Exam (elaborations)
CLINICAL THERAPEUTICS FINAL
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CLINICAL THERAPEUTICS FINAL
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CLINICAL THERAPEUTICS FINALWhat ekg finding is associated with a stemi?
What two ekg findings are associated with nste-acs? - answer- st elevation
St depression & t wave inversion
What are the two classifications of nste-acs?
What biomarker distinguishes them? - answer- unstable angina
Nstemi
(+) increase in cardiac troponin = nstemi
What are the two risk stratification approaches to guide nstemi/ua treatment? - answer-
early-invasive
Conservative (ischemia-guided)
How are stemi patients treated? - answer- cath lab - meds, pci, cabg
Fibrinolytics - alteplase
How is acs initially treated (mnemonic)?
Which med has shown mortality benefit? - answer- morphine
Oxygen
Nitrates
Aspirin* shown to dec vascular mortality (nnt 42)
What is the mechanism of aspirin?
What formulation and dose are recommended for initial treatment of acs? - answer-
non-selective cox 1/2 inhibitor (inhibits platelet aggregation)
Non enteric coated, chewable: 162-325 mg po
Suppository: 600 mg
How long is the door to ballon (d2b) time for a stemi arriving at a pci capable center? -
answer- 90 minutes or less
,What is the time to transfer a stemi patient to a pci capable center if they initially could't
get to one? - answer- 120 minutes or less
If a stemi patient cant get transferred to a pci capable center, what is the door to needle
(d2n) time to receive fibrinolytics? - answer- 30 minutes or less
T/f: fibrinolytics are only used in stemi pt for acs
Why/why not? - answer- true
Stemi clots = fibrin rich
Nstemi clots = platelet rich
What 3 antithrombotics are used to treat acs patients? - answer- aspirin
P2y12 inhibitor
Anticoagulant
What are the benefits of using prasugrel over clopidogrel?
What is the limitation?
What study showed this and what patient population was studied? - answer- dec cv
death, mi, stroke
Inc risk of bleeding
Triton-timi 38 study; patients with planned pci only
What are the benefits of using ticagrelor over clopidogrel?
What is the limitation?
What study showed this? - answer- dec cv death, mi, stroke and no difference in
bleeding risk
Bid maintenance dosing
Plato study
What study looked at bivalirudin (direct thrombin inhibitor) vs ufh (indirect) in stemi
patients with planned pci presenting within 12 hours of onset?
What were the results?
What do the guidelines recommend for stemi patients? - answer- bright-4 (2022)
Dec all-cause death and bleeding
Not indicated
What anticoag is recommended for stemi patients on alteplase to maintain ptt 2x
control? For how long? - answer- ufh
For 48 hours or until successful revascularization
, Which anticoags are recommended for stemi patients on alteplase for no than 8 days? -
answer- lmwh
Fondaprinux
What are the pros and cons of ufh? - answer- pros:
- familiar, well-tested
- short t1/2
- metabolism
Cons
- studies outdated (before pci era)
- intensive monitoring
- non-linear pk
What are the pros and cons of lmwh? - answer- pros:
- q 12 hr dosing
- no monitoring
Cons:
- complicated initial dosing
- long t1/2
- inc bleeding
- renal adjustments
- obesity
What are the pros and cons of bivalirudin? - answer- pros:
- hit
- dec bleeding
Cons:
- pci only
- cost
What are the pros and cons of fondaparinux? - answer- pros:
- easy dosing
- no monitoring
Cons:
- bad outcomes in pci
- cost
- renal adjustments
What are the statin recommendations for patients with acs?
What antiarryhtmic decreased levels of digoxin and warfarin due to cyp3a4 inhibition? -
answer- amiodarone
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