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ACS Pharmacotherapy (Foushee)
Terms in this set (34)
What is the typical sequalae from ACS?
In patients with persistent chest pain for ___min obtain a 12 lead EKG within ____min.
Depression or inversion of the T is indicative of....?
What is the strategy for acute management of STEMI?
O2 (if the O2 sat is <90%)
What is the primary treatment for a patient with STEMI (After MONA) that has had symptoms for less than 12 hours?
PCI. If there is no ability to do a PCI at the institution transfer to a hospital that can. If there is not a capable institution within 2 hours initiate fibrinolysis therapy
What are the two target times for reperfusion? (PCI and Fibrinolysis)
Fibrinolysis < 30min
What are the indications for primary PCI?
-When it can be performed in a timely fashion in the hands of experienced operators
-All patients with cardiogenic shock
-Contraindication to fibrinolytics
What drugs should be loaded before a PCI?
ASA (162-325mg) +
What are the loading doses of the P2Y12 inhibitors?
Which P2Y12 inhibitor should be administered at PCI not before?
Which P2Y12 inhibitor should only be used post PCI?
_______ and _______ should be held for 5 days prior to a CABG, ______ should be held for 7 days prior.
Clopidogrel, Ticagrelor, Prasugrel
Antithrombotic therapy should be started when?
At the time of PCI
Which drug requires utilization with Gp2B3A inhibitors?
Which drug can cause bleeding if used with Gp2B3A inhibitors?
Which anticoagulant is not recommended as monotherapy in the setting of PCI?
Which Gp2b3a inhibitor can be used in renal dysfunction and is also irreversible?
What two lab parameters are monitored for efficacy with GP2b3a inhibitors?
aPTT prior to PCI
ACT during PCI
What lab parameters are monitored for safety with GP2b3a inhibitors?
aPTT and ACT
What type of drug should be initiated within 24 hours of PCI and how should they be initiated?
Beta blockers, IV therapy is ideal to initiate due to half life
What drugs are used in long term care following PCI?
P2Y12 inhibitor + ASA for 1-12 months. 1 month if bleeding risk
What is the typical dose of UFH during PCI and what two labs are monitored for dose titration?
50-70 unit/kg bolus then monitor ACT and aPTT for dose tirtration
Which 2 anticoagulants have lower levels of evidence in the setting of primary PCI?
Enoxaparin and fondaparinux
What are the differences between the fibrinolytics as far as administration?
Alteplase- Bolus given in divided doses over 1-2 hour period depending on weight
Retavase- 2 doses given over 2 mins at 30 min intervals
Tenecteplase- Once time IV push bolus
Should patients with NSTEMI undergo fibrinolytic therapy? Why or Why not?
No; risks outweigh benefits, partial versus almost complete occlusion, timing and presence of a white clot in NSTEMI which has minimal fibrin.
If a med/high risk NSTEMI patient has a stent placed following angiography and PCI which therapies should be initiated?
-GP2b3a inhibitor for high risk patients (If bivalrudin was not used as anticoag)
-Plus anticoag (Enoaparin preffered, Bivalrudin or UFH appropriate, NO fondaparinux)
If a med/high risk NSTEMI patient needs a CABG following angiography which therapies should be initiated or discontinued?
-D/C any P2Y12 inhibitors (5 days before for clopidogrel/ticagrelor, 7 days for prasugrel)
-D/C GP2b3a prior to surgery
If a it is determined a med/high risk NSTEMI patient has no clinically significant CAD following angiography which therapies should be initiated or discontinued?
Discontinue all therapies and treat CAD risk factors if no CAD exists.
If CAD exists but not clinically significant continue;
-Statin (high intensity)
What is the early conservative strategy for a Low risk NSTEMI patient ?
-ASA+P2Y12 (not prasugrel)
-Initiate enoxaparin (UFH and fondaparinux also ok)
-Stress test (If positive treat according to invasive guideline)
If a low risk patient undergoes PCI and has a stent placed what is the primary long term therapy?
-P2Y12 inhibitor for at least 12 months
If a low risk patient undergoes PCI and does not have a stent placed what is the primary long term therapy?
-Clopidogrel or Ticagrelor for up to 12 months
Prasugrel not studied in this population
All patients should receive a Beta-blocker for ___ years following an MI.
All patients should receive an oral ACEi within 24 hours,
the largest benefit is seen in patients with __,______,_____ or ______
-type 2 DM
-LV dysfunction EF<40%
-CKD (without contraindication)
According to quality performance measures what drugs should all ACS patients receive at discharge?
Statin - high dose
ACE or ARB- for LVD
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