PCI and Discharge Medications Flashcards
What is the acronym for the medications given during the initial treatment of acute coronary syndrome?
MONAS - Morphine, Oxygen, Nitroglycerin, Aspirin, Statin
What are the two regimens of antithrombotics that have been well-studied during percutaneous coronary intervention (PCI)?
- ASA + P2Y12 + UFH ± GPIIb/IIIa inhibitor
- ASA + P2Y12 + Bivalirudin
What is the main adverse effect of clopidogrel?
Bleeding
How is prasugrel indicated, and what population should it be avoided in?
Prasugrel is indicated for patients receiving PCI. It should be avoided in patients with a history of stroke, those with weight less than 60 kg, patients at least 75 years old, and patients taking concomitant medications that increase the risk of bleeding, unless the benefit outweighs the bleeding risk.
What is the main risk associated with both prasugrel and ticagrelor?
Increased risk of bleeding.
In the study comparing ticagrelor and prasugrel, which drug was found to be superior in reducing the risk of the composite outcome of death, MI, or stroke without increasing the risk of bleeding?
Prasugrel
What is the primary mode of death in post-MI patients, and which medication can help reduce this risk?
The primary mode of death in post-MI patients is ventricular arrhythmias. Beta blockers can help reduce this risk.
What is the recommended timing for initiating an oral beta blocker in post-PCI patients without heart failure symptoms, bradycardia, or hypotension?
An oral beta blocker should be started within the first 24 hours for post-PCI patients without heart failure symptoms, bradycardia, or hypotension.
Why are angiotensin-converting enzyme inhibitors (ACE inhibitors) or angiotensin II receptor blockers (ARBs) recommended for post-ACS patients with reduced left ventricular ejection fraction?
ACE inhibitors or ARBs are recommended for post-ACS patients with reduced left ventricular ejection fraction (less than or equal to 40%) to prevent deleterious left ventricular remodeling.
What are the monitoring parameters for patients taking ACE inhibitors or ARBs?
Monitoring parameters for patients taking ACE inhibitors or ARBs include blood pressure, kidney function, potassium levels, and side effects such as cough and angioedema.
Which type of statin is preferred for post-PCI patients, and what is the recommended intensity?
High-intensity statins are preferred for post-PCI patients. High-intensity statins, such as atorvastatin 40-80 mg/day or rosuvastatin 20-40 mg/day, have been shown to reduce the risk of major adverse cardiovascular events more effectively. Atorvastatin 80 mg/day is supported by the best evidence in post-MI patients.
What is the primary goal of discharge medications for post-PCI patients, and why is it important to adhere to the recommended duration of dual antiplatelet therapy?
The primary goal of discharge medications for post-PCI patients is to reduce the risk of recurrent ACS, stent restenosis, and in-stent thrombosis. Adhering to the recommended duration of dual antiplatelet therapy is essential to prevent in-stent thrombosis, especially in patients with drug-eluting stents.
What is the normal ejection fraction, and when should angiotensin-converting enzyme inhibitors (ACE inhibitors) or angiotensin II receptor blockers (ARBs) be started in post-ACS patients?
The normal ejection fraction is at least 55%. ACE inhibitors or ARBs should be started in the first 24 hours in post-ACS patients with reduced left ventricular ejection fraction of less than or equal to 40%.
Why is it important to obtain a fasting lipid panel within the first 24 hours of admission for post-ACS patients?
t is important to obtain a fasting lipid panel within the first 24 hours of admission for post-ACS patients because the lipid levels can be falsely lower than usual during ACS, and obtaining an accurate baseline measurement is essential for proper management.
What are some of the factors contributing to an increased risk of gastrointestinal (GI) bleeding in post-ACS patients?
Several factors contribute to an increased risk of GI bleeding in post-ACS patients, including:
1. Dual antiplatelet therapy.
2. Aspirin use, which can cause GI bleeding by inhibiting the COX-1 enzyme.
3. Advanced age.
4. Concomitant use of an anticoagulant (e.g., warfarin) for other cardiovascular diseases.
5. The elderly population.
What are the recommended therapeutic options for GI prophylaxis in post-ACS patients at risk of GI bleeding, and which one is generally preferred for high-risk patients?
The recommended therapeutic options for GI prophylaxis in post-ACS patients at risk of GI bleeding include proton pump inhibitors (PPIs) and histamine2 receptor antagonists (H2RAs). PPIs are generally preferred, particularly for patients at a high risk of GI bleeding.
Which enzyme is primarily inhibited by aspirin for its antiplatelet effect?
Aspirin primarily inhibits the cyclooxygenase-1 (COX-1) enzyme for its antiplatelet effect.
Why is it important to avoid non-steroidal anti-inflammatory drugs (NSAIDs) in post-ACS patients, and what effects can NSAIDs have on the cardiovascular system?
It is important to avoid NSAIDs in post-ACS patients because NSAIDs, especially COX-2 inhibitors, have been shown to increase the risk of myocardial infarction (MI). NSAIDs may reduce the antiplatelet effect of aspirin by competing for COX enzymes and can also delay the healing of cardiac injury after MI.
What is the blood pressure goal for post-ACS patients, and which classes of drugs can help achieve this goal?
The blood pressure goal for post-ACS patients is currently <130/80. Both beta blockers and ACE inhibitors or angiotensin receptor blockers (ARBs) can help achieve this goal, so they should be maximized before considering other antihypertensives.
