Schwier Lecture 1 (3 Sets Of Notes)

Front 1

Disorders related to the process of atheroslerosis is called?

Back 1

Cardiovascular disease

Front 2

This is characterized by reduced blood supply to the heart. What is this defined as?

Back 2

IHD

Front 3

Reduced supply is called?

Back 3

Ischemia

Front 4

When tissue death with resulting inflammation happens, what its called?

Back 4

infarction

Front 5

An MI is a Heart Attack. T or F

Back 5

True

Front 6

Unstable Angina, NSTEMI, and STEMI all fall under what category?

Back 6

Acute Coronary Syndrome

Front 7

NSTEMI stands for what?

Back 7

Non-ST segment elevation myocardial infarction

Front 8

STEMI stands for what?

Back 8

ST segment elevation myocardial infarction

Front 9

When a blood clot formed within the vascular system its called what?

Back 9

A thrombus

Front 10

An inadequate supply of blood and oxygen to a specific part of the myocardium is called what?

Back 10

Ischemic heart disease

Front 11

Ischemic Heart Disease is caused by what?

Back 11

atherosclerosis of coronary anatomy

Front 12

Ischemic Heart Disease can be symptomatic or Asymptomatic. T or F

Back 12

True

Front 13

Ischemic Heart Disease can be asymptomatic. T or F

Back 13

True

Front 14

Ischemic Heart Disease can be Unstable or Stable. T or F

Back 14

True

Front 15

CSA falls under Stable or Unstable Ischemic Heart Disease?

Back 15

Stable

Front 16

Acute Coronary Syndrome (ACS) falls under Stable or Unstable Ischemic Heart Disease?

Back 16

Unstable

Front 17

What is the number 1 cause of death in the US?

Back 17

Heart Disease

Front 18

Costs of caring for patients with IHD in 2010 was greater than $200 ____

Back 18

billion

Front 19

The heart spends most of its time contracting or relaxing?

Back 19

relaxing

Front 20

Why is it important that the heart spends most of its time relaxing?

Back 20

It is important for coronary circulation. It allows for proper filling and efficient pumping.

Front 21

A relaxing heart is in diastole or systole?

Back 21

diastole

Front 22

Oxygen rich blood flows into coronary arteries during diastole or systole?

Back 22

diastole

Front 23

What is responsible for delivering oxygen rich blood to the myocardium?

Back 23

Coronary Arteries

Front 24

What is the largest vein that drains de-oxygenated blood and returns to the right atrium?

Back 24

Coronary Sinus

Front 25

The Left Anterior Descending Coronary Artery provides oxygenated blood to what?

Back 25

Left ventricle and Left atrium

Front 26

The Right Coronary Artery provides oxygenated blood to what?

Back 26

Right ventricle, right atrium, and AV node

Front 27

Which artery is important bc it goes to the back side of the heart?

Back 27

Right Coronary Artery

Front 28

The _____ _____ artery is the main coronary artery bc it goes to the LAD. LAD diffuses most of the blood to the heart.

Back 28

The left coronary

Front 29

Disruption of myocardial oxygen supply and demand within coronary anatomy is initiated by what?

Back 29

atherosclerosis

Front 30

The health of the CA will dictate what?

Back 30

oxygen extraction

Front 31

If the heart contracts more, is the less or more demand on the heart?

Back 31

more

Front 32

High wall tension leads to an increase or decrease in demand?

Back 32

increase

Front 33

If you have endothelial damage, will you have more or less oxygen extraction?

Back 33

less

Front 34

Infarction due to atherosclerosis has profound cardiac implications. T or F

Back 34

true

Front 35

Monocytes intake ____ into the endothelium.

Back 35

oxidized LDL

Front 36

When a macrophage goes into the endothelium (along with LDL) what is it called?

Back 36

foam cells

Front 37

Foam cells lead to the creation of what that cause an inflammatory response?

Back 37

Fatty streaks

Front 38

What protects the fatty streak?

Back 38

fibrous cap

Front 39

Ischemia is a result of unstable plaque that resulted from formation of a partial or total occlusive thrombus?

Back 39

partial

Front 40

Infarction is a result of unstable plaque that resulted from formation of partial or total occlusive thrombus?

Back 40

both

Front 41

IHD is all about plaque stability and thrombus occlusion. T or F

Back 41

true

Front 42

Atherosclerotic plaque is a lipid core that contains thrombogenic material and inflammatory cells. T or F

Back 42

true

Front 43

What protects the lipid core of plaque?

Back 43

Fibrous cap of atheroma

Front 44

High or low lipid content makes it more susceptible to becoming damaged?

Back 44

high

Front 45

High or low concentration of macrophages make it more susceptible to becoming damaged?

Back 45

high

Front 46

A thin or thick fibrous cap of plaque makes it more susceptible to becoming damaged?

Back 46

thin

Front 47

What transforms into foam cells?

Back 47

Macrophages

Front 48

When you rupture the fibrous cap what cells bring cytokines to the site?

Back 48

T cells

Front 49

What pathway is stimulated to produce thrombin?

Back 49

extrinsic pathway (Tissue Factor)

Front 50

When the von willebrand factor bind to a glycoprotein platelet activation begins. What does the activation cause the release of?

Back 50

Thrombin, Thromboxan, Epi, ADP and Serotonin

Front 51

A red thrombus is composed of what?

Back 51

fibrin and RBC

Front 52

A white thrombus is composed of what?

Back 52

platelets

Front 53

PAR-1 is activated by what?

Back 53

thrombin

Front 54

An NSTEMI is a partial or total occlusion of the coronary artery?

Back 54

partial

Front 55

An unstable angina is unstable plaque causing ______?

Back 55

ischemia

Front 56

Which of these (NSTEMI or STEMI) is an unstable plaque that causes an infarction?

Back 56

both

Front 57

A STEMI is a partial or total occlusion of the coronary artery?

Back 57

total

Front 58

Which of these requires immediate intervention to clear plaque from the coronary artery? NSTEMI or STEMI

Back 58

STEMI

Front 59

____ is Myocardium?

Back 59

Time

Front 60

What are the symptoms of a thrombus?

Back 60

chest pain (w/ or w/ out radiation), NV, dyspnea.

Front 61

What is it called when it feels like an elephant is standing on a person chest?

Back 61

Angina pectoris

Front 62

Do pts usually present with sharp stabbing pains or substernal chest discomfort?

Back 62

substernal chest discomfort

Front 63

Who is more likely to present atypically?

Back 63

Women, DM pts, elderly

Front 64

What type of pts are known to present with no chest pain?

Back 64

DM

Front 65

What is indicative of dying tissue?

Back 65

biomarkers

Front 66

What are the three types of biomarkers?

Back 66

troponin, Myoglobin, and CK MB

Front 67

Which biomarker is the most sensitive and most specific?

Back 67

troponin

Front 68

What is released from cardiac myocytes during myocardial infarction?

Back 68

troponin

Front 69

Troponin regulates what?

Back 69

Ca2+ mediated interaction of actin and myosin

Front 70

If you wanted to see if a person has had an infarction in the past, what wave would be effect?

Back 70

Q

Front 71

If you have a depressed (below the baseline) ST segment what is that indicative of?

Back 71

NSTEMI

Front 72

If you have an elevated (above baseline) ST segment, what is that indicative of?

Back 72

STEMI

Front 73

What system become up-regulated in response to atherosclerotic plaque prohibiting coronary oxygen supply?

Back 73

RAAS

Front 74

An increase in HR potentiates ischemia. T or F

Back 74

true

Front 75

When you have myocardial damage, the RAAS system is up-regulated, which leads to hypertrophy of ventricles. What comes next?

Back 75

Ventricular remodeling and Heart Failure

Front 76

An anterior infarction causes death of myocardium due to occlusion of what?

Back 76

LAD

Front 77

Which of these has a higher rate of mortality? Anterior or Posterior infarction

Back 77

anterior

Front 78

A posterior infarction causes death of myocardium due to occlusion of what?

Back 78

right coronary artery (RCA)

Front 79

The sinus node arises from what?

Back 79

RCA

Front 80

Stable ischemic Heart Disease is asymptomatic or symptomatic?

Back 80

can be both

Front 81

The initial presentation of coronary disease in women is more likely to be angina pectoris or MI?

Back 81

angina pectoris

Front 82

A disruption of myocardial oxygen supply and demand is called what?

Back 82

stable ischemic heart disease

Front 83

Substernal chest discomfort with a characteristic quality and duration that is provoked by exertion and relieved by rest or nitroglycerin is what?

Back 83

Chronic stable Angina pectoris (CSA)

Front 84

No angina with ordinary physical activity and angina with strenuous or prolong exertion is class I,II,III, or IV

Back 84

I

Front 85

Marked limitation of ordinary activity is class I,II,III, or IV

Back 85

III

Front 86

Inability to carry out any physical activity w/out chest discomfort and angina that occurs during rest is class I,II,III, or IV

Back 86

IV

Front 87

Early-onset limitation of ordinary activity and angina that may worsen after meals, cold temp, or emotional stress is class I,II,III, or IV

Back 87

II

Front 88

What are 3 atypical symptoms that women and elderly present with in CSA pectoris?

Back 88

NV, mid-epigastic discomfort, and sharp atypical chest pain

Front 89

CSA or SIHD is characterized by an unstable or stable coronary plaque?

Back 89

stable

Front 90

You would expect to find a thin fibrous cap and macrophages in CSA or SIHD. T or F

Back 90

False

Front 91

CSA or SIHD is angina precipitated by exertion or emotional stress and is or is not relieved by rest?

Back 91

is

Front 92

CSA or SIHD will or will not have the presence or biomakers.

Back 92

will not

Front 93

UA is a stable or unstable coronary plaque?

Back 93

unstable

Front 94

UA is an angina that can be precipitated by exertion or emotional stress and is or is not relieved by stress?

Back 94

is not

Front 95

If a pt has UA you would expect to find a thin fibrous cap. T or F

Back 95

true

Front 96

UA of is characterized by a lack of or presence of biomarkers?

Back 96

lack of

Front 97

In UA you have no infarction but just ischemia. T or F

Back 97

true

Front 98

AMI is a stable or unstable coronary plaque?

Back 98

unstable

Front 99

In an AMI angina can be precipitated by exertion or emotional stress and is or is not relieved by rest?

Back 99

is not

Front 100

AMI is characterized by the lack of or the presence of biomarkers?

Back 100

presence

Front 101

AMI = Heart attack

Back 101

yup

Front 102

What is the gold standard for diagnosing between CSA, UA, or AMI?

Back 102

Functional or stress testing

Front 103

In a functional or stress test you provoke ischemia by using _____ or _____ to increase myocardial oxygen demand.

Back 103

exercise or pharmacologic stress

Front 104

A functional or stress test can increase or decrease coronary flow to detect ischemia?

Back 104

increase

Front 105

A functional or stress test can detect ischemia in pts who are symptomatic or asymptomatic. T or F

Back 105

true

Front 106

In order to do an exercise test you should make sure what about the pt?

Back 106

Have an intermediate pretest probability of IHD.

Have an interpretable ECG.

Have moderate physical functioning with no disabling comorbidity.

Front 107

When would you use a pharmacologic stress test over an exercise stress test?

Back 107

Pt has intermediate to high pretest probability of IHD who are incapable of at least moderate physical function or are disabled.

Front 108

Beta blockers do or do not decrease mortality?

Back 108

do

Front 109

Beta blockers will or will not decrease anginal symptoms?

Back 109

will

Front 110

CCBs do or do not decrease mortality?

Back 110

do not

Front 111

CCBs will or will not decrease anginal symptoms?

Back 111

will

Front 112

Nitrates do or do not decrease mortality?

Back 112

do not

Front 113

Nitrates will or will not lead a decrease in anginal symptoms?

Back 113

will

Front 114

ACE-I/ARBs do or do not decrease mortality?

Back 114

do

Front 115

ACE-I/ARBs will or will not lead a decrease in anginal symptoms?

Back 115

will not

Front 116

Ranolazine does or does not decrease mortality?

Back 116

does not

Front 117

Ranolazine will or will not lead to a decrease in anginal symptoms?

Back 117

will

Front 118

APA/Plavix do or do not decrease mortality?

Back 118

Do

Front 119

APA/Plavix will or will not lead to a decrease in anginal symptoms?

Back 119

will not

Front 120

Statins do or do not decrease mortality?

Back 120

do

Front 121

Which of these drugs leads to a decrease in mortality?

BB, CCBs, Nitrates, ACE-I/ARB, Ranolazine, APA/Plavix, Statins.

Back 121

BB, ACE-I/ARB, APA/Plavix, Statins

Front 122

Which of these classes leads to a decrease in anginal symptoms?

BBs, CCBs, Nitrates, ACE-I/ARBs, Ranolazine, APA/Plavix, Statins.

Back 122

BBs, CCBs, Nitrates, Ranolazine

Front 123

When modifying risk factors like lipids, what kind of statin should be prescribed? High, moderate, or low dose?

Back 123

moderate to high

Front 124

Is there data to show a specific LDL target with respect to mortality?

Back 124

no

Front 125

When modifying risk factors like hypertension, what is the goal bp?

Back 125

< 140/90

Front 126

When a pt has Heart Failure (reduced EF), this is a compelling indication for which classes of drugs?
Diuretics, BB, ACE/ARB, CCB, Aldosterone Antagonists.

Back 126

Diuretics, BB, ACE/ARB, and Aldosterone Antagonists

Front 127

When a pt has Angina, this is a compelling indication for what classes of drugs?
Diuretics, BB, ACE/ARB, CCB, Aldosterone Antagonists.

Back 127

BB and CCB

Front 128

When a pt has Post-MI, this is a compelling indication for what classes of drugs?

Diuretics, BB, ACE/ARB, CCB, Aldosterone Antagonists.

Back 128

BB, ACE/ARB, and Aldosterone Antagonist

Front 129

When a pt has DM, this is a compelling indication for what classes of drugs?
Diuretic, BB, ACE/ARB, CCB, Aldosterone Antagonists.

Back 129

BB and ACE/ARB

Front 130

When a pt has CKD, this is a compelling indication for what classes of drugs?

Diuretics, BB, ACE/ARB, CCB, Aldosterone Antagonists.

Back 130

ACE/ARB

Front 131

This group of classes of drugs are indicated for what?
Diuretics, BB, ACE/ARB, Aldosterone Antagonists.

Back 131

Heart Failure (reduced EF)

Front 132

This group of classes of drugs are indicated for what?

BB and CCB

Back 132

Angina

Front 133

This group of classes of drugs are indicated for what?
BB and ACE/ARB

Back 133

DM

Front 134

This group of classes of drugs are indicated for what?
BB, ACE/ARB, Aldosterone Antagonists.

Back 134

Post-MI

Front 135

If you have a pt that is only indicated for ACE/ARB therapy what does the pt most likely have?

Back 135

CKD

Front 136

The most appropriate goal level for HbA1c in pts with DM and IHD has not been established. T or F

Back 136

true

Front 137

If you have a younger pt what do you want the A1c to be?

Back 137

<7%

Front 138

If you have an older pt or one with a lower life expectancy what do you want the A1c goal to be?

Back 138

7-9%

Front 139

If you want to prevent MI/Mortality and you are prescribing Aspirin, what is the dosage strength?

Back 139

75-162 but usually 81 mg

Front 140

If you want to prevent MI/Mortality and you are prescribing Aspirin, but its contraindicated, what would you prescribe and whats it dosage?

Back 140

Plavix 75 mg

Front 141

In what cases could you give aspirin and plavix together?

Back 141

High risk pts so documented prior: MI or ischemic stroke or pts with symptomatic PAD

Front 142

What class of drugs is the first line agents in SIHD?

Back 142

BB

Front 143

If you have a pt with HF with reduced ejection fraction, what class of drugs should you give?

Back 143

BB

Front 144

BB are the first line therapy in what?

Back 144

SIHD

Front 145

Is there any robust evidence to show effects of BB on survival/CAD event rates in pt with ONLY SIHD?

Back 145

no

Front 146

Which are more efficacious? BB or dihydropyridine CCBs?

Back 146

BB

Front 147

What should be used in ALL pts with LV Systolic dysfunction (EF <40%) with heart failure or prior MI? (which specific ones from the class)

Back 147

BB Carvedilol, Bisoprolol, and Metoprolol Succinate

Front 148

BB therapy should be started and continued for how many years in a pt with normal LV function after ACS?

Back 148

3 years

Front 149

Carvedilol, Bisoprolol, and Metoprolol succinate are THE BEST for what?

Back 149

LV systolic dysfunction (EF<40%) with heart failure or prior MI

Front 150

What are some cardioselective BBs?

Back 150

Atenolol, Betaxolol, Bisoprolol, Metoprolol, and Nebivolol

Front 151

In treatment of SIHD, ALL BB are equally efficacious. T or F

Back 151

True

Front 152

If BB need to be withdrawn, how long should you wean pts for?

Back 152

1-3 weeks

Front 153

I would use an ACE-I for pts who have SIHD AND what possible conditions?

Back 153

Hypertension, DM, LV dysfunction, or CKD

Front 154

All pts with ischemic HD should be discharged with what?

Back 154

Sublingual nitroglycerin

Front 155

How do nitrates effect SIHD?

Back 155

Improve exercise tolerance, time to angina onset, time to ST-segment depression

Front 156

MOA: Reduces myocardial demand by decreasing preload. What drug is this?

Back 156

nitrates

Front 157

What should be prescribed for all patients with SIHD?

Back 157

short acting nitrates

Front 158

SL nitroglycerin is recommended for ____ _____ _____ in pts with SIHD.

Back 158

immediate relief angina

Front 159

What will a pt feel if the SL nitro tabs are working?

Back 159

Burning sensation on tongue

Front 160

What is the maximum of nitrostat tab mg one should take?

Back 160

1.2 mg/15 minutes

Front 161

What should you use when BB are contraindicated or cause unacceptable side effects, or in combo with BBs to relieve angina symptoms?

Back 161

Long active nitrates

Front 162

Nitrates can experience what kind AE?

Back 162

tachyphylaxis

Front 163

What kind of drugs are contraindicated with nitrates?

Back 163

PDE5 inhibitors

Front 164

Which of these are ER? Monoket, Imdur, Dilatrate SR, Isordil

Back 164

Imdur and Dilatrate SR

Front 165

Which of these are dosed once a day? Monoket, Imdur, Dilatrate SR, Isordil

Back 165

Imdur and Dilatrate SR

Front 166

What is the initial therapy for relief of symptoms in patients with SIHD?

Back 166

BB

Front 167

Calcium channel blockers should be used when?

Back 167

Contraindicated BB or in combo with BB.

Front 168

Long acting nondihrdropyridine CCB should be used in conjunction or instead of a BB?

Back 168

instead of

Front 169

If you have a non-dihydropyridine CCB what mg should you not exceed with simvastatin?

Back 169

10 mg

Front 170

If you have amlodipine what mg should you not exceed with simvastatin?

Back 170

20 mg

Front 171

What is the strength range of Ranolazine?

Back 171

500-1000mg bid

Front 172

How does Ranolazine work?

Back 172

QTc prolongation

Front 173

What should you avoid with Ranolazine?

Back 173

grapefruit juice

Front 174

You do NOT exceed _____ mg with moderate inhibitors of CYP3A4 like _____ and ______.

Back 174

500mg; verapamil and diltiazem

Front 175

If a pt is taking Ranolazine, what mg do you not exceed of simvastatin daily?

Back 175

20mg

Front 176

What condition is contraindicated for pts taking Ranolazine?

Back 176

Cirrhosis

Front 177

If you have a pt with chronic angina pain and does not tolerate BB's well, is ranolazine indicated?

Back 177

yes

Front 178

You can give Ranolazine in combo with BB. T or F

Back 178

true

Front 179

Ranolazine has a decrease in mortality. T or F

Back 179

False

Front 180

Vasospastic (Prinzmetal's) Angina is a form of what?

Back 180

Unstable angina

Front 181

What UA looks clean in the CA but is actually angina?

Back 181

Prinzmetals

Front 182

Prinzmetals angina is characterized by transient ST-segment elevation or depression?

Back 182

elevation

Front 183

Prinzmetal's angina can revolve spontaneously or w/ NTG use w/out progression to MI. T or f

Back 183

True

Front 184

What is a first line agent for Prinzmetals angina?

Back 184

NTG, LAN, CCB in high doses

Front 185

What BB's could I use to treat Prinzmetal's Angina?

Back 185

labetalol or carvedilol

Front 186

Pts that present with signs/symptoms of ACS can be instructed to _____ non-enteric coated aspirin.

Back 186

chew

Front 187

What are the 3 Ds?

Back 187

Door, Data, Decision

Front 188

> 1.5 ng/mL is indicative of Cardiac Troponin I or T?

Back 188

I

Front 189

This Cardiac Troponin can return to normal range in 5-14 days. Is it I or T

Back 189

T

Front 190

>0.1 ng/mL is indicative of Cardiac troponin I or T?

Back 190

T

Front 191

When should you draw levels of cardiac troponins?

Back 191

every 6 hours

Front 192

Is myoglobin specific or non-specifc?

Back 192

non-specific

Front 193

Which of these is elevated after skeletal muscle injury, trauma, and renal failure? Myoglobin or CK-MB

Back 193

Myoglobin

Front 194

Which of these is elevated in cardiac surgery, myocaditis, and electrical cardioverison? Myoglobin or CK-MB

Back 194

CK-MB

Front 195

If you have a pt that has a heart attack and they come back to you 2 days later, what would you measure levels for to see if they are having another event? Tropinon or CK-MB

Back 195

CK-MB

Front 196

Which of these is the early marker and which is the late marker? Myoglobin and Troponin

Back 196

Myoglobin is early

Troponin is late

Front 197

MONA-B stands for what?

Back 197

Morphine, Oxygen, Nitroglycerin, APA, and BB

Front 198

What effect does Morphine have on mortality?

Back 198

None

Front 199

What is the dosage of Morphine?

Back 199

2-4 mg IV

Front 200

You administer oxygen to pts with and O2 saturation of _____?

Back 200

<90%

Front 201

When do you administer oxygen?

Back 201

w/in first 6 hours

Front 202

What effect does oxygen have on mortality?

Back 202

none

Front 203

How do you administer Nitroglycerin SL?

Back 203

0.4mg po sl q 5 minutes for a max of 3 doses

Front 204

How do you asses for IV nitroglycerin?

Back 204

5-10 mcg/min then 5-20mcg/min until symptoms are relieved

Front 205

When would you use IV instead of SL nitroglycerin?

Back 205

relief of refractory CP or pulmonary congestion

Front 206

You should not administer nitroglycerin when SBP is?

Back 206

<90mmHg (<30 mmHg below baseline)

Front 207

You should not administer nitroglycerin when HR is?

Back 207

<50 bpm

Front 208

You should avoid nitroglycerin with there is a suspected what?

Back 208

RV infarct

Front 209

What effect does nitroglycerin have on mortality?

Back 209

none

Front 210

What effect does APA have on mortality?

Back 210

decreases mortality

Front 211

What effect does BB have on mortality?

Back 211

Decreases mortality

Front 212

If you have a pt that presents with an MI do you wana administer BB orally or IV?

Back 212

orally

Front 213

If you have a pt present with _____ you should not administer BB orally.

Back 213

HF, low output state, increased risk for cardiogenic shock.

Front 214

If you have a contraindication for BB and the patient presents and there is NOT HFrEF or AV node block what class of drug would you give?

Back 214

non-dihydro CCB

Front 215

All patients with HFrEF should receive what as secondary prevention?

Back 215

BB

Front 216

You should initiate IV BB therapy in pts who are _______

Back 216

hypertensive (160s)

Front 217

If you have a pt that presents with signs of HF, low output state, or risk for cardiogenic shock you would want to give IV BB. T or F

Back 217

False

Front 218

What is used to keep the artery from reinfarcting after PCI and also blocking ADP?

Back 218

P2y12 inhibitors

Front 219

What dictates the therapy of P2Y12 inhibitors during PCI?

Back 219

The type of stent

Front 220

Which of these has a higher risk of repeat revascularization and restenosis? BMS or DES?

Back 220

BMS

Front 221

If issues with adherence arise would you use a BMS or DES?

Back 221

BMS

Front 222

If you have a pt with high risk of bleeding with dual DAPT would you use BMS or DES?

Back 222

BMS

Front 223

If surgery is imminent in a pt would you recommend DES or BMS?

Back 223

BMS

Front 224

Anti-proliferative agents coated on the stent to DECREASE restenosis describes BMS or DES?

Back 224

DES

Front 225

Which has possible delayed arterial healing and increased late stent thrombosis? BMS or DES

Back 225

DES

Front 226

What is ticagrelor's name brand?

Back 226

brilinta

Front 227

Ticlopidine, Clopidogrel, Prasugrel, and Ticagrelor are ______ receptor antagonists

Back 227

P2Y12

Front 228

Which of these is reversible? Ticlopidine, Clopidogrel, Prasugrel, or Ticagrelor

Back 228

Ticagrelor

Front 229

Ticlopidine dosing is?

Back 229

250 mg bid

Front 230

What percentage of plavix is absorbed?

Back 230

50

Front 231

Plavix is effected by intestinal what?

Back 231

P-GP

Front 232

What is the primary enzyme responsible for Plavix?

Back 232

CYP2C19

Front 233

What is the loading dose of Plavix?

Back 233

300-600 mg

Front 234

What is the maintenance dose of Plavix?

Back 234

75mg/day

Front 235

What is the Loading Dose of plavix prior to reperfusion therapy?

Back 235

300-600 mg

Front 236

A patient wont be able to metabolize Plavix if it has what polymorphism?

Back 236

CYP2c19*2

Front 237

What drug class should you avoid if youre taking Plavix?

Back 237

PPIs

Front 238

If you have a pt with stomach issues and wants to take omeprazole, but they need plavix, what could you suggest?

Back 238

H2 blockers like lansoprazole or pantoprazole

Front 239

What is a contraindication for Plavix?

Back 239

Active bleeding

Front 240

What enzymes are responsible for metabolism of Prasugrel?

Back 240

CYP 3A4 and 2B6

Front 241

What is the loading dose of Prasugrel?

Back 241

60 mg (30-60 min)

Front 242

Which has greater inhibition of platelet aggregation? Prasugrel or Clopidogrel

Back 242

Prasugrel

Front 243

Prasugrel is only to be used in UA/NSTEMI or ?

Back 243

STEMI Pts are DEFINITELY going for a PCI

Front 244

What is the age cut off for Prasugrel?

Back 244

75 years and above

Front 245

What are the contraindications for Prasugrel?

Back 245

Active bleeding or Prior TIA or stroke

Front 246

What enzyme is responsible for metabolizing Ticagrelor?

Back 246

CYP 3A4

Front 247

What is the LD of Ticagrelor?

Back 247

180 mg (30-60 min)

Front 248

Which of these has the greatest platelet inhibition? Clopidogrel, Ticagrelor, or Prasugrel

Back 248

Ticagrelor

Front 249

Which of these has an AE of ventricular pauses and bradycardia? Clopidogrel, Ticagrelor, or Prasugrel

Back 249

Ticagrelor

Front 250

Maintenance doses of ASA >_____mg reduces the effectiveness of Ticagrelor.

Back 250

100

Front 251

What are contraindications of Ticagrelor?

Back 251

Active bleeding and prior or current intracranial hemorrhage and severe hepatic impaired pts

Front 252

What class of drugs are considered "Bail out" therapy when it comes to ACS.

Back 252

Glycoprotein IIB/IIIA antagonists (abciximab, eptifibatide, or tirofiban)

Front 253

Which of these is the monoclonal antibody fragment? Abciximab, Eptifibatide, or Tirofiban

Back 253

Abciximab

Front 254

Which of these is non-peptide small molecule? Abciximab, Eptifibatide, or Tirofiban

Back 254

Tirofiban

Front 255

Which of these is a cyclic peptide? Abciximab, Eptifibatide, or Tirofiban

Back 255

Eptifibatide

Front 256

What is the platelet bound half life of Abciximab?

Back 256

4 hours

Front 257

What is the platelet bound half life of Eptifibatide?

Back 257

seconds

Front 258

What is the platelet bound half life of Tirofiban?

Back 258

seconds

Front 259

What is the plasma half-life of Abciximab?

Back 259

20-30 minutes

Front 260

What is the plasma half life of Eptifibatide?

Back 260

2-3 hours

Front 261

What is the plasma half life of Tirofiban?

Back 261

1.5-2 hours

Front 262

Which has the greatest decrease in thrombin generation? Abciximab, Eptifibatide, or Tirofiban

Back 262

Abciximab

Front 263

Which of these two drugs have the same amount of decrease in thrombin generation? Abciximab, Eptifibatide, or Tirofiban

Back 263

Eptifibatide and Tirofiban

Front 264

What is the reversibility time w/ out platelets with Abciximab?

Back 264

72 hours

Front 265

What is the reversibility time w/out platelets with Eptifibatide?

Back 265

4 hours

Front 266

What is the reversibility time w/out platelets with Tirofiban?

Back 266

3-4 hours

Front 267

Is there reversibility w/ platelets with Abciximab?

Back 267

Yes

Front 268

Is there reversibility w/ platelets with Eptifibatide?

Back 268

No

Front 269

Is there reversibility w/ platelets with Tirofiban?

Back 269

No

Front 270

What is the route of elimination with Abciximab?

Back 270

Spleen

Front 271

What is the route of elimination with Eptifibatide?

Back 271

Renal

Front 272

What is the route of elimination with Tirofiban?

Back 272

Renal

Front 273

What is the renal dose adjustment for Abciximab?

Back 273

None

Front 274

What is the renal dose adjustment for Eptifibatide?

Back 274

Decrease MD by 50%

Front 275

What is the renal dose adjustment for Tirofiban?

Back 275

Decrease MD by 50%

Front 276

If you have a pt with history of HIT undergoing PCI, what drug should you administer?

Back 276

Argatroban