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BCPS study guide

ACS

QuestionAnswer
GP IIb IIIa agents available for use in ACS. when is it appropriate to use these drugs abciximab (Reopro) Eptifibatide (Integrilin) tifofiban (Aggrastat) use in pts who were not pretreated with P2Y12 agents who are getting PCI. Reopro and Integrilin not recommended for use in pts with ACS without PCI
dose of abciximab in ACS 0.25 mcg/kg bolus f/b 0.125 mcg/kg/min (max 10 mcg/kg) for 12 hours
dose of eptifibatide in ACS 180 mcg/kg bolus x2 f/b 2 mcg/kg/min infusion for 18-24 hours [start infusion after FIRST bolus]
dose of tirofiban in ACS 25 mcg/kg bolus f/b 0.15 mcg/kg/min for 18-24 hours
dose of UFH in ACS - UA/NSTEMI 60 unit/kg bolus (max 4000) f/b 12 u/kg/hr for 48 hrs target aPTT 50-70. For PCI and STEMI, target appropriate ACTs
therapeutic enoxaparin dose for ACS 1 mg/kg BID, at least 1-2 days post PCI or up to 8 days
fondaparinux dose for ACS 2.5 mg SQ QD. do not use as solo agent for PCI
dose of bivalirudin in UA/NSTEMI and PCI 0.1 mg/kg bolus f/b 0.25 mg/kg/hr. if PCI or STEMI +/- primary PCI, 0.75 mg/kg bolus f/b 1.75 mg/kg/hr during procedure and up to 4 hours post procedure.
dose of ASA in ACS if on ASA PTA, can do 81-325 mg, if not do 162-325 mg.
dose of clopidogrel for ACS. include duration of therapy 300-600 mg LD f/b 75 mg QD. for at least 12 months post PCI. if no ACS can do 1 month-12 months for BMS or 12 months for DES.
dose of prasugrel for ACS. include duration of therapy 60 mg LD f/b 10 mg QD for 12 months minimum
dose of ticagrelor for ACS 180 mg LD f/b 90 mg QD for 12 months minimum.
when are fibrinolytics appropriate in ACS STEMI only. door to needle 30 minutes as long as onset of ischemic sx is <12 hours. Primary PCI is preferred but if anticipate that it cannot be done within 120 minutes of first medical contact then fibrinolysis is appropriate.
if fibrinolytics used, pts should recieve anticoagulation (UFH, LMWH or fondaparinux) following this. how long to continue therapy for at least 48 hours, up to 8 days or duration of hospitalization if less than 8 days. may stop once revascularization is performed if applicable.
dose of alteplase (t-PA) in ACS/STEMI if pt <67 kg (>67) 15 mg IVP f/b 0.75 mg/kg (max 50 mg) over 30 minutes, f/b 0.5 mg/kg (max 35 mg) over 60 minutes
dose of renectaplase in STEMI 10 units. repeat in 30 mins
Dose of tenecteplase in STEMI ~0.5 mg/kg
What medications should be started in a pt post ACS for long term management beta blocker [continue for at least 3 years, can consider discontinuing once EF>40], AVE inhibitor in ALL pts regardless of LVF. spironolactone if LVEF <40 if on beta blocker and ACE AND DMII or sx HF sx. statin high intensity. CCBs and nitrates optional.
Created by: mjuhlin