ACS

Question 1

Immediate treatment for ACS?

Answer 1

ONAM

Question 2

what are the 3 classes of unstable angina?

Answer 2

rest angina, new-onset agina, crescendo angina

Question 3

definition of NSTEMI according to ACC/ECC

Answer 3

rise and fall of troponin, fall of CK-MB, ischemia, pathologic EKG changes

Question 4

How to antiplatelets work?

Answer 4

ASA decreases thromboxane A2 levels to decrease platelet clumping

Question 5

Uses for ASA

Answer 5

pain, ACS, stroke, rheumatic fever

Question 6

Which trial showed reduction in risk of death when ASA is used after ACS?

Answer 6

ISIS-2

Question 7

what are ADR for ASA?

Answer 7

respiratory, cutaneous, and systemic (anaphylaxis) sensitivity

Question 8

how long do you need to be off ASA before procedures?

Answer 8

24 hours

Question 9

how do oral antiplatelets work?

Answer 9

bind to ADP and downregulate Iib/IIIa which decreases platelet sticking to each other

Question 10

name the oral antiplatelets

Answer 10

ticlid, plavix, effient, brillinta

Question 11

what metabolizes clopidogrel?

Answer 11

2C19 (2 step reaction)

Question 12

how is brillinta metabolised and dosed?

Answer 12

it is an active drug (faster onset) and needs to be taken twice a day

Question 13

what drug can decrease clopidogrel efficacy?

Answer 13

nexium, PPIs

Question 14

what causes clopidogrel resistance?

Answer 14

genetic basis that increases CYP2C19

Question 15

according to the CHARISMA study, do oral antiplatelets decrease risk of death?

Answer 15

nope

Question 16

ADR for antiplatelets

Answer 16

bleeding, rash, pruritis, GI hemorrhage, TTP

Question 17

how soon does clopidogrel begin to work?

Answer 17

10-11 days

Question 18

why is ticlid not used?

Answer 18

BID, life-threatening hematologic reactions

Question 19

Which oral antiplatelet is weight-based?

Answer 19

effient

Question 20

Who should not use effient?

Answer 20

>75 y/o, <60kg

Question 21

how do IV antiplatelets work?

Answer 21

block Iib/IIIa to decrease pletelet binding

Question 22

what are the IV antiplatelets?

Answer 22

abxicimab, eptifibatide, tirofiban

Question 23

what are indications for abxicimab use?

Answer 23

when sending a pt to PCI

Question 24

What are the indications for eptifibatide use?

Answer 24

medical management - “cooling off” in ED

Question 25

Compare the plasma/platelet half lives of abxicimab and eptifibatide

Answer 25

abxicimab: short plasma, long platelet - eptifibatide: long plasma, short platelet

Question 26

ADR for IV antiplatelets

Answer 26

bleeding, TTP (may need reversal therapy with platelets)

Question 27

which IV antiplatelet are PAs not allow to prescribe?

Answer 27

integrellin

Question 28

When does an integrellin infusion stop?

Answer 28

after 18 hours

Question 29

what are the nitrates used in ACS?

Answer 29

isosorbide dinitrate, isosorbide mononitrate, nitroglycerin (explosive)

Question 30

which nitrates have rapid onset and short duration?

Answer 30

nitroglycerin and isosorbide dinitrate SL

Question 31

Which nitrates have slow onset and sustained duration?

Answer 31

nitroglycerin patch and isosorbide mononitrate tablets

Question 32

does the use of a nitrate reduce mortality rates?

Answer 32

not really

Question 33

when does SL nitroglycerin reach peak levels?

Answer 33

4 minutes - call 911 after this

Question 34

what are oral and cutaneous nitro used for?

Answer 34

prophylaxis

Question 35

What is the drug free zone?

Answer 35

time for nitroglycerin therapy where pt has no exposure to it: 12 hours

Question 36

ADR for nitrates

Answer 36

HA, dizziness, weakness, postural HOTN

Question 37

which drug is contraindicated when using nitrates?

Answer 37

viagra

Question 38

what is the ROA for amyl nitrate?

Answer 38

inhalation - same MOA

Question 39

what happens if amyl nitrates are used in combo with cocaine or ecstasy?

Answer 39

euphoric state is prolonged and intensified - "popper" were once thought to be the genesis of AIDs in the gay community

Question 40

what BB is used in ACS?

Answer 40

metoprolol

Question 41

what are the anticoagulants?

Answer 41

unfractionated heparin, LMW heparin, factor Xa inhibitors, direct thrombin inhibitors

Question 42

which anticoagulant requires a CrCl level before administration?

Answer 42

LMWH/factor Xa inhibitors: enoxaparin (except in STEMI)

Question 43

What labs are necessary to monitor with heparin therapy?

Answer 43

aPTTs (should be 1.5-2x the control)

Question 44

which anticoagulants are used only in PCI?

Answer 44

direct thrombin inhibitors (bivalirudin)

Question 45

name the fibrinolytics

Answer 45

alteplase, reteplase, tenecteplase

Question 46

when are fibrinolytics contraindicated?

Answer 46

bleeding disorders, previous head injury, cranial neoplasm, stroke, aortic dissection, active bleeding

Question 47

how do fibrinolytics work?

Answer 47

activate plasmin for fibrin breakdown

Question 48

how soon should fibrinolytics be administered to pts with AMI?

Answer 48

30 minutes

Question 49

for pts with ischemic sxs of an AMI of less than 12 hours and ST elevation which fibrinolytic is indicated?

Answer 49

any

Question 50

for pts with sxs less than 6 hours which fibrinolytic is indicated?

Answer 50

alteplase, tenecteplase

Question 51

what are uses for alteplase?

Answer 51

acute ischemic stroke, acute PE

Question 52

What is the reversal agent for fibrinolytics?

Answer 52

none specific - unlabeled use of tranexamic acid which helps you clot

Question 53

ADR of fibrinolytic therapy

Answer 53

bleeding, rapid lysis causing reperfusion (causing atrial/ventricular arrhythmias), cardiovascular events

Question 54

how are statins useful post MI?

Answer 54

plaque stabilization

Question 55

post MI/ACS care

Answer 55

ASA (clopidogrel), BB, ACEi, lipid lowering with HMGCoA reductase inhibitors

Question 56

what are target lipid levels for post MI/ACS care?

Answer 56

LDL \< 100, HDL \> 40, TG \< 200