Pre-Revascularization Initial Management
Emergency Revascularization
Post-MI Management
Diagnostic Labs/Tests
Antiplatelet Pearls
100
Which formulation of aspirin should be given immediately upon presentation of ACS?
Chewable tablet
100
What agents can be used for revascularization when PCI is not readily available?
Thrombolytics (alteplase, tenecteplase, reteplase)
100
Give one example of a non-pharmacologic intervention a patient can do for risk reduction of further cardiovascular events
Stop smoking, exercise, healthy diet, etc.
100
What is the main cardiac biomarker used to assist with diagnosis NSTEMI/STEMI
Troponin
100
How long should DAPT be continued for post-stent placement in PCI (irrespective of type of stent)?
12+ months
200
What nitrate is most commonly used for angina? What is the dosing regimen?
Nitroglycerin0.4 mg SL q5min (max of 3 tabs in 15 minutes)
200
Prior to PCI, what are the loading doses of clopidogrel, prasugrel, and ticagrelor?
600 mg, 60 mg, 180 mg
200
For patient starting DAPT therapy, what would be a good counseling point?
Compliance, bleeding risk, etc.
200
A patient presents with chest pain, has elevated troponin, and this is the EKG. What is the diagnosis? 
NSTEMI
200
Which P2Y12 inhibitor is a prodrug that requires metabolism of (mainly) CYP2C19?
Clopidogrel
300
Oxygen is indicated in patients when O2 saturations reach below what percent?
90%
300
For patients with a STEMI, primary PCI should be conducted within how many minutes?
90 minutes
300
Give an example of a lipid-lowering agent that should be used in patients post-MI (drug and dose)
High-intensity statin
300
True or False: Only an initial troponin level should be drawn for patients with ACS
False. Should be drawn initially and 3-6 hours after
300
What is the most common side effect associated with ticagrelor (other than bleeding risk)?
Dyspnea
400
Beta-blockers are recommended for initial management of ACS. In what patients/disease states would an initiation of a beta-blocker not be recommended?
Cardiogenic shock, Acute heart failure
400
For STEMI patients presenting to a non-PCI center, thrombolytics should be administered within how many minutes? (aka door-to-needle time)
30 minutes
400
What four drug classes should be prescribed on discharge for secondary prevention in ALL patients with ACS?
ACE/ARB, BB, Statin, DAPT
400
What other cardiac biomarker can be elevated in NSTEMI/STEMI?
CK-MB
400
Which P2Y12 inhibitor is contraindicated in patients with a history of TIA/stroke?
Prasugrel
500
Anticoagulation should be used in conjunction to antiplatelets for patients with ACS. What is the dose of heparin that should be used?
60 u/kg bolus followed by 12 u/kg/hr infusion
500
Cangrelor is often used as a bolus and continuous infusion during PCI. When the patient is transferred to a floor, does the continuous infusion dose change? If so, what does it change to?
0.75 mcg/kg/min
500
For patients with a lower than expected response to a statin, or patients with a statin intolerance, what drug/drug class is recommended 2nd line for lipid lowering? (+100 if you name both, +100 if you name the goal LDL)
Ezetemibe, PCSK9i (Goal LDL <70)
500
Which medication is used during a stress test to increase coronary blood flow, mimicking that of a coronary blood flow increase during exercise?
Regadenoson (Lexiscan)
500
When transitioning from cangrelor to an oral P2Y12 inhibitor, which two oral P2Y12 inhibitors must be given after the cangrelor drip has been turned off?
Clopidogrel and prasugrel