Therapeutics IHD 3

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Therapeutics IHD 3
2014-02-23 23:21:09
Therapeutics IHD

Therapeutics IHD 3
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  1. Dose adjust prausegrel in what group?
    <60 kg or 132 lbs
  2. How does Ticagrelor compare to Clopidegrel?
    • More platelet inhibition and faster OOA, same bleeding risk
    • Lower death rate/Potential Mortality benefit
    • Greater incidence of dyspnea and ventricular pauses
  3. Why do you not need to wait 5-7 days to go to bypass surgery with Ticagelor?
    Reversible binding
  4. Use Ticagrelor with caution in what patients?
    • COPD/asthma
    • Sick sinus syndrome without a pacemaker
    • Second or third degree AV block
    • Bradycardic-related syncope
  5. Describe the appropriate anti-platelet therapy for a patient with UA/NSTEMI:
    • Dual antiplatelet therapy
    • Ticagrelor or clopidegrel + 81 mg ASA for 1 year
    • Continue aspirin after a year
  6. Describe the appropriate anti-platelet therapy for a patient with UA/NSTEMI and PCI:
    • Dual antiplatelet therapy
    • Ticagrelor /prausegrel/clopidegrel + 81 mg ASA for 1 year
    • Continue aspirin after a year
  7. What are the CIs for ADP inhibitors?
    Hypersensitivity, active bleeding, severe bleeding risk
  8. How long should you hold the ADP inhibitors prior to CABG?
    • Clopidegrel: 5 days
    • Prausegrel: 7 days
    • Ticagrelor: insert says 5 days, PLATO says 24-72 hrs
  9. GPIII inhibitors are only used in combination with what other drugs?
    Enoxaparin or Heparin
  10. When would you add a GP III inhibitor in IHD?
    • Used if there is a delay in angiography
    • Patient is at high risk
    • Early recurrent ischemia
    • Planned PCI
  11. What are the GP III iinhibitors:
    Eptifibatide (Integrilin), abciximab (Reopro), or tirofiban (Aggrastat)
  12. What is the MOA of GP III inhibitors?
    Inhibit GP IIb/IIIa receptor on a platelet which allows crosslinking of fibrinogen
  13. Eptifibatide Integrilin
  14. What are the CIs for GP III inhibitors?
    • Active / recent bleeding (4-6 weeks)
    • Severe hypertension (180/110)
    • Any CVA
    • Major surgery or trauma within 4-6 weeks
    • Thrombocytopenia
    • Warfarin with elevated INR
    • Some doses must be avoided with renal insufficiency or failure
  15. When are ACEIs CI?
    Blood pressure is too low, intolerance, bilateral renal artery stenosis, low K, acute renal failure, pregnancy
  16. What IHD groups do we really want to push to get on ACEIs?
    • Diabetes
    • Chronic kidney disease
    • Hypertension
    • Left ventricular systolic dysfunction
  17. For an ST elevation MI, if your going to use lytic therapy you have a window of:
    12 hours
  18. When would you use Bivalirudin over UHP and GP III inhibitor combo?
    Patient has a high bleed risk
  19. Would you use ADP III inhibitors with Lytic therapy?
    No, CI =increased risk of bleed
  20. What STEMI patients are not candidates for Lytic therapy?
    • ST depression
    • Prior intracranial hemorrhage
    • CV lesion
    • Malignant intracranial neoplasm
    • Ischemic stroke within 3 months EXCEPT acute ischemic stroke within 3 hours
    • Aortic dissection
    • Active bleeding (not menses)
    • Significant closed-head or facial trauma within 3 months
    • Initial symptoms of STEMI began >24 hours ( most cases 12 hours) earlier
  21. What is the MOA of Lytics?
    • Convert Plasminogen to Plasmin
    • Which digest fibring
    • Clotting factors I, II, V, VII break down
  22. What are the Lytics?
    • Alteplase
    • Reteplase
    • Tenecteplase
  23. What are the benefits of Tenecteplase?
    • Minimal hypersensitivty
    • Most fibrin specific
    • One bolus dosing
    • 85% patency rate
  24. What are the benefits of Reteplase?
    • Fibrin specific
    • Minimal hypersensitivity
    • 84% patency rate
    • Don’t need to know patients weight
  25. What are the benefits of Alteplase?
    • Fibrin specific
    • Minimal hypersensitivity
    • 73-84% patency rate
  26. If an IHD patient must be on an NSAID, which one would you first recommended and try to maximize?
  27. What are the three classes of medications used to treat refractory angina?
    • BBs and CCBs to reduce O2 demand
    • Long acting Nitrates to improve O2 supply
  28. What do they think is the MOA of Ranolazine?
    • Inhibitor of late sodium current, relative to peak sodium current
    • Reduces intracellular calcium overload
  29. Does Ranolazine improve coronary blood flow or increase coronary blood flow?
  30. What is Ranolazine used for?
    Refractory Angina
  31. What drugs does Ranolazine interact with?
    • CYP3A4 metabolized Statins (especially Simvastatin)
    • Digoxin (increases 2x)
    • Diltiazem/Verapamil can increase ranolzine through CYP3A4
  32. What is the major side effect of Ranolazine?
    Dizziness (just back off dose)