Acute Coronary Syndromes Flashcards Preview

Fall 2014 - Pharm Cardio > Acute Coronary Syndromes > Flashcards

Flashcards in Acute Coronary Syndromes Deck (25):
1

TIMI Risk Calculation

-predicts risk of death or MI in the next 14 days
-risk varies from 5-41%

2

What are the 3 goals of therapy for unstable angina/NSTEMI?

1. diminish coagulability
2. relieve pain
3. decrease workload of the heart

3

What meds are used to diminish coagulability in UA/NSTEMI pts?

-anti platelets: ASA, P2Y12, IIbIIIa inhibitors
-anti coagulants: heparinoids, bivalrudin

4

What meds are used to relieve pain in UA/NSTEMI pts?

-SL and IV nitro
-morphine
-BB

5

What meds are used to decrease the workload of the heart in UA/NSTEMI pts?

BB

6

UA/NSTEMI Aspirin Therapy

-162-325 mg unless CI or already taken

7

What are the P2Y12 Inhibitors and what are they used for?

-clopidogrel (Plavix)
-ticagrelor (Brilinta)
-prasugrel (Effient)
-used to diminish coagulability (anti platelet agents)

8

Who should receive a high dose clopidogrel regimen? What is considered a "high dose?"

-300 mg vs 600 mg load
-hx MI, stent placement, ACS, DM

9

In what patients should prasugrel be avoided?

-hx of TIA or stroke
- 75 y.o
-undergoing surgical procedure (CABG)
-CrCl < 60 mL/min
-warfarin pts

10

Prasugrel should be used in what types of pts?

-in high risk MI patients (DM or hx of MI) getting PCI

11

When should IIaIIIb inhibitors be used before PCI?

-DM or STEMI or elevated troponins and low bleed risk
-recurrent pain on ASA, P2Y12, and heparin

12

What is the dosing of sublingual nitro?

-0.4 mg SL q5 minutes for 3 doses

13

When is IV nitro contraindicated?

-hypotension (SBP < 100)
-tachycardia > 100 bpm
-phosphodiesterase inhibitor within 24-48 hrs

14

When is IV morphine sulfate indicated?

-uncontrolled chest pain despite IV NTG

15

When is IV morphine sulfate contraindicated?

-hypotension SBP < 100
-tachycardia > 100 bpm

16

What is the indication for oral beta blockers?

First 24 hours for all patients who do not have:
-signs of active HF
-evidence of low output state/cardiogenic shock
-PR interval greater than 0.24 seconds
-2nd or 3rd degree heart block
-active asthma

17

Signs and Sxs of Uncompensated Heart Failure

-orthopnea
-PND
-DOE
-ascites
-2-3+ pitting edema

18

What patients should receive oral ACE-I/ARBs?

in first 24 hrs to pts w/ pulmonary congestion or LVEF < 40% unless contraindicated

19

What are the CIs for ACE-I/ARBs?

-hypotension (SBP < 100)
-BL renal artery stenosis
-hx angioedema
-2 or 3 trimester pregnancy

20

What are the goals of therapy for treating STEMI?

-relieve pain
-re-perfuse
-diminish coagulability

21

When are lytics used?

-given if the 90 minute PCI window is not met
-most effective within 12 hours of symptom onset

22

Absolute CI of Lytics

-active bleeding or hx of intracranial hemorrhage
-ischemic (thrombotic) stroke within 3 months

23

Relative CI of Lytics

-uncontrolled HTN
-current anticoagulant use (warfarin)
-pregnancy
-surgery <3 weeks

24

At discharge, how long should pts be kept on BBs?

-at least 6 months, ideally 3 years
-in pts with low EF, indefinitely

25

What discharge meds should pts be on?

-BB
-PRN SL NTG
-statins for all
-ACE-I for EF <40%, DM, CKD