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  #1  
Old 10-19-2011
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Default Cardiology

A 61-year-old man comes to the emergency department with crushing chest pain. On arrival he receives aspirin, sublingual nitroglycerin, a beta-blocker, and pain control with morphine. An electrocardiogram shows diffuse T-wave changes and nonspecific ST segment changes compared with an old electrocardiogram. Cardiac enzymes are normal. The patient is diagnosed with unstable angina and receives lovastatin and subcutaneous enoxaparin. The patient is admitted to the hospital, and the next day undergoes cardiac catheterization. Although evidence of diffuse disease is noted, there are no lesions amenable to stenting and the patient is not felt to be a candidate who would benefit from coronary artery bypass grafting. He is recommended for aggressive medical management. In addition to the medications this patient has already received, full outpatient medical management would include which of the following?
A. Clopidogrel
B. Eptifibatide
C. Heparin
D. Ticlopidine
E. Warfarin
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Old 10-19-2011
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A. Clopidogrel ?
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  #3  
Old 10-19-2011
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C. Heparin
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Old 10-20-2011
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C. Heparin
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clopidogrel
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Old 10-20-2011
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clopidogrel or ticlopidine
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Old 10-20-2011
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Default Answer

The correct answer is A. Clopidogrel inhibits platelet aggregation by blocking adenosine diphosphate binding, a key step in platelet aggregation. It is a proven intervention that will reduce morbidity in patients with acute coronary syndrome. It is recommended in addition to aspirin, another antiplatelet medication. Clopidogrel is controversial if a patient is planned for coronary artery bypass grafting, but is otherwise an excellent antiplatelet agent in patients with acute coronary syndromes.

Eptifibatide (choice B) is a glycoprotein IIb/IIIa inhibitor, which blocks a separate step in platelet activation. Although it is used in patients with acute coronary syndromes, it is used mainly as a bridge to catheterization. It is not an outpatient medication, and its utility in patients not receiving catheterization and stent placement is debatable.

Heparin (choice C) can be used instead of enoxaparin, though there is evidence that enoxaparin is more effective. It is not indicated for outpatient medical management of acute coronary syndromes.

Ticlopidine (choice D) is another antiplatelet agent that also acts by ADP inhibition. It has not been shown to be as effective as clopidogrel and has the side effect of neutropenia, and is thus not recommended as primary medical management for coronary artery disease.

Warfarin (choice E) is used for long-term anticoagulation and is often used in severe congestive heart failure, where a low-flow state is thought to predispose patients to clot formation. Patients with coronary artery disease do not require long-term anticoagulation with warfarin
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  #8  
Old 10-20-2011
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Quote:
Originally Posted by drnrpatel View Post
The correct answer is A. Clopidogrel inhibits platelet aggregation by blocking adenosine diphosphate binding, a key step in platelet aggregation. It is a proven intervention that will reduce morbidity in patients with acute coronary syndrome. It is recommended in addition to aspirin, another antiplatelet medication. Clopidogrel is controversial if a patient is planned for coronary artery bypass grafting, but is otherwise an excellent antiplatelet agent in patients with acute coronary syndromes.

Eptifibatide (choice B) is a glycoprotein IIb/IIIa inhibitor, which blocks a separate step in platelet activation. Although it is used in patients with acute coronary syndromes, it is used mainly as a bridge to catheterization. It is not an outpatient medication, and its utility in patients not receiving catheterization and stent placement is debatable.

Heparin (choice C) can be used instead of enoxaparin, though there is evidence that enoxaparin is more effective. It is not indicated for outpatient medical management of acute coronary syndromes.

Ticlopidine (choice D) is another antiplatelet agent that also acts by ADP inhibition. It has not been shown to be as effective as clopidogrel and has the side effect of neutropenia, and is thus not recommended as primary medical management for coronary artery disease.

Warfarin (choice E) is used for long-term anticoagulation and is often used in severe congestive heart failure, where a low-flow state is thought to predispose patients to clot formation. Patients with coronary artery disease do not require long-term anticoagulation with warfarin
thankss for all the questions
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