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PEBC > 35 - ACS > Flashcards

35 - ACS Flashcards

1
Q

Don’t use fibrinolytic therapy in ____

A

NSTEMI

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2
Q

Describe the urgent acute tx for UA/NSTEMI

A

need early, urgent coronary angiography followed by if possible, by revascularization with PCI or bypass surgery in all high risk patients

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3
Q

UA/NSTEMI:

What do you use for initial attempts at symptom relief

A

nitroglycerin

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4
Q

UA/NSTEMI:

What drug do you start ASAP in all patients without contraindications?

A

Beta blocker

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5
Q

UA/NSTEMI:

When are CCBs indicated?

A

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

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6
Q

UA/NSTEMI:

Which type of CCBs should be used cautiously with BBs?

A

Non-DHPs (diltiazem, verapamil)

  • they act more centrally and behave similar to BBs
  • can cause LV dysfunction, severe bradycardia or increased AV nodal block
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7
Q

UA/NSTEMI:

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

A

IR nifedipine

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8
Q

UA/NSTEMI:

Why are ACEi’s used?

A

they reduce mortality

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9
Q

UA/NSTEMI:

When should you initiate an ACEi?

A

within 24 hours of presentation

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10
Q

UA/NSTEMI:

What is the preferred heparin in those who don’t have significant renal dysfunction (i.e. CrCl > 30)

A

Enoxaparin

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11
Q

UA/NSTEMI:

What do you use if CrCl < 30?

A

UFH is appropriate

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12
Q

UA/NSTEMI:

How long is heparin used for?

A

usually used x 2-5 days

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13
Q

UA/NSTEMI:

Do you use heparin following successful PCI?

A

Not usually

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14
Q

UA/NSTEMI:

_____ is as effective as enoxaparin in patients with NSTEMI

A

fondaparinux (factor Xa inhibitor)

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15
Q

UA/NSTEMI:

When would you consider bivalrudin (direct thrombin inhibitor)?

A

Bivalrudin use is considered a reasonable strategy in patients with ACS undergoing PCI with concomitant P2Y12 inhibition and/or GP2b/3a inhibitor use

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16
Q

UA/NSTEMI:

Give ____ indefinitely as part of antiplatelet therapy

A

ASA

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17
Q

UA/NSTEMI:

What are the 3 P2Y12 platelet receptor inhibitors that are classified as thienopyridines?

A
  • Clopidogrel
  • Prasugrel
  • Ticlopidine (rarely used bc the other 2 are more safe)
18
Q

UA/NSTEMI:

What is an example of P2Y12 platelet receptor inhibitor that is classified as a cyclopentyltriazolopyrimidine?

A

Ticagrelor

19
Q

UA/NSTEMI:

_____ does not require metabolic activation

A

Ticagrelor

20
Q

UA/NSTEMI:

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

A
  • Clopidogrel and Ticagrelor = hold 5 days

- Prasugrel = hold 7 days

21
Q

UA/NSTEMI:

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

A

eptifibatide, tirofiban, abciximab

22
Q

UA/NSTEMI:

eptifibatide, tirofiban, abciximab - These agents can cause _______

A

thrombocytopenia

*so have to monitor platelet counts

23
Q

STEMI:

If can’t do PCI within ___ hours, do pharmacoinvasive strategy

A

2

24
Q

STEMI:

List 2 options for thrombolytic therapy

A

alteplase or tenecteplase

25
Q

STEMI:

When should thrombolytic therapy bc started?

A

best if started within 6 hours of symptom onset

26
Q

STEMI:

Give _____ to all STEMI patients receiving alteplase or tenecteplase

A

IV UFH

27
Q

STEMI:

What is an alternative to IV UFH?

A

enoxaparin (LMWH)

28
Q

STEMI:

Who should you caution enoxaparin in?

A

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

29
Q

STEMI:

Heparins should be continued for a minimum of ___ hours

A

48

30
Q

STEMI:

____ is initiated for life

A

ASA

31
Q

STEMI:

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

A

BB

32
Q

STEMI:

What is your target for BB’s?

A

Titrate doses to a resting HR of 50-60 bpm

33
Q

STEMI:

What drug do we absolutely NOT recommend in STEMI patients?

A

CCBs - they increase morbidity and mortality in STEMI patients

34
Q

STEMI:

In what situation could you use a CCB?

A

ONLY if person is CI to BB. Use cautiously. Consider low-dose diltiazem and monitor HR closely

35
Q

STEMI:

Use ____ if ischemia is persistant or recurrent

A

nitrates

36
Q

STEMI:

When should you start an ACEi?

A

within 24 hours of the event unless patient is hypotensive

37
Q

STEMI:

When would you use an ARB?

A

if patient can’t tolerate ACEi

38
Q

STEMI:

When would you use a MRA (ex. spironolactone or eplerenone)?

A

if patient on ACEi and BB still have symptoms of HF, LVEF < 40% or both

39
Q

STEMI:

Add ____ as DAPT with ASA

A

clopidogrel

40
Q

STEMI:

How do you treat pericarditis ?

A

increases ASA dose or adding NSAID, corticosteroid or colchicine

PEBC (130 decks)

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