Cardio Exam 5 (Winstead)

T/F: ACS includes acute MI or ischemia due to STEMI or NSTEMI but not unstable angina

False, ACS includes unstable angina

• occurs at rest for longer than 10 minutes

• progressively gets more severe, prolonged or frequent

Unstable angina

T/F: unstable angina can progress to an MI

True

T/F: females are more at risk of having an ACS event

False, males are

Select the correct order

plaque ruptures → ischemia → thrombus formation → MI

Are thin or thick fibrous caps on a plaque more likely to rupture?

Thin

Occurs when oxygen demand exceeds supply

Ischemia

Occurs when blood flow stops

Infarction

Elevated troponin levels indicate…

MI (STEMI or NSTEMI)

Normal troponin levels indicate…

Unstable angina

T/F: unstable angina and NSTEMI do not have changes in EKG readings

False, they can have ST depression or T wave inversion

Which ACS event requires immediate invasive intervention no matter what?

STEMI

T/F: All ACS events should be considered for MONA and anticoagulation

True

Morphine should only be given…

AFTER MI is confirmed

Oxygen should only be given…

if O2 saturation is less than 90%

Aspirin given for ACS events should be…

Chewed

Which P2Y12 inhibitor is only labeled for use with PCIs and is NOT for medical management?

Prasugrel

Hold 5 days prior to surgery

Clopidogrel

Hold 3-5 days prior to surgery

Ticagrelor

Hold 7 days prior to surgery

Prasugrel

Which P2Y12 inhibitor has the lowest bleed risk (but is still higher than aspirin)

Clopidogrel

How long should patients with STENTS be treated with aspirin after an ACS event?

Lifelong

Which P2Y12 inhibitor can’t be used with aspirin doses 100mg or greater?

Ticagrelor

How long should patients with STENTS be treated with dual antiplatelet therapy?

12 months minimum

Glycoprotien IIb/IIIa inhibitors are used for patients treated with early invasive strategy and DAPT with…

intermediate or high risk features such as persistent elevated troponins and inadequate treatment with P2Y12 inhibitors

The following drugs belong to which class?

• Abciximab

• Eptifibatide

• Tirofiban

Glycoprotien IIb/IIIa inhibitors

The following drugs belong to which class?

• Alteplase

• Retaplase

• Tenecteplase

Fibrinolytics

T/F: anticoagulation should be used in all patients, regardless of initial treatment

True

T/F: morphine can be used in patients immediately

False, it should only be used if other antianginals fail and AFTER MI is confirmed

Enoxaparin dosing for ACS

IV loading dose, then SQ

T/F: fibriolysis should be used in all ACS patients

False, only in specific STEMI cases

When are fibrinolytics indicated in STEMI patients?

If they can not get to a PCI capable facility within 2 hours, so they should be given within 30 minutes then transferred

Which is the gold standard treatment option for STEMI patients?

PCI

T/F: Fibrinolytics should never be given if BP is greater than 180/100 mmHg

False, if BP can be lowered, then they can be given

T/F: previous stoke or recent head trauma/surgery an absolute contraindication for fibrinolytics

True, due to the increased risk of head bleeds

T/F: home use of oral anticoagulation is an absolute contraindication to receiving a fibrinolytic

False, they can still be given if benefit outweighs the risks

Which antiplatelet agents can be used in STEMI patients who have received a fibrinolytic?

Aspirin and clopidogrel only

Which antiplatelet agents can be used in STEMI patients who have undergone a PCI?

Aspirin and any P2Y12 inhibitor

If patients also need oral anticoagulation after discharge, should they be on triple therapy or dual therapy? drug options: aspirin, P2Y12, any oral anticoag agent

Dual is preferred (P2Y12 + any oral anticoag agent), but triple may be done for less than 30 days if necessary

What additional agents should be started in ALL patients after an ACS event?

Oral beta blockers and statin or other lipid lowering agent

What drug class should be started in the following patients after an ACS event?

• HTN

• Diabetes

• CKD

• LVEF less than 40%

ACE inhibitors

When should aldosterone receptor antagonists be used in patients post ACS event?

Only if they have EF less than 40% AND are already taking an ACEi AND beta blocker