8 ACS Part V

Question 1

Beta Blockers

initiate within the first ___ hours of ACS

Reasons not to start beta-blocker
- ___ cardia
- HF or other low output state
- risk for cardiogenic shock

Other contraindications to beta blockade
- ___ interval > 0.24
- 2nd or 3rd degree heart block
- active asthma or reactive airway disease

Answer 1

24
bradycardia
PR

Question 2

Beta Blockers - dosing

metoprolol
Starting dose: ___ - ___ mg q6-12h (tartrate)

Target dose:
- ___ mg ___ (tartrate)
- ___ mg daily (succinate)

Answer 2

25-50
100, BID
200

Question 3

Beta Blockers - Dosing

carvedilol
Starting dose: ___ mg ___
target dose: ___ mg ___

Answer 3

6.25, BID
25, BID

Question 4

Beta Blockers - Dosing

propranolol
Starting dose: ___ mg ___ - ___
Target dose: ___ mg ___

Answer 4

40, BID, TID
80, QID

Question 5

Beta Blockers - Dosing

atenolol
Starting dose: ___ - ___ mg daily
Target dose: ___ mg daily

Answer 5

25, 50
100

Question 6

Beta Blockers - Dosing

use sustained release metoprolol ___ , carvedilol, or ___ in patients with HFrEF

Consider IV beta bocker only when ___ or ongoing ischemia
- metoprolol ___ 5 mg IV q5min (up to 3 doses)

Answer 6

succinate, bisoprolol
hypertensive
tartrate

Question 7

Beta Blockers and Cocaine

cocaine stimulates both ___ and ___ receptors.

Giving a beta blocker allows all of the cocaine to stimulate ___ receptors (unopposed ____ effects). Leads to:
- hypertensive complications or increased ___
- consider ___ BB such as ___ (good bc has alpha blockade as well)

Answer 7

alpha, beta
alpha, alpha
- troponin
- non-selective, carvedilol

Question 8

Beta Blockers and HF

avoid starting or increasing beta blockers during an acute HF exacerbation
- BB slow down the heart and can decrease ___ output
- starting/increasing them during an exacerbation can cause ____

it is safe to continue ___ BBs because worse outcomes have been shown when they are d/c
- continue ___ dose, but do not increase until euvolemic

Answer 8

• cardiac
• pulmonary edema
  maintenance
• home

Question 9

Hold parameters

HR < ___ - ___
BP < ___ / ___

Answer 9

50-60
90/60

Question 10

Answer 10

Question 11

CCBs

administer ___ CCBs ( ___ and ___ ) to patients with recurrent ischemia and contraindications to beta blockers

Do not use in patients with
- ___ dysfunction
- increased risk for cardiogenic shock
- ___ interval > 0.24 s
- 2nd or 3rd AV block without a cardiac pacemaker

Answer 11

non-DHP, verapamil, diltiazem
- LV
- PR

Question 12

Statins

use high intensity statins
name them and their doses (2)

SE: muscle pain

Answer 12

atorvastatin 40-80 mg
rosuvastatin 20-40 mg

Question 13

Statins

if a patinet is experiencing muscle pain, switch to ___ bc it is hydrophilic and will have less SE

Answer 13

rosuvastatin

Question 14

ACEi

recommended in all patients, but especially important in patients with ___ , ___ , or ___
- decreases mortality and ___
- use cautiously in the first 24 hours of AMI because it may resut in ___ or ___ dysfunction
- they are getting contrast dye, dont want to stress the kidney even more

Class effect
- captopril, enalapril, lisinopril, ramipril, and trandolapril have indication in ACS

can trade ACEi for ARB

Answer 14

HFrEF, DM, CKD
MACE
hypotension, renal

Question 15

ACEi Dosing

captopril
Starting Dose: ___ - ___ mg ___
Target Dose: ___ - ___ mg ___

Answer 15

6.25-12.5, TID
25-50, TID

Question 16

ACEi Dosing

lisinopril
Starting Dose: ___ - ___ mg daily
Target Dose: greater than or equal to ___ mg daily

Answer 16

2.5-5
10

Question 17

ACEi Dosing

ramipril
Starting Dose: ___ mg ___
Target Dose: ___ mg ___

Answer 17

2.5, BID
5, BID

Question 18

ACEi Dosing

trandolapril
Starting Dose: ___ mg daily
Target Dose: ___ mg daily

Answer 18

0.5
4

Question 19

ARB Dosing

valsartan
Starting Dose: ___ mg ___
Target Dose: ___ mg ___

Answer 19

20, BID
160, BID

Question 20

ACEi

When not to use an ACEi
- ___ /shock
- bilateral renal artery ___
- acute ___ failure
- drug allergy/angioedema

Answer 20

hypotension
stenosis
renal

Question 21

ACEi

Monitoring
- SCr (increases due to ___ arteriole vasodilation)
- Potassium (increases)
- BP (decreases)
- Angioedema
- may cause dry cough

blocks angiotensin II from causing vasocontriction

Answer 21

efferent

Question 22

Answer 22

Question 23

Maintenance DAPT

ASA __ mg daily indefinitely and P2Y12 inhibitor for ___ months
- clopidorel ___ mg daily
- ticagrelor ___ mg ___
- prasugrel ___ mg daily

Answer 23

81 , 12
75
90, BID
10

Question 24

Triple Antithrombotic Therapy After ACS

some patients require oral anticoagulation in addition to DAPT
- patients with ___ (CHADSVASc greater than or equal to 2)
- ___ and asymptomatic ___ mural thrombi
- ___ and anterior apical akinesis or dyskinesis (abnormal heart ___ movement)

Answer 24

AFib
STEMI,LV
STEMI, wall

Question 25

Triple Antithrombotic Therapy After ACS

duration of triple antithrombotic therapy with an oral anticoagulant, ___ and ___ should be minimized
- benefit vs bleeding risk
- in patients with AF - d/c ___ after 1-4 week after PCI and continue ___ and anticoagulant ( ___ preferred over warfarin due to decreased bleeding risk)

Answer 25

ASA, P2Y12i
- ASA, P2Y12i, NOAC

Question 26

NTG

every patient should be given a prescription for ___ - ___ mg under tongue q ___ min for chest pain
- max ___ doses, then call 911

Answer 26

0.3-0.4
5
3

Question 27

T or F: NTG spray needs to be primed before spraying under tongue

Answer 27

T
- nitrolingual: 5 sprays
- nitromist: 10 sprays