ACS pt4

Question 1

What is anticoag for in ACS?

Answer 1

Recommended in addition to antiplatelet therapy to improve vessel patency and prevent re-occlusion

Question 2

What is the MOA of UFH?

Answer 2

Anti-Xa and anti-2a activity

Question 3

What is the problem w UFH and LMWH?

Answer 3

It can cause HIT, which is a drop in platelet count and increased thrombosis

Question 4

How is HIT caused?

Answer 4

Caused by formation of antibodies that activate platelets

Question 5

What screening tests are available for HIT?

Answer 5

ELISA and SRA

Question 6

What should be done if pt tests positive for HIT?

Answer 6

If pt is + for HIT, stop UFH/LMWH, and tx for HIT while doing SRA for true + HIT diagnosis

Question 7

How is UFH administered?

Answer 7

As a continuous infusion

Question 8

What is dosing of UFH based on?

Answer 8

aPTT or ACT

Question 9

What LMWH drug is used?

Answer 9

Enoxaparin

Question 10

What is the MOA of LMWH?

Answer 10

Anti-Xa and anti-2a activity

Question 11

How is LMWH eliminated?

Answer 11

By kidneys
- accumulates in renal impairment

Question 12

What drug class is bivalirudin?

Answer 12

DTI

Question 13

What other drug class is bivalirudin not used together with?

Answer 13

Not used together w GP2b/3a inhibitors (except bail out)

Question 14

What drug class is fondaparinux?

Answer 14

Factor Xa inhibitor

Question 15

When is fondaparinux used?

Answer 15

• Not commonly used
• Can be used in pts w hx of HIT

Question 16

When is fondaparinux not used?

Answer 16

• Do not use alone for PCI bc of higher rates of thrombosis
• Not drug of choice if planning PCI

Question 17

What should be done if pt is given fondaparinux and pt needs PCI?

Answer 17

Need to give pt UFH or bivalirudin also

Question 18

When is fondaparinux CI?

Answer 18

If pt CrCl <30 ml/min