ACS

Question 1

Difference between NSTEMI and UA

Answer 1

severity of ischemia. NSTEMI has positive biomarkers and UA does not

Question 2

ECG suggesting NSTEMI/UA

Answer 2

ST depression, T wave inversion

Question 3

ECG suggesting STEMI

Answer 3

ST elevation; left bundle branch block

Question 4

Door to balloon time of _________ or less for patients undergoing PCI for STEMI

Answer 4

90 minutes

Question 5

P2Y-12 inhibitor contraindicated in patients with any history of stroke or TIA because of bleeding risk

Answer 5

Prasugrel

Question 6

Prasugrel has a warning of use in patients > ______ years old and < _______kg

Answer 6

> 75 yo

<60 kg

Question 7

Which P2Y12 inhibitor is given IV?

Answer 7

Cangrelor

Question 8

Which P2Y12 inhibitor(s) should held 5 days prior to CABG

Answer 8

Clopidogrel

TIcagrelor

Question 9

Which P2Y12 inhibitor(s) should be held for 7 days prior to CABG

Answer 9

Prasugrel

Question 10

Avoid concomitant maintenance dose of aspirin >100mg due to lack of efficacy with this P2Y12 inhibitor

Answer 10

Ticagrelor

Question 11

Clopidogrel LD and MD

Answer 11

LD: 300-600mg
MD: 75mg QD

Question 12

Prasugrel LD & MD

Answer 12

LD: 60mg
MD: 5-10mg QD

Question 13

Ticagrelor LD & MD

Answer 13

LD: 180mg
MD: 90 mg BID

Question 14

Which p2Y12 inhibitor is not recommended as an inhitial antiplatelet therapy before PCI and why

Answer 14

prasugrel

increase in bleeding (CABG, non-CABG and life-threatening)

Question 15

Common adverse effect with ticagrelor

Answer 15

dyspnea

Question 16

Duration of clopidogrel/prasugrel/or ticagrelor after PCI with BMS or DES

Answer 16

ideally >= 12 months

HIgh bleeding risk (OAC or increased risk severe bleeding complications like major intracranial surgery) less than 12 months is suggested

Question 17

Antiplatelet after CABG

Answer 17

DAPT to complete 1 year

Question 18

Antiplatelet after fibrinolytic (STEMI)

Answer 18

Minimum 14 days; ideally >=12 months with clopidogrel

Question 19

Antiplatelet after medical therapy (no revascularization)

Answer 19

> =12 months (clopidogrel or ticagrelor)

Question 20

Switching from ticagrelor or prasugrel to clopidogrel

Answer 20

Take clopidogrel 600mg LD 24 hours after last dose.

COnsider starting with clopidogrel 75mg MD 24 hours after last dose instead of LD if bleeding or bleeding concerns

Question 21

Switching from clopidogrel or prasugrel or ticagrelor

Answer 21

GIve LD (ticagrelor 180mg or prasugrel 60mg) irrespective of timing and last dose of clopidogrel

Question 22

heparin dose for ACS

Answer 22

60 units/kg bolus (max 4000 units) then 12 unit/kg/hr (max 1000 units/hr) titrated to Xa goal

During PCI: 50-100 units/kg depending on target ACT

Question 23

Morphine has a potentially significant drug-drug interaction with what class of medications?

Answer 23

P2Y12 inhibitors

potentially affects absorption and kinetics leading to delayed effect on platelets

?due to slowing of GI motility

Question 24

Role of morphine in ACS

Answer 24

Relieve ischemia, vasodilating coronary arteries and mitigating the effects of the sympathetic nervous system

Question 25

Beta-blockers have shown what benefit and at what risk in ACS

Answer 25

Benefit: reduction in reinfarction and sudden cardiac death/malignant ventricular arrhythmias RIsk: hypotension and cardiogenic shock