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71 Cards in this Set
- Front
- Back
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anticoagulants:
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heparins
factor X-A inhibitor Direct Thrombin Inhibitor |
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what do you monitor w/ anticoagulants
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aPTT
platelets QD s/s bleeding |
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CI of anticoagulants:
hx of ---- active ------ severe ------ risk recent ------- |
HIT
bleeding bleeding stroke |
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AE of anticoagulants
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bleeding
HIT |
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if a person has hx of HIT what do you give them
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enoxaparin
Factor 10A |
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ufh binds ---- and inhibits clotting factors --- and ----
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antithrombin
Xa IIa |
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how is UFH given
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bolus then infusion
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how is ufh adjusted
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accroding to aPTT or antifactor Xa levels
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t/f
UFH CI w/ renal dysfunction |
f
can be used w/ renal dysfunction |
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when do you continue ufh and when do you d/c
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continue 48 hrs w/ pts who'll be on warfarin
d/c immediately after PCI if no warfarin |
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why is ufh better to control
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easy to monitor
easy to titrate |
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what's the first line anticoagulant for STE ACS
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UFH
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what do you administer ufh w/
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fibrin selective fibrinolytic (class 1)
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who do you give ufh to
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pt's undergoing PCI
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ufh is the preferred anticoa for pt's w/ NSTE ACS following
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angiography in pts unergoing CABG
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NSTE ACS: ufh is an option for patients undergoing planned early --- and -----
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angiography
revascularization |
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NSTE ACS may be used in pts in whom an initial --- ---- is planned
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conservative strategy
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enoxaparin binds to antithrombin and inhibits factors ---- and ---
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10a
2a |
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how is enoxaparin different from ufh
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it has a shorter chain
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which has more predictable effects ufh or enoxaparin
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enoxaparin
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when to avoid enoxaparin
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acitve bleeding
severe bleeding risk cabg pt crcl < 15 ml/min |
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avoid enoxparine when
pt has had a --- in the past and when CrCL is < -- ml/min |
CABG
15 |
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--- adjustment required for enoxaparin
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renal
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t/f
iv bolus may be used for enoxaparin |
t
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dose of enoxaparin
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1mg/Kg SQ q 12 hrs
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t/f
ok to give enoxaparin w/ stemi |
f
not studied w/ primary PCI |
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for pt's w/ NSTEMI enoxaparin is an option for:
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those undergoing early angiography and revasc
those for initial conservative stategy is planned |
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t/f fondaparinux inhibits factor 10a and 2 a
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f
only 10a |
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which med is least likely to cause HIT
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fondaparinux
than UFH and LMWH |
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enox has a 17% risk reduction for death or nonfatal MI in pt than ----, but --- --- ---
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ufh
more bleeding |
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what's the alternative to pt's ufh for pt's not undergoing repeferfusion or receiving fibrinolytics
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fondaparinux
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t/f
ok to give fondaparinux alone to pt's w/ PCI |
f
not recommended |
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for nste acs: fonda is an option for pt's undergoing ----- and -----
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planned early angio and revasc
initial conservative stategy planned |
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fonda is the preferred agent for pt's ----- ----- ---
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w/ a high risk of bleeding
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w/ nstemi what the recommended me for those undergoing planned early angiography and revascularization
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ufh
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for nstemi what the recommended med for initial conservative strategy
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fonda over enox
enox over ufh |
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direct thrombin inhibitors are an option for nste pts undergoing planned --- and ---
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angiography
revascularization |
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direct thrombin inhibitors inhibit ---- and circulating ----
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clot-bound
thrombin |
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which has a more predictable response ufh or direct thrombin inhibitors
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direct throm inhib
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what can bivalirudin replace
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ufh
enoxaparin + GP 2b/3a inhibitor in mod to high risk acs patients undergoing pci |
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how long do you continue asa
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indefinately unless CI
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dose of asa
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75-81 mg
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pt's w/ stents should received what dose of asa
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325 mg for 1-12 months, then reduce to 75-81 mg
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if pt has ASA allergy what do you give
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clopidogrel
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clopidigrel given for planned ---
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pci
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post bare mental stent how long to give clopid
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1 month
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how long to give clopid for sirolimus stent
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x 3 mo
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how long to give clopid for paclitaxel stent
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x 6 mo
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for stents how long can you give if no risk of bleeding
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x 12 mo
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dose of clop pre procedure
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300mg
or 600 mg ( becoming more popular) |
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maintenance dose of clop
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75 mg
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when do you stop clop for at least 5 days
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CABG
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stemi pt w/out --- may receive clop for --- to --- days
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14-28
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which cyp can activate clop
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cyp2C19
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monitor for what in clopidogrel
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bleeding
rash GI upset |
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what can clopi interact w/ and why
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PPI
they inhibit CYP2C19, which is needed for activation of plavix. . . more deaths and hospitalization |
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what's ppi doesn't inhibit cyp 2c19
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omeprazole
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indication for prasugrel
reduction of thrombotic cv events including --- thrombosis, in those managed w/ --- |
stent
pci |
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black box warning w/ prasugrel
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increased risk of bleeding
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followin stemi and nstemi tx pts indefinately w/ ---, ---, and ---
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ASA
BB ACEI |
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what else do you give pts for 2ndary mi prevention
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NTG
Clopidogrel flu shot warfarin: for select statins glycemic control |
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who should received warfarin
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lv thrombus
hx of thromboembolic events chronic a fib valvular heart disease |
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who should not recieve warfarin
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HF pts w/ NSR w/o indication
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what do you use ot monitor warfarin
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INR
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warfarin has response to genetic variation in --- and --
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CYP2c9
VKORC1 |
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combo drugs w/ asa --- and --- requires close monitoring. lower --- target may be appropriate
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clopidogrel
warfarin |
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when do you start acei
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w/in 24 hrs
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arbs:
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candesartan
valsartan |
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candesartan and valsartan improve outcomes in -- pts
used in pts w/ low ---- following mi |
HF
EF |
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consider --- or ---- w/ in 2 weeks following MI in pts w/ HF
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eplerenone
spironolacotne |
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pt's cad have ldl goal of
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< 100
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