention PCI or stent

35
Q

which agents are glycoprotein

A

abciximab, eptifibatide, tirofab
**rmr eptifibatidde seen in the cath lab at slu

36
Q

what are p2y12 inhibitors

A

clopidogrel or prasugrel (ticagrelor) - for all pts loading dose followed by maintenance dose unless undergoing cabg

37
Q

medications to avoid is acs

A

nsaids including cox2
dhp clacium cahannel blockers
iv fibrinolytic therpay is not indicated.

38
Q

prasugrel for who

A

reduction of thrombotic events in pts with ACS who have DONE A PCI

39
Q

ticagrelo drug interaction what common drugs

A

simvastatin dont use more than 40 mg.

40
Q

STEMI diagnosis

A

chest pain > 20 mins, shows ST elevation on ECG, toponin T or I elevation/CK MB elevation

41
Q

fibrinolytics CI

A

History of CVA-
recent intracranial or intraspinal surgery w/in last 3 months
intracranial neoplasm
ischemic stroke w/in 3 months!!
aortic dissection
uncontrolled htn
careful if***SBP> 185

42
Q

fibrinolytics side effects

A

bleeding, hypotension, intracranial hemorrage, fever*** thats why intracranial neoplasm and htn stuff are CI!!

43
Q

plavix how often take

A

once daily

44
Q

if you are using aspirin, clopidogrel and warfarin all three agents then maintain INR at

A

2-2.5
you would add on warfarin if afib or IF pt has LV thrombus.