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Flashcards in 35 - ACS Deck (40):
1

Don't use fibrinolytic therapy in ____

NSTEMI

2

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

3

UA/NSTEMI:
What do you use for initial attempts at symptom relief

nitroglycerin

4

UA/NSTEMI:
What drug do you start ASAP in all patients without contraindications?

Beta blocker

5

UA/NSTEMI:
When are CCBs indicated?

used to control ongoing symptoms of ischemia in patients receiving max doses of BBs and nitrates

6

UA/NSTEMI:
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

7

UA/NSTEMI:
What CCB should you avoid bc it can cause acute drop in BP and cause a stroke?

IR nifedipine

8

UA/NSTEMI:
Why are ACEi's used?

they reduce mortality

9

UA/NSTEMI:
When should you initiate an ACEi?

within 24 hours of presentation

10

UA/NSTEMI:
What is the preferred heparin in those who don't have significant renal dysfunction (i.e. CrCl > 30)

Enoxaparin

11

UA/NSTEMI:
What do you use if CrCl < 30?

UFH is appropriate

12

UA/NSTEMI:
How long is heparin used for?

usually used x 2-5 days

13

UA/NSTEMI:
Do you use heparin following successful PCI?

Not usually

14

UA/NSTEMI:
_____ is as effective as enoxaparin in patients with NSTEMI

fondaparinux (factor Xa inhibitor)

15

UA/NSTEMI:
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

16

UA/NSTEMI:
Give ____ indefinitely as part of antiplatelet therapy

ASA

17

UA/NSTEMI:
What are the 3 P2Y12 platelet receptor inhibitors that are classified as thienopyridines?

-Clopidogrel
-Prasugrel
-Ticlopidine (rarely used bc the other 2 are more safe)

18

UA/NSTEMI:
What is an example of P2Y12 platelet receptor inhibitor that is classified as a cyclopentyltriazolopyrimidine?

Ticagrelor

19

UA/NSTEMI:
_____ does not require metabolic activation

Ticagrelor

20

UA/NSTEMI:
How long do you hold each agent before surgery? (clopidogrel, prasugrel and ticagrelor)

-Clopidogrel and Ticagrelor = hold 5 days
-Prasugrel = hold 7 days

21

UA/NSTEMI:
List some Glycoprotein 2b/3a inhibitors (antiplatelet agents)

eptifibatide, tirofiban, abciximab

22

UA/NSTEMI:
eptifibatide, tirofiban, abciximab - These agents can cause _______

thrombocytopenia

*so have to monitor platelet counts

23

STEMI:
If can't do PCI within ___ hours, do pharmacoinvasive strategy

2

24

STEMI:
List 2 options for thrombolytic therapy

alteplase or tenecteplase

25

STEMI:
When should thrombolytic therapy bc started?

best if started within 6 hours of symptom onset

26

STEMI:
Give _____ to all STEMI patients receiving alteplase or tenecteplase

IV UFH

27

STEMI:
What is an alternative to IV UFH?

enoxaparin (LMWH)

28

STEMI:
Who should you caution enoxaparin in?

in those > 75 yo or those with renal insufficiency due to increased risk of bleed

29

STEMI:
Heparins should be continued for a minimum of ___ hours

48

30

STEMI:
____ is initiated for life

ASA

31

STEMI:
Initiate ___ once hemodynamically stable to reduce mortality and risk of recurrent MI

BB

32

STEMI:
What is your target for BB's?

Titrate doses to a resting HR of 50-60 bpm

33

STEMI:
What drug do we absolutely NOT recommend in STEMI patients?

CCBs - they increase morbidity and mortality in STEMI patients

34

STEMI:
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

35

STEMI:
Use ____ if ischemia is persistant or recurrent

nitrates

36

STEMI:
When should you start an ACEi?

within 24 hours of the event unless patient is hypotensive

37

STEMI:
When would you use an ARB?

if patient can't tolerate ACEi

38

STEMI:
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

39

STEMI:
Add ____ as DAPT with ASA

clopidogrel

40

STEMI:
How do you treat pericarditis ?

increases ASA dose or adding NSAID, corticosteroid or colchicine

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