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RxPrep
Acute Coronary Syndrome(s) (CH 30)
| Question | Answer |
|---|---|
| 3 main types of ACS? | UA, NSTEMI, and STEMI |
| Fibrinolytics for ACS (mainly STEMI) should be given within _____ of admission. | 30 minutes |
| Fibrinolytics normal use? | Used when PCI is not available in time (within 120 minutes of admission) |
| PCI is generally recommended when? | For STEMI (almost always) and can be used for NSTEMI |
| What is MONA? | Morphine, Oxygen, Nitrates, Aspirin |
| When is oxygen indicated for ACS? | O2 sat < 90% |
| Benefits of nitrates in ACS? | ↓ preload/afterload, relieve chest pain |
| Avoid nitrates when? | Right ventricular infarction |
| Aspirin loading dose for ACS? | 162-325mg chewable |
| Beta blocker timing for ACS? | Within 24 hours |
| Avoid beta blockers in? | Decompensated HF, shock, HR <45 |
| ACE inhibitor timing for ACS? | Within 24 hours |
| ACE inhibitor indication(s)? | LVEF <40%, HTN, DM, CKD |
| Plavix loading dose for ACS? | 300–600 mg |
| Boxed warning for Plavix? | CYP2C19 poor metabolizers, less effective |
| Interactions for Plavix? | omeprazole, esomeprazole |
| MOA of plavix? | Irreversible P2Y12 inhibition |
| Prasugrel loading dose? | 60mg |
| Prasugrel maintenance dose? | 10mg daily |
| Prasugrel box warning? | Fatal bleeding |
| Prasugrel should be avoided in what age(s)? | >75 years old |
| CI for prasugrel | history of TIA or stroke |
| Prasugrel use? | ACS managed with PCI (dont use in patient who didnt have PCI) |
| Plavix should be stopped ______ before surgery | 5 days |
| Prasugrel should be stopped _______ before surgery | 7 days |
| Ticagrelor loading dose? | 180mg |
| Ticagrelor maintenance? | 90 mg BID × 1 year then 60 mg BID |
| Prasugrel Brand name | Effient |
| Ticagrelor brand name | Brilinta |
| Cangrelor brand name | Kengreal |
| Boxed warning Brilinta? | Bleeding |
| Aspirin dose with ticagrelor? | ≤ 100 mg daily |
| Ticagrelor contraindication? | History intracranial hemorrhage |
| Ticagrelor side effect? | Dyspnea |
| Ticagrelor MOA | Reversible P2Y12 inhibitor |
| Ticagrelor interaction? | Strong CYP3A4 inhibitors and inducers (just like ranolizine) |
| Cangrelor use? | PCI patients unable to take oral P2Y12 inhibitors, transition to oral P2Y12 after PCI if possible. |
| Cangrelor dose? | 30 mcg/kg bolus then 4 mcg/kg/min |
| CI for ALL P2Y12 inhibitors? | Active bleeds |
| Cangrelor duration? | 2 hours or duration of PCI |
| Cangrelor transition? | Switch to oral P2Y12 after (usually after PCI) |
| Which P2Y12 inhibitor is ONLY indicated for patients with ACS managed with PCI? | Prasugrel (Effient) |
| Which drugs are GP IIb/IIIa inhibitors? | Eptifibatide (Integrilin) and Tirofiban (Aggrastat) |
| When are GP IIb/IIIa inhibitors indicated in ACS? | Usually just given for patient with PCI, MUST be used with heparin |
| CI of Eptifibatide (Integrilin)? | Thrombocytopenia |
| Both of the GP IIb/IIIa inhibitors should be avoided when? | During active bleed |
| Eptifibatide loading dose and maintenance dose? | LD: 180 mcg/kg bolus ×2 MD: 2 mcg/kg/min infusion |
| Tirofiban loading and maintenance dose? | LD: 25 mcg/kg IV bolus MD: 0.15 mcg/kg/min |
| Which drugs are fibrinolytics? | Alteplase (Activase), Tenecteplase (TNKase), Vorapaxar (Zontivity) |
| Alteplase use? | STEMI when PCI unavailable |
| Major risks with alteplase? | Bleeding, ICH (CI in patients with history of brain hemorrhage) |
| Brand name alteplase? | Activase |
| Brand name of tenectaplase | TNKase |
| Which fibrinolytics have boxed warnings for ICH? | Alteplase and vorapaxar (tenecteplase does NOT have this box warning) |
| Duration of P2Y12 therapy after ACS event? | At least 12 months |
| Beta blocker duration after ACS? | 3 years (or indefinite if HF) |
| ACE inhibitor after ACS? | Indefinite if LVEF ≤40% |
Created by:
cdaughtry