Acs

Front 1

Abciximab
a.) generic
b.) class

Back 1

a.) ReoPro
b.) GP IIb/IIIa receptor antagonist

Front 2

Eptifibatide
a.) generic
b.) class

Back 2

a.) Integrilin
b.) GP IIb/IIIa receptor antagonist

Front 3

Tirofiban
a.) generic
b.) class
c.) when to use

Back 3

a.) Aggrasta
b.) GP IIb/IIIa receptor antagonist
c.) UA/NSTEMI cath lab upstream

Front 4

Elevated troponin
a.) value
b.) indication

Back 4

a.) greater than or equal to 1.5 ng/mL
b.) STEMI/NSTEMI

Front 5

Normal troponin
a.) value
b.) indication

Back 5

a.) less than or equal to 0.6 ng/mL
b.) unstable angina

Front 6

When is fibrolytics contraindicated?

Back 6

In UA/NSTEMI

Front 7

Prasugrel should not be given to who? (3)

Back 7

Pts with TIA/stroke, <60kg, >75 years old

Front 8

Prasugrel
a.) brand
b.) class
c.) loading dose
d.) maintanence dose
e.) avoid in (3)

Back 8

a.) Effient
b.) antiplatelet
c.) 60 mg PO once
d.) 10 mg PO daily
e.) TIA/stroke, >75 years old, <60 kg

Front 9

Clopidogrel
a.) brand
b.) class
c.) loading dose
d.) maintenance dose
e.) place in therapy (3)
f.) duration for maintenance (2)

Back 9

a.) Plavix
b.) antiplatelet
c.) 600 mg PO once
d.) 75 mg PO daily
e.) MONA for NSTEMI, STEMI when symptoms <12 hours, alternative if aspirin C/I
f.) maintenance: minimum 12 months when on aspirin, indefinite when ASA C/I

Front 10

Aspirin
a.) loading dose
b.) maintenance dose
c.) place in therapy & dose
d.) MOA
e.) mortality effect
f.) role in ACS (2)
g.) duration

Back 10

Aspirin
a.) 162-325 mg PO once
b.) 75-162 mg PO daily
c.) MONA (162-325mg CHEWED); maintenance (usually 81 mg)
d.) inhibits TXA2
e.) decreases mortality
f.) stabilizes coronary plaque, quality of care indicator for MI patients
g.) indefinite

Front 11

Thienopyridines
a.) class
b.) MOA

Back 11

Thienopyridines
a.) antiplatelets (Clopidogrel and Prasugrel)
b.) inhibits ADP

Front 12

UA/NSTEMI: TIMI score < or equal to 2
a.) therapy
b.) preferred drug
c.) alternative (2) and duration if applicable
d.) avoid

Back 12

UA/NSTEMI: TIMI score <2
a.) antithrombotic therapy
b.) Enoxaparin/lovenox SQ
c.) IV UFH for 2-5 days or fondaparinux for high risk bleeding
d.) glycoprotein inhibitors

Front 13

UA/NSTEMI: TIMI score >2
a.) therapy
b.) upstream drugs
c.) downstream drugs

Back 13

UA/NSTEMI: TIMI score >2
a.) Cardiac catherization
b.) upstream: antithrombotic therapy & glycoprotein therapy
c.) downstream: antithrombotic therapy and glycoprotein therapy

Front 14

When to never use glycoprotein inhibitors (2)

Back 14

NSTEMI/UA medication only
b.) fibrolytic therapy for STEMI

Front 15

When to use glycoprotein inhibitors (2)

Back 15

Cath labs in both NSTEMI and STEMI

Front 16

Major ADR of glycoprotein inhibitors

Back 16

Thrombocytopenia

Front 17

NTG SL
a.) place in therapy
b.) dose

Back 17

NTG SL
a.) MONA; at the door for STEMI/UA or NSTEMI
b.) 0.4 mg SL q5min x 3doses

Front 18

NTG IV
a.) place in therapy
b.) dose
c.) > 24 hr

Back 18

NTG IV
a.) MONA if person has refractory angina after NTG SL fails
b.) 5-10 mcg/min IV infusion, titrated up to 200 mcg/min until relief or intolerance (HA/hypotension)
c.) monitor for tolerance. Can switch to oral if symptom-free for 24 hr

Front 19

Morphine Sulfate
a.) place in therapy
b.) indication (2)
c) antidote
d.) mortality effect

Back 19

Morphine Sulfate
a.) MONA ACS
b.) pain after 3 NTG SL or pain after adequate anti-ischemic therapy
c.) naloxone
d.) no effect on mortality

Front 20

Nitrates
a.) place in therapy
b.) SL dose
c.) IV dose
d.) mortality effect
e.) affects demand or supply?
f.) why use in ACS? (2)

Back 20

a.) MONA
b.) 0.4 mg SL q5min x 3 doses
c.) 5-10 mcg, titrated up to 200 mcg until relief or intolerance; >24 monitor tolerance
d.) no effect on mortality
e.) both (also reverses vasospasms for prinzmetal's)
f.) improves exercise tolerance and onset of angina

Front 21

Nitrates + PDE-5 inhibitors
a.) ADR
b.) 24 hour free period
c.) 48 hour free period

Back 21

Nitrates + PDE-5 inhibitors
a.) irreversible hypotension
b.) Sildenafil (Viagra) + Vardenafil (LeVitra)
c.) Tadalafil (Cialis)

Front 22

Beta-Blockers
a.) place in therapy
b.) doses
c.) MOA demand or supply?
d.) mortality effect
e.) Target resting heart rate
f.) don't use when HR
g.) taper & why

Back 22

a.) at the door, oral preferred. IV if hypertensive
b.) Tenormin 25-100mg PO QD; Lopressor 25-200mg PO BID
c.) decrease demand
d.) decrease mortality
e.) HR: 50-60 bpm
f.) HR <50 bpm
g.) taper gradually over 1-2 weeks bc increased beta receptors/ can precipitate MI

Front 23

Ticagrelor
a.) brand
b.) class
c.) loading dose
d.) maintenance dose
e.) place in therapy
f.) duration (maintenance)

Back 23

a.) Brilinta
b.) antiplatelet
c.) 180 mg PO once
d.) 90 mg PO BID (con)
e.) MONA at NSTEMI, STEMI when symptoms less than 12 hours, maintenance
f.) at least 12 months when on 81 mg ASA (higher dose = decrease efficacy)

Front 24

Brilinta
a.) Pros (2)
b.) Cons (2)

Back 24

Tacagrelor
a.) fast onset, reversible
b.) CYP3A4 drug interactions, many side-effects/bleeds

Front 25

Plavix
a.) Pros (2)
b.) Cons (2)

Back 25

Clopidogrel
a.) high clinical experience, low bleeding
b.) CYP2C19 drug interactions, irreversible

Front 26

Effient
a.) Pros (2)
b.) Cons

Back 26

Prasugrel
a.) No drug interactions! lowest loading dose
b.) irreversible, longest hold before CABG

Front 27

Unstable angina requirements (3)

Back 27

NEED AT LEAST 1 OR MORE OF THE FOLLOWING:
1.) pain AT REST > 20 minutes
2.) new onset and severity: <2 months ago, occurring >3 times a day
3.) recent acceleration of angina (CSA that worsened in terms of severity, duration, frequency, or requires less exertion to precipitate

Front 28

NSTEMI requirements (3)

Back 28

NEED AT LEAST 2 OR MORE OF THE FOLLOWING
1.) elevated myocardial markers
2.) EKG shows signs of ischemia/necrosis
3.) pain unrelieved by nitrates

Front 29

STEMI on EKG

Back 29

ST elevation > 1mm in two continuous leads

Front 30

NSTEMI on EKG

Back 30

Either looks normal or has ST-depression or T-wave inversion. Need troponin to confirm

Front 31

When should cardiac markers be drawn?

Back 31

3 times: In the ED and 2x within the next 12-24 hours

Front 32

TIMI risk score
a.) indication
b.) acronym

Back 32

a.) NSTEMI only, assesses risk of THROMBOLYSIS in MI
b.) 3 CA3SE: Greater than 3 CAD risks (HTN, smoking, diabetes, dislipidemia, premature FH of CHD), established CAD stenosis >50%, ASA use within 7 days, angina > 2 episodes in a day, age >65, ST change in initial EKG, elevated myocardial markers

Front 33

3 CA3SE

Back 33

TIMI risk score:
3 CA3SE: Greater than 3 CAD risks (HTN, smoking, diabetes, dislipidemia, premature FH of CHD), established CAD stenosis >50%, ASA use within 7 days, angina > 2 episodes in a day, age >65, ST

Front 34

Why should you avoid NSAIDs? (2)

Back 34

1.) inhibits aspirin
2.) increases platelet aggregation

Front 35

Sirolimus

Back 35

drug for drug-eluting stent

Front 36

Everolimus

Back 36

drug for drug-eluting stent

Front 37

Paclitaxel

Back 37

drug for drug-eluting stent

Front 38

Drug-Eluting stent drugs (3)

Back 38

PES
1.) paclitaxel
2.) everolimus
3.) sirolimus

Front 39

PES

Back 39

1.) paclitaxel
2.) everolimus
3.) sirolimus

Front 40

TIMI grade
a.) indication
b.) goal
c.) grade meanings

Back 40

TIMI grade
a.) assess blood flow in reperfusion therapy
b.) TIMI grade 3 = normal blood flow
c.) grade 0 = no blood flow;
grade 1 = minimal blood flow
grade 2 = moderate blood flow
grade 3 = NORMAL blood flow

Front 41

IV beta-blocker
a.) drug
b.) dose

Back 41

a.) metoprolol tartate
b.) 5 mg IV for 1-2 minutes every 5 minutes for 15 minutes

Front 42

Alteplase
a.) brand
b.) abbreviation
c.) class

Back 42

a.) activase
b.) t-PA
c.) fibrolytic

Front 43

Reteplase
a.) brand
b.) abbreviation
c.) class

Back 43

a.) Retevase
b.) r-PA
c.) fibrolytic

Front 44

Tenecteplase
a.) brand
b.) abbreviation
c.) class

Back 44

a.) TNKase
b.) TNK
c.) fibrolytic

Front 45

Bivalirudin
a.) brand
b.) place in therapy
c.) never use

Back 45

a.) Angiomax
b.) Cath lab in both NSTEMI and STEMI
c.) with glycoprotein inhibitors upstream NSTEMI

Front 46

The alphabet of secondary prevention risks for ACS

Back 46

A: ASA and antianginal
B: beta blockers and BP
C: cholesterol and cigarette cessation
D: diabetes and diet
E: exercise and education

Front 47

Other than maintenance therapy, what should all post NSTEMI and STEMI patients receive? (2)

Back 47

NTG, annual vaccine

Front 48

Lisinopril
a.) brands (2)
b.) initial dose
c.) target
d.) when to give

Back 48

a.) Zestril, Prinivil
b.) 2.5-5 mg PO daily
c.) 10-20 mg PO daily
d.) within 24 hours after MI

Front 49

Ramipril
a.) brand
b.) initial dose
c.) target dose
d.) when to give

Back 49

a.) Altace
b.) 1.25-2.5 mg PO daily
c.) 5-10mg PO daily
d.) within 24 hours after MI

Front 50

When should statin be initiated?

Back 50

10 days after MI

Front 51

When should CCB be use in ACS?
a.) avoid in
b.) mortality effect

Back 51

For refractory ischemia when b-blockers and nitrates fail.
a.) EF<40%
b.) neutral

Front 52

Stool softeners
a.) indication
b.) drugs

Back 52

a.) prevent valsalva maneuver
b.) docusate sodium or docusate calcium