Flashcards in 35 - ACS Deck (40):
Don't use fibrinolytic therapy in ____
Describe the urgent acute tx for UA/NSTEMI
need early, urgent coronary angiography followed by if possible, by revascularization with PCI or bypass surgery in all high risk patients
What do you use for initial attempts at symptom relief
What drug do you start ASAP in all patients without contraindications?
When are CCBs indicated?
used to control ongoing symptoms of ischemia in patients receiving max doses of BBs and nitrates
Which type of CCBs should be used cautiously with BBs?
Non-DHPs (diltiazem, verapamil)
-they act more centrally and behave similar to BBs
-can cause LV dysfunction, severe bradycardia or increased AV nodal block
What CCB should you avoid bc it can cause acute drop in BP and cause a stroke?
Why are ACEi's used?
they reduce mortality
When should you initiate an ACEi?
within 24 hours of presentation
What is the preferred heparin in those who don't have significant renal dysfunction (i.e. CrCl > 30)
What do you use if CrCl < 30?
UFH is appropriate
How long is heparin used for?
usually used x 2-5 days
Do you use heparin following successful PCI?
_____ is as effective as enoxaparin in patients with NSTEMI
fondaparinux (factor Xa inhibitor)
When would you consider bivalrudin (direct thrombin inhibitor)?
Bivalrudin use is considered a reasonable strategy in patients with ACS undergoing PCI with concomitant P2Y12 inhibition and/or GP2b/3a inhibitor use
Give ____ indefinitely as part of antiplatelet therapy
What are the 3 P2Y12 platelet receptor inhibitors that are classified as thienopyridines?
-Ticlopidine (rarely used bc the other 2 are more safe)
What is an example of P2Y12 platelet receptor inhibitor that is classified as a cyclopentyltriazolopyrimidine?
_____ does not require metabolic activation
How long do you hold each agent before surgery? (clopidogrel, prasugrel and ticagrelor)
-Clopidogrel and Ticagrelor = hold 5 days
-Prasugrel = hold 7 days
List some Glycoprotein 2b/3a inhibitors (antiplatelet agents)
eptifibatide, tirofiban, abciximab
eptifibatide, tirofiban, abciximab - These agents can cause _______
*so have to monitor platelet counts
If can't do PCI within ___ hours, do pharmacoinvasive strategy
List 2 options for thrombolytic therapy
alteplase or tenecteplase
When should thrombolytic therapy bc started?
best if started within 6 hours of symptom onset
Give _____ to all STEMI patients receiving alteplase or tenecteplase
What is an alternative to IV UFH?
Who should you caution enoxaparin in?
in those > 75 yo or those with renal insufficiency due to increased risk of bleed
Heparins should be continued for a minimum of ___ hours
____ is initiated for life
Initiate ___ once hemodynamically stable to reduce mortality and risk of recurrent MI
What is your target for BB's?
Titrate doses to a resting HR of 50-60 bpm
What drug do we absolutely NOT recommend in STEMI patients?
CCBs - they increase morbidity and mortality in STEMI patients
In what situation could you use a CCB?
ONLY if person is CI to BB. Use cautiously. Consider low-dose diltiazem and monitor HR closely
Use ____ if ischemia is persistant or recurrent
When should you start an ACEi?
within 24 hours of the event unless patient is hypotensive
When would you use an ARB?
if patient can't tolerate ACEi
When would you use a MRA (ex. spironolactone or eplerenone)?
if patient on ACEi and BB still have symptoms of HF, LVEF < 40% or both
Add ____ as DAPT with ASA