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CAD / Lytic Drugs
Cardiology
| Question | Answer |
|---|---|
| Antithrombotics include: | Fibrinolytics, anticoagulants, antiplatelet drugs |
| Use of fibrinolytics | STEMI only |
| Anticoagulants: acute & chronic | Acute: UFH, LMWH, DTIs; chronic: warfarin |
| UFH vs LMWH re: inactivating thrombin | UFH > LMWH |
| Beta blockers AEs | Hypotension; Decrease HR, heart block; May worsen HF symptoms; CNS (fatigue, malaise, depression); Bronchospasm (use ß1 selective agents) |
| Irreversibly binds to ADP receptor on platelets; Full reversal requires removal of plts | Clopidogrel |
| Fibrinolytics: absolute CI | Prior hemorrhagic CVA; any cerebrovascular events < 1 year; active internal bleeding; Known intracranial neoplasm; suspected aortic dissection |
| Fibrinolytics: relative CI | BP > 180/110; Use of anticoags w/ INR > 2; Noncompressible vascular punctures; Prolonged CPR (> 10 minutes); PG or Menstruation; Trauma < 2-4 weeks prior; Major surgery < 3 weeks prior |
| UFH: main risk = | bleeding |
| UFH: used for: | Both STEMI and NSTEMI |
| ATPIII/heparin has greatest effect on: | Factor II (thrombin) |
| Can use to monitor LMWH | Factor Xa |
| UFH/LMWH adverse effects | Bleeding, HIT, osteoporosis |
| UFH vs LMWH: which inhibited by PF4 (thus limited effect vs ACS)? | UFH |
| UFH vs LMWH: which requires renal dose adjustment? | LMWH |
| Tx for catheter thrombosis during PCI | Fondiparinux |
| Bivalirudin is used in STEMI in place of: | UFH / LMWH |
| Add warfarin for: | pts w/ USA or NSTEMI w/anticoag indication (to maintain INR 2.0-3.0) |
| Clopidogrel dosing | usu loading & maint doses |
| Clopidogrel AEs | Bleeding; Thrombocytopenia; Leukopenia; TTP |
| Which patients get clopidogrel? | All STEMI/NSTEMI (2-4 wks to 1 yr) |
| Which patients get GP IIb/IIIa inhibitors? | STEMI pts going for PCI |
| GP IIb/IIIa inhibitors are not recommended if: | PCI is not planned |
| ACS mgmt = | MONA (morphine, O2, NTG, ASA or antiplatelet tx); BB, ACEI, CCB, statin, anticoag (STEMI: fibrinolytics: streptokinase / alteplase); Surg: PTCA |
| Examples (5) of direct thrombin inhibitors | dabigatran (Pradaxa), desirudin, lepirudin, argatroban, bivalidrudin |
| Xa inhibitors | Fondaparinux (Arixtra): DVT/PE. Rivaroxaban (Xarelto): nonvalvular A-fib. Apixaban (Xarelto): DVT/PE |
Created by:
Abarnard
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