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951 Block 3 > 2. Fibrinolytics > Flashcards

2. Fibrinolytics Flashcards

(43 cards)

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1
Q

ASA is an effective treatment across the entire spectrum of ACS. (T/F)

A

True

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2
Q

What is the goal of ASA therapy in ACS?

A

quickly block formation of TXA2 in platelets

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3
Q

What is the effective acute dose of ASA?

A

160 - 325 mg

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4
Q

Why is the low dose ASA (81mg) ineffective in ACS?

A

takes several days to achieve full antiplatelet effect

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5
Q

Why is the ASA chewed in ACS?

A

buccal and sublingual absorption rather than GI

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6
Q

What is the ACS general treatment acronym and what does it stand for?

A

O: oxygen
M: morphine
N: nitroglycerin
A: antiplatelet

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7
Q

Why is pain management an important element of ACS treatment?

A

pain leads to increased SNS activity which increases the heart rate and leads to more ischemia

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8
Q

What analgesic agents are used with AMI?

A
  • morphine
  • Meperidine
  • Pentazocine
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9
Q

What is the analgesic agent of choice with ACS?

A

morphine

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10
Q

Why is morphine the agent of choice for ACS?

A

it has venodilatory effects that reduce ventricular preload

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11
Q

What organic nitrate agent is indicated in most ACS?

A

sublingual nitroglycerin - patient must be conscience

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12
Q

Why are organic nitrates indicated in ACS?

A
  • enhances cardiac blood flow by coronary vasodilation

- decreases ventricular preload

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13
Q

What patients are contraindicated for sublingual NG?

A
  • hypotension (SBP < 90)

- especially accompanied by bradycardia

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14
Q

After administering sublingual NG, what should be monitored?

A

BP

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15
Q

What is the goal of using beta-blockers in ACS?

A

reducing infarct size

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16
Q

Which AMI patients are most suited for beta-blocker therapy?

A

sinus tachycardia and HTN

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17
Q

Why are AMI patients who have sinus tachycardia and HTN suitable for BB therapy?

A
  • BBs lower HR and BP

- reduce myocardial O2 demand

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18
Q

What AMI patients are contraindicated for BB therapy?

Study These Flashcards
A
  • HF

- Hypotension/bradycardia

19
Q

What BB agent is preferred in ACS and why?

Study These Flashcards
A

metoprolol because it is cardio-selective

20
Q

What is the goal of therapy for using fibrinolytics in ACS?

Study These Flashcards
A

remove unwanted fibrin thrombi

21
Q

What stimulates the endothelium to release t-PA?

Study These Flashcards
A

reduced flow when thrombi occlude vessels

22
Q

Released t-PA has a relatively long half-life. (T/F)

Study These Flashcards
A

False: rapidly cleared from blood or inhibited by plasminogen activator inhibitors

23
Q

Plasmin that leaves the clot is inhibited by what?

Study These Flashcards
A

alpha 2-antiplasmin

24
Q

Describe the t-PA 90 minute administration

Study These Flashcards
A
  • 15 mg IV bolus
  • 0.75 mg/kg (50 mg max) over 30 minutes
  • 0.5 mg/kg (35 mg max) over 60 minutes
25
t-PA is rapidly deactivated; why do we administer it?
Pharmacological administration of plasminogen activators overwhelms the inhibition
26
What is the first generation fibrinolytic agent?
streptokinase
27
What produces streptokinase?
beta-hemolytic streptococci
28
Streptokinase has high intrinsic enzymatic activity. (T/F)
False: no intrinsic enzymatic activity
29
Streptokinase forms a stable, non-covalent 1:1 complex with what?
plasminogen
30
Streptokinase is not fibrin specific. (T/F)
True
31
What is the MOA of streptokinase?
Complexes with plasminogen to expose active sight and cleave into plasmin which goes on to degrade fibrin.
32
Why can streptokinase administration not be repeated?
antibodies develop after treatment
33
What is the second generation fibrinolytic agent?
rt-PA : alteplase
34
What is the key fibrinolytic feature of ateplase?
prolonged plasma clearance
35
What are the third generation fibrinolytic agents?
- derivatives of t-PA - rPA : reteplase - TNK-t-PA : tenecteplase
36
Reteplase lacks domains that increase elimination by the _______.
liver
37
Reteplase has a ______ affinity for fibrin than t-PA.
lower
38
Why is reteplase thought to be more effective than t-PA?
it is hypothesized that it can penetrate the clot and "chew it up" from the inside
39
Why is tenecteplase thought to be more effective than t-PA?
It is 80x more resistant to plasminogen activator inhibitor-1 than t-PA.
40
How is tenecteplase dosed?
single IV bolus (weight based) over 5 seconds
41
Tenecteplase is more fibrin-specific than t-PA. (T/F)
True
42
What is anistreplase?
complex of protein bound streptokinase
43
What is the thrombolytic activity of anistreplase?
release of the streptokinase component

951 Block 3 (10 decks)

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