阿摩線上測驗
1.王先生長期使用aspirin 100 mg qd，即將接受心導管手術並放置支架（stent），下列何種術前處方最適合？
(A)aspirin 100 mg stat，clopidogrel 300 mg stat，abciximab IV bolus then IV infusion for 12 hrs，unfractionated heparin
(B)aspirin 100 mg stat,clopidogrel 600 mg stat,unfractionated heparin infusion
(C)aspirin 325 mg stat,abciximab IV bolus then IV infusion for 12 hrs,unfractionated heparin
(D)clopidogrel 600 mg stat，abciximab IV bolus then IV infusion for 12 hrs，enoxaparin
統計： A(3192), B(766), C(551), D(239), E(0) #1631331
詳解 (共 10 筆)
25.下列針對急性心肌梗塞病人之處理何者錯誤？
(A)若沒有禁忌症，應給與速效劑量的aspirin
(B)在進行心導管之前須停用aspirin避免出血
(C)若沒有禁忌症，應給與β-blocker及ACEI/ARB
(D)須校正心血管疾病的危險因子，包含血糖及血脂的控制
24. 有關心導管心臟支架置放術的說明，下列何者正確？
(A)可讓冠狀動脈恢復血流通暢，有效改善心肌缺氧狀況，手術完成後病人就不需長期服藥
(B)無論放置那一種支架，手術完成後病人都應接受至少一個月的雙重抗血小板製劑治療
(C)aspirin與金屬支架相容性佳，只要在術後一個月內使用600 mg qd，一個月後就可以降低 劑量至160 mg qd
(D)clopidogrel與塗藥支架相容性佳，術後只需使用300 mg qd就可以達到預防血管阻塞的效 果
2013 ACCF/AHA Guideline for the Managementnof ST-Elevation Myocardial Infarction提到Clopidogrel 600 mg
loading 比較好
Loading doses of P2Y12 inhibitors are provided before or at the time of primary PCI. These agents are continued in a maintenance dose for 1 year after PCI with a stent (BMS or DES) in the absence of bleeding. A 600-mg loading dose of clopidogrel is preferred to a 300-mg loading dose, given the more extensive and rapid platelet inhibition achieved with the higher dose, as well as the beneficial effects reported in a CURRENT-OASIS 7 subgroup analysis.
所以我覺得B也可以!!!
也沒有說一定要用(GP) IIb/IIIa inhibitor (如abciximab)。
只有提到若有一起用，unfractionated heparin劑量應調低。
ref： https://www.ahajournals.org/doi/pdf/10.1161/CIR.0b013e3182742cf6
可以點進這裡看懶人包：
不過裡面也有提到
A 300-mg loading dose should be given before or at the time of PCI to patients who did not receive a previous loading dose and who are undergoing PCI within 24 hours of receiving fibrinolytic therapy (Level of Evidence: C);
A 600-mg loading dose should be given before or at the time of PCI to patients who did not receive a previous loading dose and who are undergoing PCI more than 24 hours after receiving fibrinolytic therapy (Level of Evidence: C);
A dose of 75 mg daily should be given after
PCI. (Level of Evidence: C)
即將可能就是要選300 mg吧
抓不太到出題者要考什麼
感謝9F大大超詳盡地整理!!!
幫補充一下
術後若使用塗藥支架，則DAPT最少使用至少一年；使用金屬支架(沒塗藥)，則DAPT用一個月
18.有關abciximab的敘述，下列何者錯誤？
(A)屬於glycoprotein IIb/IIIa受器抑制劑，為一種單株抗體生物製劑
(B)只限用於尚未使用血栓溶解治療，而將進行經皮冠狀動脈介入治療（PCI）的急性冠心症病人
(C)不可以與aspirin、clopidogrel或heparin併用
(D)可能引起免疫性血小板減少症（immune-mediated thrombocytopenia） .
