ACS

Question 1

What are the symptoms of ACS?

Answer 1

chest pain lasting 10/+ minutes
severe dyspnea
diaphoresis
radiating pain to arms, back, neck, jaw or epigastric region

Question 2

What are the risk factors for ACS?

Answer 2

Men older than 45
Women older than 55
Women who had an early hysterectomy
Family history with a first degree relative that had an event before age 55 (male) or age 65 (female)
Smoking
Hypertension
Known Coronary Artery Disease
Dyslipidemia
Diabetes
Chronic Stable Angina
Lack of Exercise
Excessive Alcohol

Question 3

For a suspected ACS, a 12 lead ECG should be obtained within how many minutes of the first medical contact?

Answer 3

10

Question 4

Which has ECG changes: NSTEMI or STEMI?

Answer 4

STEMI

Question 5

Which has a partial blockage of the artery: NSTEMI or STEMI?

Answer 5

NSTEMI

Question 6

Which enzymes are we looking for during presentation of someone with ACS?

Answer 6

Troponin 1 and Troponin T

Question 7

What happens during a percutaneous intervention?

Answer 7

A balloon is inserted into an artery and widened to improve blood flow

Question 8

If a patient has an NSTEMI what are the treatment options?

Answer 8

Medication alone
OR
Percutaneous Intervention

Question 9

If a patient has a STEMI a PCI is preferred within how many minutes of hospital arrival?

Answer 9

90

Question 10

What can be given if a PCI is not possible?

Answer 10

Fibrinolytic therapy within 30 minutes of hospital arrival

Question 11

Which medications should be immediately given for ACS?

Answer 11

1. Morphine
2. Oxygen
3. Nitrogen
4. Aspirin

Question 12

How much and what type of Aspirin should be given at the start of ACS intervention?

Answer 12

162-325mg enteric coated, chewable

Question 13

Which medications should be given after the immediately administered medications for ACS?

Answer 13

1. GP2b/3a receptor antagonists
2. Anticoagulants
3. P2Y12 (-)

Question 14

Which medications should be given within 24 hours of ACS?

Answer 14

1. Beta Blockers
2. ACE (-)

Question 15

Which anticoagulants can be used for ACS intervention?

Answer 15

LMWH (enoxaparin, dalteparin)
UFH and bivalirudin

Question 16

What are the 3 P2Y12 receptors antagonists that can be used in ACS?

Answer 16

1. Clopidogrel
2. Prasugrel
3. Ticagrelor

Question 17

What is the loading dose of Clopidogrel for ACS intervention?

Answer 17

300-600mg

Question 18

What is the loading dose of Prasugrel?

Answer 18

60mg

Question 19

What is the maintenance dose of Prasugrel?

Answer 19

10mg

Question 20

What is the loading dose of Ticagrelor?

Answer 20

180mg

Question 21

What is the maintenance dose of Ticagrelor?

Answer 21

90mg x1 year, then 60mg BID

Question 22

How many days should prasugrel be held prior to surgery?

Answer 22

7

Question 23

How many days should ticagrelor be held prior to surgery?

Answer 23

5

Question 24

What are the contraindications to Prasugrel?

Answer 24

bleeding
history of stroke or TIA

Question 25

What are the contraindications to Ticagrelor?

Answer 25

serious bleeding history of intracranial hemorrhage

Question 26

What can be given as an adjunct to PCI if a patient is not getting a GP2b/3a inhibitor?

Answer 26

Cangrelor IV

Question 27

Which 4 drug classess should be avoid with a P2Y12 (-)?

Answer 27

NSAIDs Warfarin SSRIs SNRIs

Question 28

Ticagrelor should be avoided with strong inhibitors or inducers of which enzyme?

Answer 28

CYP3A4

Question 29

If ticagrelor is given with simvastatin or lovastatin, what is the max dose of statin that can be given?

Answer 29

40mg/d

Question 30

Clopidogrel + repaglinide =

Answer 30

Hypoglycemia

Question 31

What are the 2 glycoprotein 2b/3a antagonists?

Answer 31

Eptifabitide and Tirofiban

Question 32

What are the contraindications to glycoprotein 2b/3a drugs?

Answer 32

thrombocytopenia history of bleeding active internal bleeding severe uncontrolled hypertension recent surgery (past 6 weeks eptifabitde; 4 tirofiban) history of stroke within 30 days (eptifabitide)

Question 33

Should glycoprotein 2b/3a drugs be shaken?

Answer 33

No

Question 34

How long after discontinuing a glycoprotein 2b/3a drug does it take for platelet function to return to baseline?

Answer 34

4-8 hours

Question 35

Which receptor does thrombin bind to?

Answer 35

PAR-1 receptor

Question 36

Which medication is a protease activated receptor-1 antagonist?

Answer 36

Vorapaxar

Question 37

How do fibrinolytics work?

Answer 37

break down clots, bind to fibrin, convert plasminogen to plasmin

Question 38

True or False: Fibrinolytics can be used in STEMIs only

Answer 38

True

Question 39

What are the 4 fibrinolytics?

Answer 39

Alteplase Cathflo Activase Tenectaplase Reteplase

Question 40

What are the contraindications to fibrinolytics?

Answer 40

internal bleeding history of recent stroke/intracranial hemorrhage spinal surgery/trauma in last 2-3 months intracranial neoplasm arteriovenous malformation aneurysm uncontrolled hypertension

Question 41

True or false: Alteplase dosing for ACS is different than for ischemic stroke

Answer 41

True

Question 42

What should be monitored with a fibrinolytic

Answer 42

Hgb Hct bleed

Question 43

Which medications should be continued indefinitely for secondary prevention after ACS?

Answer 43

Aspirin Nitroglycerin ACE (-) Aldosterone antagonist (heart failure) Statin beta blocker (if heart failure/hypertension)

Question 44

Which medication should be continued for at least 12 months for secondary prevention after ACS?

Answer 44

P2Y12 (-)

Question 45

Which medication should be continued for 3 years for secondary prevention after ACS?

Answer 45

beta blockers

Question 46

If pain relief is needed for musculoskeletal pain, what can be used for someone with ACS?

Answer 46

Naproxen

Question 47

For a patient with ACS and Afib, you can use triple therapy for a short time, but should add on which class of medications?

Answer 47

Proton pump inhibitors