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Flashcards in ACSFC Deck (44):
1

Classic signs and sx of ACS

chest pain, diaphoresis, N/V, numbness/tingling sensation, SOB, dyspnea. Pain is not relieved by NTG spray or SL

2

Diagnosis: UA/NSTEMI/STEMI

UA: Chest pain (10/10) crushing chest pain
NSTEMI: Chest pain & + biomarkers Troponin I or T, CK-MB
STEMI: Chest pain, + biomarkers, ECG changes (1mm ST elevations

3

Treatment of UA/NSTEMI and STEMI

UA/ NSTEMI: MONA + GAP-BA
STEMI: MONA + GAP-BA + thrombolytics

4

Risk factors for ACS

Age men >45 women >55 or early hysterectomy
Family hx of coronary events B4 age 55 in men and 65 in women. Smoking, HTN, hyperlipidemia, diabetes, chronic angina, known CAD

5

what does MONA + GAP-BA stand for?

Pre hospital care: Morphine
Oxygen
Nitrates
Aspirin
ER care: Glycoprotein IIb/IIIa inhibitors
Anticoagulants
P2Y12 inhibitors
Beta Blocker
ACEIs

6

Morphine

decreases O2 demand; vasodilator. used for chest discomfort. dosed 2-5mg IV PRN. s/e bradycardia, hypotension, respiratory depression, sedation.

7

Oxygen

give in pts O2 sat <90%. if cyanosis or respiratory distress

8

Nitrates, what types? when Do not use?

Acute SL or spray. take 1 dose if not better call 911. hospital IV drip to decrease chest pain. do not use if SBP <50

9

Aspirin

325mg chew if EC. Take indefinitely if tolerated but 81 mg dose

10

integrilin

eptifibatide

11

ReoPro

abciximab

12

Glycoprotein IIb/IIIa inhibitors MOA & CI

reversibly block platelet aggregation on binding site of fibrongen, von willibrand factor. , preventing thrombosis. C.I. active internal bleeding, uncontrolled BP S/E: Bleeding, thrombocytopenia esp abciximab), hypotension. Administration: Do not shake vial upon reconstitution.

13

Abciximab (Reopro) CI: w/ administration what should u do? when does plt function return to normal after d/c

C.I. w/ hx of CVA w/in 2 years. hypersensitivity to murine proteins, and thrombocytopenia. Must filter with administration. Platelet fxn returns in 24-48hrs after d/c abciximab

14

Eptifibatide (Integrilin)
CI:
what CrCL to reduce dose

CI in hx of stroke with 30 days or any hx of hemorrhagic stroke, renal dysfunction-reduce infusion rate by 50% in pts Crcl <50ml/min

15

Tirofiban (Aggrastat)

CI in hx of stroke with 30 days or any hx of hemorrhagic stroke, renal dysfunction-reduce infusion rate by 50% in pts Crcl <30ml/min

16

P2Y12 inhibitors MOA, lifespan of drugs? which one has fast onset and offset? lifespan of drugs
which one has fast onset and offset

inhibit platelet activation and aggregation on the ADP receptors on platelets. Clopidogel and Prasugrel are prodrugs and have irreversible binding to the receptor. Lifespan of platelet is 7-10days Ticagrelor had reversible binding and faster on and off set

17

Clopidogrel (Plavix)
dose
bbw
adr
when d/c in pts doing cabg?

LD: 300-600mg MD: 75mg d BBW: poor metabolizers of 2C19 allele b/c PRODRUG*. S/E- bleeding, TTP (rash), bruising. Do not start in pts likely to undergo CABG. D/C 5 days prior to any major surgery

18

Prasugrel (Effient)
do not use in what age
why not use in that age
when do you start givign after a pci has been given.

LD: 60mg MD: 10mg, 5mg 75 unless they have DM or MI. D/C 7 days prior to major surgery. if PCI, give dose no later than 1 hr

19

Ticagrelor (Brilinta)

LD: 180mg/d MD: 90mg bid. use w/ ASA 75-100mg. BBW: sever fatal bleeding. S/E bleeding, dyspnea. D/C 5 days prior to major surgery. MD of ASA above 100mg reduce effectiveness of ticagrelor-only 81 mg. used for just ACS pts

20

When do you use BB and CCB

use within the 1st 24hrs to prevent cardiac remodeling

21

When to use thrombolytics per guidelines?

*when you can't perform PCI w/in 90 mins.
use thrombolytics within 12 hrs from sx onset.Door to balloon time should be <30mins (thrombolytics) if at a hospital. but thrombolytics should be beneficial as long as under 12 hrs of symptom onset.

22

Thrombolytics MOA

cause fibrinolysis by binding to fibrin in a thrombus (clot) and convertingp entrapped plasminogen to plasmin.

23

Thrombolytics

Alteplase (t-PA)
Reteplase (r-PA
Tenecteplase (TNKase)
Streptokinase (Streptase)
S/E intercranial bleeding, hypotension, fever, bleeding

24

Medications to avoid with ACS

NSAIDs, IR DHP (nifedipine) should not be used in the absence of b-blockers. IV fibinolytics is not indicated in pts w/o ST-segment elevation

25

What drugs should you avoid with clopidogrel?

cimetidine, azole antifungals, omeprazole, fluoxetine, fluvoxamine etc

26

What drugs should be continued when pt goes for CABG?

ASA, UFH

27

What drugs should be discontinued when pt goes for CABG?

Clopogrel and ticagrelor 5 days b4 and Prasagel 7 days B4. if enoxaparin: 12-24hrs B4, if fonda: 24hrs b4, if bivalirudin 3 hrs b4

28

Long term meds for status post MI?aspirin- bare metal stent, sirolimus eluting stent, and paclitaxel eluting stent.

ASA indefinitely 81mg, if stent placement use ASA 325mg: 1mos bare metal stent, 3 mos sirolimus- eluting stent, 6mos w/ paclitaxel-eluting.

Plavix 75mg or effient 10mg for at least 1mon and up to 12 mos to 15 mos if drug eluting stentstent.

NTG SL or spray, BB d, ACE-I < 40%, statin, warfarin, tylenol for pain relief.

29

acs cause

imbalance b/w oxy demand and supply due to athersclorosis--> infarction. this causes release of markers:

30

what markers are released after infarketion

troponin I or T and CK and Myocardial band (MB).

31

morphine moa

arteriolar and venous dilation , prompts a decrease in o2 demand and pain relief.

32

morphine adr

hypotension bradycardia, n/v/ resp depression

33

GAP-BA

1. GP II/III receptor antagonist
Anticoagulant
P2y12 inhinitors (plavix, prasugrel)
Beta blockers
Ace inhibitors

34

glycoprotein II/II antag for who

those doing an intervention PCI or stent

35

which agents are glycoprotein

abciximab, eptifibatide, tirofab
**rmr eptifibatidde seen in the cath lab at slu

36

what are p2y12 inhibitors

clopidogrel or prasugrel (ticagrelor) - for all pts loading dose followed by maintenance dose unless undergoing cabg

37

medications to avoid is acs

nsaids including cox2
dhp clacium cahannel blockers
iv fibrinolytic therpay is not indicated.

38

prasugrel for who

reduction of thrombotic events in pts with ACS who have DONE A PCI

39

ticagrelo drug interaction what common drugs

simvastatin dont use more than 40 mg.

40

STEMI diagnosis

chest pain > 20 mins, shows ST elevation on ECG, toponin T or I elevation/CK MB elevation

41

fibrinolytics CI

History of CVA-
recent intracranial or intraspinal surgery w/in last 3 months
intracranial neoplasm
ischemic stroke w/in 3 months!!
aortic dissection
uncontrolled htn
careful if***SBP> 185

42

fibrinolytics side effects

bleeding, hypotension, intracranial hemorrage, fever*** thats why intracranial neoplasm and htn stuff are CI!!

43

plavix how often take

once daily

44

if you are using aspirin, clopidogrel and warfarin all three agents then maintain INR at

2-2.5
you would add on warfarin if afib or IF pt has LV thrombus.