Anticoagulant Medications Discussion Assignment

Anticoagulant Medications Discussion Assignment
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Anticoagulant Medications Discussion Assignment
1. Which of the following anti-ischemic medications
does not have an American College of Cardiology/
American Heart Association (ACC/AHA) Class I
indication for patients with non–ST-elevation ACS?
(A) Nitroglycerin
(B) Morphine sulfate
(C) ACE inhibitor
(D) β-adrenergic antagonist.
(E) Dihydropyridine calcium channel blocker
6 Which of the following antiplatelet or anticoagulant
medications does not have an ACC/AHA Class I
indication for patients with non–ST-elevation ACS?
(A) Low molecular weight heparin (LMWH) subcutaneously
(B) Unfractionated heparin intravenously
(C) Fondaparinux
(D) Aspirin
(E) Clopidogrel for patients who have a documented
allergy to aspirin
7 A 68-year-old man with no previous history of bleeding sustains an NSTEMI and undergoes coronary
angiography that reveals a recanalized right coronary artery (RCA) culprit lesion with only mild
residual stenosis. No PCI is performed. His echocardiogram reveals normal ventricular function. His
BP is 106/68 mm Hg. A lipid profile reveals total
cholesterol of 214 mg per dL, high-density lipoprotein (HDL) of 50 mg per dL, low-density lipoprotein
(LDL) of 140 mg per dL, triglycerides of 120 mg per
Anticoagulant Medications Discussion Assignment
dL. He is discharged home on aspirin and atorvastatin. Should he also be prescribed clopidogrel?
(A) No
(B) Yes, for 1 month
(C) Yes, for 9 months
(D) Yes, for 2 years
(E) Yes, indefinitely
8 A 72-year-old woman with a previous history of
CABG surgery and severe dementia is admitted to
the hospital with unstable angina. Her EKG reveals
sinus rhythm and dynamic ST depressions. Her HR
is 64 bpm and BP is 110/55 mm Hg. Her troponin T
level is 0.05 ng per mL. She and her family adamantly
refuse cardiac catheterization. She is started on
aspirin, enoxaparin, simvastatin, IV nitroglycerin,
and IV metoprolol. She denies any chest discomfort
at present. To improve her medical regimen:
(A) Add abciximab
(B) Add eptifibatide
(C) Add tirofiban
(D) Add clopidogrel
(E) Substitute enoxaparin with unfractionated heparin
9 A 59-year-old woman presents to the emergency department with 12 hours of severe unremitting chest
heaviness with onset at rest. Her past medical history is remarkable for hypertension, type 2 diabetes
mellitus, obesity, hyperlipidemia, obstructive sleep
apnea, and renal insufficiency. Her EKG reveals sinus
rhythm and a normal tracing. Her CK is 500, CK-MB
is 43.4, TnT is 1.88. Her creatinine is 1.6 mg per
dL. After receiving aspirin, heparin, and nitroglycerin in the emergency department, her discomfort is
relieved. The most appropriate next step in management is:
(A) Continued monitoring of her renal function with
plans for coronary angiography if renal function
improves
(B) Early invasive strategy with plans for urgent left
heart catheterization
(C) Early conservative strategy given the absence of
chest discomfort and a normal EKG
(D) Echocardiogram to evaluate the left ventricular
function
(E) Resting nuclear sestamibi scan to evaluate for a
perfusion abnormality at rest
10 A 74-year-old man is admitted to the hospital with
NSTEMI. His prior medical history is significant
for a remote coronary artery balloon angioplasty
(with no stenting). He also has hyperlipidemia and
gout. His echocardiogram reveals sinus rhythm with
nonspecific T-wave changes. His cardiac biomarkers are positive. The coronary angiogram reveals a
290 900 Questions: An Interventional Cardiology Board Review
right-dominant system with severe stenoses in the
proximal left anterior descending (LAD) and in the
mid-RCA. The proximal LAD lesion does not involve
the ostium of the LAD and is not near any diagonal
or septal branches. It appears to be a discrete lesion
obstructing approximately 75% of the lumen diameter. It does not appear thrombotic and it seems to be
only mildly calcified. The mid-RCA stenosis appears
hazy, but has TIMI grade 3 flow. It is near a small
marginal branch. Ventriculography reveals inferior
hypokinesis with an estimated left ventricular ejection fraction (LVEF) of 40%. An EKG performed in
the emergency department also estimated LVEF at
40%. What is the most appropriate revascularization
strategy for this patient?
(A) PCI to LAD and RCA
(B) Balloon angioplasty to RCA followed by CABG
to LAD and right posterior descending artery
(RPDA)
(C) CABG to LAD and RPDA
(D) PCI to RCA with a bare-metal stent implantation
followed by 1 month of clopidogrel therapy and
CABG to LAD
(E) No revascularization therapy unless further ischemia is detected
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