Acute Coronary Syndromes and Secondary MI Prevention

Question 1

Post-Elective PCI Antiplatelet Therapy for Bare Metal Stents

Answer 1

At least 1 month of DAPT, ideally for 12 months
Increased risk of bleeding: minimum 2 weeks
ASA 325 mg x 1 then 81-325 mg PO daily AND
Clopidogrel 300 to 600 mg x 1, then 75 mg PO daily

Question 2

Post-Elective PCI Antiplatelet Therapy for Drug Eluting Stent

Answer 2

DAPT for 12 months if not high risk for bleeding,
ASA 325 mg x 1 then 81-325 mg PO daily AND
Clopidogrel 300 to 600 mg x 1, then 75 mg PO daily

Question 3

Alteplase dosing for STEMI

Answer 3

“Front loaded”
15 mg IV bolus then
0.75 mg/kg (max 50 mg) IV over 30 minutes then
0.5 mg/kg (max 35 mg) IV over 60 minutes

Question 4

Reteplase dosing for STEMI

Answer 4

10 units IV x 2, 30 minutes apart

Question 5

Tenecteplase dosing for STEMI

Answer 5

IV Bolus
Less than 60 kg: 30 mg 
60 to 69.9 kg: 35 mg 
70 to 79.9 kg: 40 mg 
80 to 89.9 kg: 45 mg
90 kg or above: 50 mg

Question 6

Nitroglycerin dose for relief of angina symptoms (Early hospital care)

Answer 6

0.4 mg sublingual NTG every 5 minutes x 3 PRN
IV NTG for persistent ischemia, angina, hypertension
10 mcg/min infusion, double rate every 5 to 10 minutes to rate of 150-400 mcg/min
Contraindication: recent phosphodiesterase inhibitor use

Question 7

Contraindications to Beta-Blocker Therapy

Answer 7

1. Age > 70
2. Systolic BP 70, sinus tachycardia (>110) or HR 0.24 second
3. Second- or third-degree heart block without an implanted cardiac pacemaker
4. Active asthma or airway disease

Question 8

Bivalirudin usage

Answer 8

NSTE ACS for an early invasive strategy

PCI for STEMI

Question 9

Bivalirudin dose

Answer 9

0.75 mg/kg IV bolus followed by 1.75 mg/kg/hour (1 mg/kg/hour if CrCl

Question 10

Abciximab dose

Answer 10

0.25 mg/kg IV bolus then 0.125 mcg/kg/ min

Max: 10 mcg/min

Question 11

Eptifibatide dose

Answer 11

180 mcg/kg IV bolus x 2, 10 minutes apart then
2 mcg/kg/min
Max: 15 mg/hour
Reduce rate by 50% for CrCl

Question 12

Tirofiban dose

Answer 12

25 mcg/kg IV bolus then .15 mcg/kg/min

Reduce rate by 50% if CrCl

Question 13

When do you give an MRA post-ACS?

Answer 13

LVEF

Question 14

Physical activity post-ACS

Answer 14

30-60 minutes of moderate-intensity aerobic activity at least 5 days but preferably 7 days per week