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Pharm II MHM - FINAL > STEMI > Flashcards

Flashcards in STEMI Deck (56):
1

What is the recommended anti-platelet therapy for Class I NSTE-ACS patients?

ASA
-Use clopidogrel if ASA intolerant/allergic
-Use a GP IIb/IIIa inhibitor if cath and PCI planned (max tx = 8 days)

2

What is the recommended anti-platelet therapy for Class IIa NSTE-ACS patients?

-Use GP IIb/IIIa inhibitor in high risk pts if invasive strategy NOT planned
-Use a GP IIb/IIIa inhibitor in pts receiving clopidogrel if cath and PCI planned

3

What is the recommended anti-platelet therapy for Class IIb NSTE-ACS patients?

Use a GP IIb/IIIa inhibitor in low risk pts when PCI NOT planned

4

What is the recommended anti-platelet therapy for Class III NSTE-ACS patients?

Use abciximab in pts when PCI is NOT planned

5

Why is anti-platelet therapy essential in ACS?

Prevents thrombosis from plaque rupture

6

Chewing aspirin tablets inhibits platelets ___ faster

50%

7

162 mg daily of aspirin completely inhibits:

COX-1

8

325 mg daily of aspirin is max effective dose for ____

TXA2 inhibition

9

Peak serum concentration of aspirin occurs within:

1-2 hours

10

How do NSAIDs and aspirin interact?

-Compete for same receptor
-NSAIDs block and prevent acetylation
-Space these 3 hours apart

11

Why is aspirin held for 6 hours after CABG and 24 hours after thrombolytics?

Prolonged wound healing

12

What is clopidogrel and what does it do?

-Thienopyridine
-Selective irreversible inhibition of ADP-mediated platelet activation (cold, shear stress)

13

Clopidogrel binds ___ but has no effect on ____

-P2Y12 and P2Y1 receptors
-No effects on TXA2, PGI2

14

Which anti-platelet has extensive hepatic metabolism?

Clopidogrel

15

Activity of clopidogrel is reduced by:

PPIs and other potent CYP219 inhibitors

16

Clopidogrel has reduced bioactivation in which population?

Persons of Chinese ancestry

17

How is clopidogrel used after coronary stent placement?

With ASA for up to 1 year

18

What is ticlopidine?

-Irreversible thienopyridine P2Y12 inhibitor
-Clopidogrel/prasugrel now replaces this

19

How does dipyridamole work?

-Inhibits adenosine deaminase and PDE
-Allows cAMP and adenosine accumulation and vasodilation

20

How does cilostazol work?

-Inhibits PDE 3
-Increases cAMP
-Allows vasodilation
-Inhibits vascular SMC proliferation
-Inhibits platelets

21

How do GP IIb/IIIa inhibitors work?

-Typically the receptors bind fibrin, thrombin, vWF
-Allows for adhesion, activation, aggregation of platelets
-Blocking the receptors prevents clotting

22

How does eptifibatide work?

-Selective, reversible, competitive GP IIb/IIIa inhibition
-Temporarily blocks fibrin cross-linking

23

When should you be cautious with eptifibatide?

-PTT 45+ secs
-CrCl less than 50

24

When should you be cautious with tirofiban?

-Platelets less than 150K
-PTT 45+ secs
-CrCl less than 30

25

What is abciximab and how does it work?

-Mouse monoclonal antibody
-GP IIb/IIIa inhibitor
-Binds and dissociates rapidly

26

What is a major ADE to be aware of with abciximab?

Hypersensitivity reactions from infusion

27

What type of compound is Heparin?

Sulfated mucopolysaccharide

28

Where is endogenous heparin found?

Mast cells

29

LMWH favors inhibition of which factor?

Xa

30

How do sodium and calcium heparin relate?

They are bioequivalent

31

What is the half life of heparin anticoagulation?

1.5 hours

32

How is heparin eliminated?

Transported to reticuloendothelial system, phagocytized

33

When can heparin resistance occur?

-Hepatic cirrhosis
-Nephrotic syndrome
-DIC

34

Which populations have highest occurrence of bleeding complications with heparin?

-Renal failure
-Elderly women

35

Who is at highest risk to developing HIT?

Surgical patients

36

When does peak anti-Xa activity of Enoxaparin occur?

Within 3-5 hours

37

What is dalteparin?

LMWH ranging from 3000-8000 daltons

38

When does peak anti-Xa activity of Dalteparin occur?

Within 2-4 hours

39

When is Fondaparinux used?

-STEMI pts receiving fibrinolytics
-NSTEMI PCI or conservative treatment

40

When is Fondaparinux contraindicated?

-CrCl less than 30
-Wt less than 50 kg

41

When should Fondaparinux be stopped prior to CABG or surgery?

-24 hours prior
-Switch to heparin

42

What kind of compound is Bivalirudin and how does it work?

-20 AA synthetic direct thrombin inhibitor
-Analogue to a natural 65 AA thrombin inhibitor
-Binds catalytic site on thrombin
-Temporarily prevents soluble and clot-bound thrombin interactions

43

When should fibrinolytics be given in acute STEMI?

Within 30 minutes (if PCI within 90 mins is not possible)

44

When should fibrinolytics be used?

STEMI only

45

How are fibrinolytics reversed?

Aminocaproic acid

46

What kind of compound is Alteplase and how does it work?

-Serine protease
-Cleaves Arg-Val bond in plasminogen, converting it to plasmin
-Plasmin degrades fibrin

47

What is Alteplase less active on?

Systemically circulating plasminogen

48

Alteplase is given with which other meds?

Heparin, enoxaparin

49

How is Alteplase administered?

Infused over 1.5 - 3 hours

50

What is reteplase?

-Fibrinolytic
-Recombinant deletion mutant of wild type tissue plasminogen activator

51

What happens when reteplase is given?

-Early platelet inhibition (w/in 6 hours)
-Rebound platelet aggregation (at 24 hours) with increased GP IIb/IIIa expression

52

What inactivates reteplase in the blood?

-C1 inactivator
-a1 antitrypsin
-a2 antiplasmin

53

What is tenecteplase?

-Fibrinolytic
-Genetically re-engineered alteplase
-2 AA, 4 alanine substitutions
-Produced in Chinese hamster ovary cells

54

How is tenecteplase inactivated in the blood?

By PAI-1
Extensive inactivation in the liver

55

Which fibrinolytic has a biphasic half-life?

Tenecteplase

56

Which anti-platelet acts by REVERSIBLE inhibition?

Ticagrelor