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Flashcards in ACS/AMI II Deck (63):
0

How do you decide if pt w/ UA/NSTEMI should get conservative management over early invasive strategy?

Low risk TIMI/Grace score

1

Formula for volume of contrast that will cause CIN

Vol. Contrast = 4 x CrCl

2

In pt's with stage II or III CKD and UA/NSTEMI, is early invasive or conservative strategy preferred?

Invasive (Class IIa)

3

what to do for pt w/ 2 vessel dz (incld pLAD) and LV dysfxn?

CABG

4

What did TACTICS-TIMI 18 show for women with UA/NSTEMI?

Had more death, MI, and hospitalization if low trop and LHC

5

Reasonable

Class IIa

6

what GRACE score is high risk?

> 140

7

What is the timing of cath in early invasive strategy?

12-24 hrs

8

Reasons for NSTEMI with normal coronary anatomy on angio

Auto lysis of thrombus
Spasm
Non coronary trops (PE, etc)

9

Name 2 platelet receptors that can activate platelets

Thrombin receptor
ADP receptor

10

Thienopyridines (clopidogrel, prasugrel) mech

Irreversibly Block P2Y12 receptor and inhibit ADP-induced plt activation

11

Ticagrelor mech

Non-thienopyridine REVERSIBLE antagonist of P2Y12 ADP platelet receptor

12

GP 2b3a inhibitors and reversibility

Eptifibatide
Tirofiban (reversible)
Abciximab (irreversible)

13

Class I indication in NSTEMI for pt's intolerant of ASA

Clopidogrel

14

Chronic ASA dosing after DES

325 for 3-6 mo's
After 3-6 mo's, 81mg indefinitely

15

CURE study

Lower stroke/MI/CV Death w/ Plavix & ASA c/w ASA & placebo

16

What to remember about pt's who are poor metabolizes from abnormal CYP2C19 fxn?

Clopidogrel is less effective, consider alternative treatment

17

which trial showed that carriers of reduced fxn allele CYP2C19 have higher incidence of CV death, MI, or stroke?

TRITON-TIMI 38

18

Does prasugrel get affected by poor CYP2C19 metabolism?

No

19

Which anti platelets are Class I before PCI in NSTEMI?

Plavix
GP2b3a

20

What did TRITON TIMI 38 show for Plavix vs prasugrel?

Prasugrel had lower CV death, MI AND STROKE

21

Contraindications to prasugrel

Prior CVA
Age> 75
Weight <60kg

22

What did TRITON TIMI 38 show for IST?

50% Lower with prasugrel c/w clopidogrel

23

Why is ticagrelor faster acting than clopidogrel?

B/c it is not a prodrug

24

Which anti platelet drug reversibly binds to ADP receptor? When can that come in handy?

Ticagrelor
Need for Sx

25

Which trial showed that ticagrelor lowers death from vascular causes and IST c/t Plavix?

PLATO

26

In PLATO, was there a difference in bleeding b/w ticagrelor and Plavix?

Not statistically sig but inc'd trend in non-CABG bleeding for ticagrelor

27

Which anti platelet has the fastest onset?

Ticagrelor

28

Which anti platelet has the most variable response?

Plavix

29

Plavix and ticagrelor need to be held for 5 d before CABG. What about prasugrel.

7-10d

30

Which anti platelet has the highest bleeding risk.

Prasugrel

31

Which anti platelet has the most side effects (esp. SOB)?

Ticagrelor

32

Which anti platelet requires a max ASA dose of 81mg?

Ticagrelor

33

Which is the only ADP antagonist you can use in pt w/ prior ICH?

Plavix

34

Which ADP antagonist is preferred if pt is a high bleed risk?

Plavix

35

Which ADP antagonists are preferred in STEMI?

Prasugrel
Ticagrelor

36

Which ADP Antagonists are preferred in complex PCI or DM?

Prasugrel
Ticagrelor

37

What part of the plt pathway do GP2b3a antagonists inhibit?

Aggregation

38

**Which GP2b3a antagonist requires dose adjustments for CrCl<50?

Eptifibatide

39

Ticagrelor can cause insig bradycardia. What other SE is common and what is the mech?

SOB
adenosine release

40

In the EARLY ACS trial, what were the results of eptifibatide use when pt's also received ASA, hep, and Plavix? Was there a benefit to giving it upstream in NSTEMI vs. immediately prior to PCI?

Increased TIMI major bleeding
No

41

Main results for ACUITY study and bivalirudin?

In ACS , Less bleeding with bivalirudin alone (c/t hep and GP2b3a or bival + GP2b3a)

42

how long before CABG do you have to d/c IV GP IIb/IIIa inhibitors?

4h

43

when do you stop lovenox before CABG?

12-24hrs

44

when do you stop fondaparinux before CABG?

24h

45

when do you stop bivalirudin before CABG?

3h

46

what two antiplatelets/anticoagulants can you continue for CABG?

ASA, UFH

47

in a pt with NSTEMI/UA, if you find CAD on angio but decide on OMT, when can you d/c GPIIb/IIIa inhibitors if started pre-angio?

at least 12h

48

in pt. w/ NSTEMI/UA w/ CAD on angio going for just OMT, when do you D/C UFH?

after 48h (2d)

49

in pt. w/ NSTEMI/UA w/ CAD on angio going for just OMT, when do you D/C lovenox or fondaparinux?

on discharge from hospital

50

in pt. w/ NSTEMI/UA w/ CAD on angio going for just OMT, when is the max time you can d/c bivalirudin?

72 h (at a dose of .25mg/kg/h)

51

in pt. w/ NSTEMI/UA w/ CAD on angio going for just OMT, how long do you cont. ASA and clopidogrel?

ASA forever
Clopidogrel at least 1 mo (prefer 1 yr)

52

what are preferred strategies in patients that require triple antithrombotic therapy but are at high bleeding risk?

d/c ASA first
consider BMS

53

When ASA blocks COX, production of what is decreased?

TXA2

54

What did CURRENT-OASIS-7 show for pt's undergoing PCI and Plavix 600 vs 300?

600 lowered ischemic events but caused more bleeding

55

According to TRITON-TIMI-38, what happens if a pt is on clopidogrel and has CYP2C19 reduced-fxn allele?

Higher CV death/MI/Stroke

56

Is prasugrel a prodrug?

Yes

57

Which GP2b3a inhibitor is contraindicated to give upstream for UA/NSTEMI?

Abciximab

58

Which GP2b3a inhibitors are Class I at time of PVI for UA?

All

59

Does prasugrel have more major bleeding than Plavix according to TRITON-TIMI-38?

Yes

60

Is ticagrelor a prodrug?

No

61

Which anti platelet agent has been shown to reduce BOTH all-cause mortality and CV mortality?

Ticagrelor

62

Which anti platelet should you not use if patient had any type of AVB?

Ticagrelor