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atherosclerosis And ACS Treatment Flashcards

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1
Q

How to prevent?

A

Healthy eating, no smoking , manage stress, know LDL and total cholesterol, BP, and exercise

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2
Q

What is primary prevention?

A

Lipid lowering meds, BP control, smoking cessation, diabetes, physical activity, Mediterranean diet

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3
Q

What is secondary prevention?

A

More aggressive dosing of 1’ and +- Aspirin, P2Y12 I., cardiac rehab

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4
Q

2’ prevention: lipid lowering meds?

A

Ezetimibe, evolocumab, alirocumab, anacetrapib

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5
Q

2’ prevention: anti-thrombotic?

A

Rivaroxaban, prasugrel

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6
Q

2’ prevention: anti-inflamm

A

Colchicine and canakinumab

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7
Q

OHBATMANS- meaning?

A

O- oxygen
H-heparin
B- beta blocker
A- antiplatelets
T-thrombolytic
M-morphine
A-angiotensin converting enzyme I. Or aldosterone Antag.
N-nitroglycerin
S-statin

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8
Q

Which drugs from OHBATMAN Is mainly for discharge use?

A

A-angiotensin converting enzyme I. Or aldosterone Antag.
S-statin

*the rest are given based on presentation

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9
Q

What do tPa do?

A

Activates plasminogen to plasmid and binds to fibrin to break it down (degradation)

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10
Q

What is known as natural fibronolytic?

A

Plasmin

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11
Q

Can you benefit if fibrin is hard and give a tpa?

A

No , no benefit-needs to be loose

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12
Q

What is the patho of a clot?

A

Increased clot formations-activates thrombin, leads to fibrin and a clot

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13
Q

What are the two fibrinolytics? (Tissue plasminogen activators)

A

tpa-alteplase
Tnk- tenecteplase

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14
Q

What do thrombolytics do?

A

Reestablish circulation and blood flow

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15
Q

Nitroglycerin is?

A

A strong venal dilator
Decreased preload, ventricular size, and end diastolic pressure
Overall decrease O2 demand

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16
Q

Nitroglycerin at higher doses is?

A

Both arterial and venal dilation

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17
Q

Can you use thrombolytics for stable or unstable angina ?

A

No can cause major bleed

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18
Q

When can you use thrombolytics?

A

For STEMI(full thickness)

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19
Q

Thrombolytics guideline:

A

Use for acute MI in 1st 12 hours
Acute ischemic stroke
Peripheral artery occlusion
Pulmonary embolism
DVT

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20
Q

If no cath lab…?

A

Give thrombolytics

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21
Q

If no PCI (cath lab?

A

Administer fibrinolytic<30 min

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22
Q

If PCI?

A

Fix can do angiogram, or fibrinolytic

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23
Q

Alteplase vs tenecteplase

A

Alteplase has a short half life
Tenecteplase is more fibrin specific and longer duration -less chance of bleeding

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24
Q

Contraindications to thrombolytics?

A

Active bleed, stroke in last 3 months, cerebral hemorrhage
Major surgery within 2 weeks
Peptic ulcer
Head injuries or neoplasm
Uncontrolled HTN >180
Already on anticoagulant

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25
What are the fibrinolytic inhibitors ? Use if patient starts bleeding
Amino sprout acid Tranexamic acid Inhibits formation of plasmin/ plasminogen
26
Do not give fibrinolytic if patient is:
On aspirin/ nsaids Renal failure Thrombocytopenia VWD Hemophilia Platelet >50,000
27
Nitroglycerin patho?
Enhances NO-GTp-cGMP—-dephosphorylates to myosin LC=relaxation
28
Contraindications to nitroglycerin?
Do not take nitrates for 12 hours Use sildenafil due to shorter half life
29
SE of nitroglycerin ?
Tachyphylaxis , headache, syncope, increased HR
30
When is the best time to take nitroglycerin?
When the most exertion is used
31
What antiplatelets therapy should be given?
DAPT-clopidogrel plus aspirin
32
Moa of clopidogrel?
Inhibits activation of platelet by blocking pgy12 receptor
33
Aspirin moa?
1. Decrease thromboxane=increased platelet aggregation and decreased vasoconstriction 2. Increase prostacyclin=decreased platelet aggregation and vasodilation
34
What is the loading dose for clopidogrel?
600 mg But can use 300mg if person is over 75 years old, already on clopidogrel, history of at risk for bleeding Then 75 mg qd
35
How long should you take clopidogrel if: stent
1 month
36
How long should you take clopidogrel if: drug eluding stent +ACS
12 month
37
How long should you take clopidogrel if: CABG
Hold for 5-7 days
38
Contraindications for prasugrel?
>\=75 years old, intracranial hemorrhage, previous stroke, weight <60 kg *increased risk of bleed
39
Tricagrelor characteristics?
Reversible non competitive No need for bio transformation Good for surgery Active metabolite Downside- dyspnea and BiD dosing
40
What anticoagulants should you use?
UFH, fondaparinux, enoxaparin
41
Anticoagulants use how long?
48 hours
42
Atorvastatin high dose?
40-80
43
Rosuvastatin high dose?
20-40
44
Statin contraindications?
Pregnancy, myopathy, DDI with 3A4 or fibrates, hepatic dysfunction
45
What bb to use?
Selective- metoprolol or carvedilol
46
Contraindication for bb?
Cold( poor perfusion, decreased HR(<60) , increase risk of cardiogenic shock , asthma and severe allergies
47
If tachyarrythmia or hypertensive give;
Bb
48
Continue bb how long?
Indefinitely
49
When to use Ace/ arb?
When Ef< 40%
50
Antianginal therapy?
Nitrates plus bb Enhanced activity Reduces O2 consumption
51
When not to use antianginal therapy?
When it is Cocaine induced chest pain
52
What therapy improves mortality?
Bb and aspirin
53
First line for all patients is ?
Antiplatelets
54
Higher doses of antiplatelets?
Do not improve outcomes just increase bleeding
55
Treatment for NSTEMI?
Based on TIMI score, If low-OHBATMAN if high- carb lab for revasculatization
56
Omeprazole and plavix interaction?
Omeprazole metabolizes 2C19 so decreases plavix
57
Put a stent for how long: ACS? No ACS just MI?
12 months 6 months
58
Heparin vs enoxaprin
Heparin has a shorter half life (good) Enoxaparin has a longer half life
59
Which anticoagulant should you use in HIT?
Bivalrudin and fondaparinux or agatroban
60
Heparin dosing?
IVPB: 60 units/kg max:4,000U IV: 12U/kg/ hr max: 1,000 U/ hr for 48 hr until PCI performed Always use low intensity
61
Enoxaparin dosing?
1 dose: 1mg BID/ kg In other words 1mg\ kg every 12 hours
62
What does timi score tell us?
Risk of death, MI, and urgent revascularization by day 14
63
Timi score:
0-1: 5% 2: 8% 3: 13% 4: 20% 5: 26% 6-7: 41%
64
Timi score high risk if >\=?
5
65
Timi score risk factors(1 point)
65 or older CAD Aspirin use in 7 days Severe angina Elevated cardiac marker ST deviation >\= 0.5 Or 3 risk factors for CAD: Dm, HTN,smoker, hyper cholesterol
66
Prasugrel dosing?
60 mg loading then 10mg dosing qd
67
Ticagrelor dosing?
180 mg loading Then 90mg BID
68
If can’t do PCI and tpa is contradicted what do you do?
Give heparin and aspirin

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