Flashcards in ACS/AMI II Deck (63):
How do you decide if pt w/ UA/NSTEMI should get conservative management over early invasive strategy?
Low risk TIMI/Grace score
Formula for volume of contrast that will cause CIN
Vol. Contrast = 4 x CrCl
In pt's with stage II or III CKD and UA/NSTEMI, is early invasive or conservative strategy preferred?
Invasive (Class IIa)
what to do for pt w/ 2 vessel dz (incld pLAD) and LV dysfxn?
What did TACTICS-TIMI 18 show for women with UA/NSTEMI?
Had more death, MI, and hospitalization if low trop and LHC
what GRACE score is high risk?
What is the timing of cath in early invasive strategy?
Reasons for NSTEMI with normal coronary anatomy on angio
Auto lysis of thrombus
Non coronary trops (PE, etc)
Name 2 platelet receptors that can activate platelets
Thienopyridines (clopidogrel, prasugrel) mech
Irreversibly Block P2Y12 receptor and inhibit ADP-induced plt activation
Non-thienopyridine REVERSIBLE antagonist of P2Y12 ADP platelet receptor
GP 2b3a inhibitors and reversibility
Class I indication in NSTEMI for pt's intolerant of ASA
Chronic ASA dosing after DES
325 for 3-6 mo's
After 3-6 mo's, 81mg indefinitely
Lower stroke/MI/CV Death w/ Plavix & ASA c/w ASA & placebo
What to remember about pt's who are poor metabolizes from abnormal CYP2C19 fxn?
Clopidogrel is less effective, consider alternative treatment
which trial showed that carriers of reduced fxn allele CYP2C19 have higher incidence of CV death, MI, or stroke?
Does prasugrel get affected by poor CYP2C19 metabolism?
Which anti platelets are Class I before PCI in NSTEMI?
What did TRITON TIMI 38 show for Plavix vs prasugrel?
Prasugrel had lower CV death, MI AND STROKE
Contraindications to prasugrel
What did TRITON TIMI 38 show for IST?
50% Lower with prasugrel c/w clopidogrel
Why is ticagrelor faster acting than clopidogrel?
B/c it is not a prodrug
Which anti platelet drug reversibly binds to ADP receptor? When can that come in handy?
Need for Sx
Which trial showed that ticagrelor lowers death from vascular causes and IST c/t Plavix?
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
Which anti platelet has the fastest onset?
Which anti platelet has the most variable response?
Plavix and ticagrelor need to be held for 5 d before CABG. What about prasugrel.
Which anti platelet has the highest bleeding risk.
Which anti platelet has the most side effects (esp. SOB)?
Which anti platelet requires a max ASA dose of 81mg?
Which is the only ADP antagonist you can use in pt w/ prior ICH?
Which ADP antagonist is preferred if pt is a high bleed risk?
Which ADP antagonists are preferred in STEMI?
Which ADP Antagonists are preferred in complex PCI or DM?
What part of the plt pathway do GP2b3a antagonists inhibit?
**Which GP2b3a antagonist requires dose adjustments for CrCl<50?
Ticagrelor can cause insig bradycardia. What other SE is common and what is the mech?
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
Main results for ACUITY study and bivalirudin?
In ACS , Less bleeding with bivalirudin alone (c/t hep and GP2b3a or bival + GP2b3a)
how long before CABG do you have to d/c IV GP IIb/IIIa inhibitors?
when do you stop lovenox before CABG?
when do you stop fondaparinux before CABG?
when do you stop bivalirudin before CABG?
what two antiplatelets/anticoagulants can you continue for CABG?
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
in pt. w/ NSTEMI/UA w/ CAD on angio going for just OMT, when do you D/C UFH?
after 48h (2d)
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
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)
in pt. w/ NSTEMI/UA w/ CAD on angio going for just OMT, how long do you cont. ASA and clopidogrel?
Clopidogrel at least 1 mo (prefer 1 yr)
what are preferred strategies in patients that require triple antithrombotic therapy but are at high bleeding risk?
d/c ASA first
When ASA blocks COX, production of what is decreased?
What did CURRENT-OASIS-7 show for pt's undergoing PCI and Plavix 600 vs 300?
600 lowered ischemic events but caused more bleeding
According to TRITON-TIMI-38, what happens if a pt is on clopidogrel and has CYP2C19 reduced-fxn allele?
Higher CV death/MI/Stroke
Is prasugrel a prodrug?
Which GP2b3a inhibitor is contraindicated to give upstream for UA/NSTEMI?
Which GP2b3a inhibitors are Class I at time of PVI for UA?
Does prasugrel have more major bleeding than Plavix according to TRITON-TIMI-38?
Is ticagrelor a prodrug?
Which anti platelet agent has been shown to reduce BOTH all-cause mortality and CV mortality?