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ACS/AMI II Flashcards

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1
Q

Formula for volume of contrast that will cause CIN

A

Vol. Contrast = 4 x CrCl

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2
Q

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

A

Invasive (Class IIa)

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3
Q

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

A

CABG

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4
Q

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

A

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

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5
Q

Reasonable

A

Class IIa

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6
Q

what GRACE score is high risk?

A

> 140

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7
Q

What is the timing of cath in early invasive strategy?

A

12-24 hrs

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8
Q

Reasons for NSTEMI with normal coronary anatomy on angio

A

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

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9
Q

Name 2 platelet receptors that can activate platelets

A

Thrombin receptor

ADP receptor

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10
Q

Thienopyridines (clopidogrel, prasugrel) mech

A

Irreversibly Block P2Y12 receptor and inhibit ADP-induced plt activation

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11
Q

Ticagrelor mech

A

Non-thienopyridine REVERSIBLE antagonist of P2Y12 ADP platelet receptor

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12
Q

GP 2b3a inhibitors and reversibility

A

Eptifibatide
Tirofiban (reversible)
Abciximab (irreversible)

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13
Q

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

A

Clopidogrel

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14
Q

Chronic ASA dosing after DES

A

325 for 3-6 mo’s

After 3-6 mo’s, 81mg indefinitely

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15
Q

CURE study

A

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

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16
Q

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

A

Clopidogrel is less effective, consider alternative treatment

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17
Q

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

A

TRITON-TIMI 38

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18
Q

Does prasugrel get affected by poor CYP2C19 metabolism?

A

No

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19
Q

Which anti platelets are Class I before PCI in NSTEMI?

A

Plavix

GP2b3a

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20
Q

What did TRITON TIMI 38 show for Plavix vs prasugrel?

A

Prasugrel had lower CV death, MI AND STROKE

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21
Q

Contraindications to prasugrel

A

Prior CVA
Age> 75
Weight <60kg

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22
Q

What did TRITON TIMI 38 show for IST?

A

50% Lower with prasugrel c/w clopidogrel

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23
Q

Why is ticagrelor faster acting than clopidogrel?

A

B/c it is not a prodrug

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24
Q

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

A

Ticagrelor

Need for Sx

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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
63
How do you decide if pt w/ UA/NSTEMI should get conservative management over early invasive strategy?
Low risk TIMI/Grace score

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