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P2 Spring: PHRM 845 > Exam 1: Rogers > Flashcards

Exam 1: Rogers Flashcards

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1
Q

what are the risk factors for ACS?

A
  • older age
  • male
    • hx of CAD
  • DM
  • renal insufficiency
  • Prior MI
  • Smoking
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2
Q

what are the signs & symptoms?

A
  1. Retrosternal Chest Pain
    –> Left side (arm and jaw)
  2. N/V
  3. Diaphoresis
  4. SOB
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3
Q

What are the atypical symptoms? (what people as well?)

A
  1. Likely for
    - Elderly, Females, Diabetics, impaired renal function, dementia
  2. Symptoms
    - epigastric pain, indigestion, stabbing or pleuritic pain, inc. dyspnea in the absence of chest pain
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4
Q

What does a STEMI refer to on an ECG?

A

persistent ST elevation and potential Q wave changes

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5
Q

What does an NSTEMI and UA how on an ECG?

A

no ST elevation; could show depression if anything

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6
Q

What test should be done to see if the patient has a STEMI/NSTEMI?

A

Troponin

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7
Q

What is a high troponin level for both tests?

A
  1. High sensitivity
    –> Normal <14 ng/L
  2. Conventional
    –> Normal <0.05 ng/mL
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8
Q

When do you need to check trends?

A
  • repeat every 3-6hrs for the first 12 h
  • repeat will identify pattern
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9
Q

What is the difference bwtn Stable/Unstable angina & STEMI/NSTEMI?

A
  1. Stable
    –> goes away within 20min or less
    –> normal ECG
  2. Unstable
    – normal ECG
    – persistent pain > 20 min
    – normal troponin
  3. STEMI
    – high troponin
    – ST elevation
  4. NSTEMI
    – high troponin
    – no ST elevation
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10
Q

What are some complications of ACS?

A
  1. HF
  2. valvular dysfunction
  3. arrhythmias
  4. bradycardia/HB
  5. shock
  6. death
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11
Q

what is ventricular remodeling mean? How does this happen/what causes it?

A
  1. changes in size, shape, and function on LV after ACS; leading to HF
  2. can happen from activation of RAAS system or increased preload/afterload
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12
Q

what does MONA stand for?

A

Morphine, Oxygen, Nitrate, Aspirin

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13
Q

what is the morphine dose that you would give ?

A

Initial: 4-8mg IV, followed by 2-8mg IV q5-15min

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14
Q

what are side effects of morphine?

A

sedation, respiratory depression, N/V

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15
Q

what do you want to avoid when using morphine and why?

A

NSAID, except aspirin
–> d/c home ones and don’t initiate can inc. MACE

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16
Q

when do you want to use oxygen?

A

when O2 <90%

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17
Q

what nitrate dose do you use or give them?

A

0.3-0.4mg q5min x 3 if continuing

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18
Q

what are side effects of nitrates?

A

HA, hypotension

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19
Q

how long do you have to wait to take a nitrate with tadalafil?

A

48hrs

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20
Q

how long do you have to wait to take sildenafil or vardenafil?

A

24 hr

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21
Q

What is the dose of aspirin you would give for MONA?

A

162-325 chewable for 1 dose

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22
Q

What is a coronary angiography?

A

test that shoots dye in veins to see how they are and if blockages

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23
Q

What are the absolute CIs for fibrinolytics?

A
  1. history of brain bleeds, strokes, any type of active bleed or trauma
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24
Q

what are the relative CIs to fibrinolytics?

A

severe HTN, dementia, any surgery in last 3 weeks or internal bleeding

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25
what reperfusion do you use for a STEMI?
PCI or fibrinolytic
26
When do you use a PCI vs a fibrinolytic for a STEMI?
1. use a PCI unless not at a PCI capable hospital and you are more than 120 min away (do this within 12 hours)
27
how fast do you need to do reperfusion therapy for STEMI?
within 30 minutes upon arrival
28
what is the reperfusion therapy for NSTEMI/UA?
ischemia guided strategy (med management) or early invasive strategy (PCI)
29
what should the continued regimen be for aspirin? what is a counseling tip?
81-325mg; TWF
30
What it the discussion of therapy with a P2Y12 inhibitor for DAPT therapy? is a loading dose needed?
1. loading dose then maintenance 2. 12 m therapy
31
when would you use cangrelor in therapy?
when you did not receive a loading dose; IV given during PCI procedure
32
What is the loading dose and maintenance dose for clopidogrel?
loading: 300-600 main: 75 QD
33
What is the loading dose and maintenance dose for prasugrel?
load: 60 main: 10 qd
34
What is the loading dose and maintenance dose for ticagrelor?
load 180 main 90 bid
35
when is the 600mg dose not preferred for plavix and what would the loading dose be in different age brackets?
- with fibrinolytics < or 75 = 300mg > 75 = no load dose
36
What could be some reasons to switch to other P2Y12?
cost, side effects, not a good response, stroke risk, bleeding risk
37
When using a P2Y12 for an NSTEMI/UA and have the ischemia guided strategy, what is the preferred agents?
clopidogrel and ticagrelor
38
When using a P2Y12 for an NSTEMI/UA and have the early invasive stretegy, what is the preferred agents?
preference for prasugrel or ticagrelor but any can be used
39
When using a P2Y12 for an STEMI with fibrinolytic strategy, what is the preferred agents?
plavix
40
When using a P2Y12 for an STEMI with PCI, what is the preferred agents?
ticagrelor or prasugrel preferred
41
what are some minor vs. major risk of bleeding?
MINOR: - bruising - light nosebleeds - bleeding gums when flossing MAJOR: - blood in urine/stool - coughing blood - ongoing bleeding wounds
42
Should aspirin be held before a CABG surgery?
no
43
How long should the P2Y12s be held for prior to elective CABG?
- ticag --> 3d - clop --> 5d - prasu --> 7d
44
how long should a P2Y12 be held for an urgent CABG?
24h if possible
45
what are the GP2b/3a inhibitors ?
abiciximab, eptifibatide, and tirofiban
46
when would you use a GP2b/3a?
in addition to DAPT - given at same time of PCI and on an individual basis
47
what are the specific reasons you would give a GP2a/3b in STEMI/NSTEMI?
NSTEMI: high risk features such as high troponin STEMI: large thrombus burden 1. not good loading for P2Y12 2. Bail Out --> during procedure if thrombus develops or low after stenting
48
what is the bolus dose for abciximab?
0.25/kg IV
49
what is the bolus dose for eptifibatide
180mcg/kg x 2 " double bolus"
50
what is the bolus dose for tirofiban?
25 mcg/kg
51
what GP2a/3bs need renal adjustment? What is the cut off?
eptifibatide = < 50 tirofiban = < 60
52
when using UFH what is it administered as and what do you need to keep watch for? ( what values?)
1. continuous infusion 2. aPTT ot ACT
53
how is enoxaparin eliminated?
kidneys and accumulates in renal impairment
54
what is bivalirudin and what have trials shown? (what trials)
1. DTI 2. not used with GPs except bail out 3. HEAT-- not effective as much for MACE 4. -- BRIGHT and MATRIX as lower bleed risk
55
what is fondaparinux and when should you not use it?
factor 10a inhibitor 1. dont use alone for PCI --> high thrombis rates 2. CI in CrCl < 30
56
when should a BB be initiated for ACS?
first 24 hrs of ACS
57
when would you not want to start a BB?
HR < 50 uncontrolled asthma/ RAD Risk of shock or low output state
58
what 3 BBs are utilized more in patients with HFrEF? (<40% for reference)
metoprolol succinate, carvedilol, bisoprolol
59
when should you give a BB in a person using cocaine?
use carvedilol since binds to alpha receptors but initiate when out of system
60
what should you do with a BB in HF?
avoid starting new or increasing dose during an acute exacerbation due to inc. risk of pulmonary edema
61
when could you consider a CCV? what type specifically of CCB?
non-DHP if pt has recurrent ischemia and CI to BBs (diltiazem or verapamil)
62
what is the theory for a statin in ACS?
initiate or be on HIS
63
when should an ace/arb be initiated for different groups?
1. they should get it but if they have HFrEF, CKD, DM they should get it ideally within 24 hours or sooner rather than later
64
when would you not use an ace or arb?
- hypotension/shock - acute renal failure - angioedema - bilateral renal artery stenosis

P2 Spring: PHRM 845 (10 decks)

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