8 ACS Part V Flashcards
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
24
bradycardia
PR
Beta Blockers - dosing
metoprolol
Starting dose: ___ - ___ mg q6-12h (tartrate)
Target dose:
- ___ mg ___ (tartrate)
- ___ mg daily (succinate)
25-50
100, BID
200
Beta Blockers - Dosing
carvedilol
Starting dose: ___ mg ___
target dose: ___ mg ___
6.25, BID
25, BID
Beta Blockers - Dosing
propranolol
Starting dose: ___ mg ___ - ___
Target dose: ___ mg ___
40, BID, TID
80, QID
Beta Blockers - Dosing
atenolol
Starting dose: ___ - ___ mg daily
Target dose: ___ mg daily
25, 50
100
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)
succinate, bisoprolol
hypertensive
tartrate
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)
alpha, beta
alpha, alpha
- troponin
- non-selective, carvedilol
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
- cardiac
- pulmonary edema
maintenance - home
Hold parameters
HR < ___ - ___
BP < ___ / ___
50-60
90/60
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
non-DHP, verapamil, diltiazem
- LV
- PR
Statins
use high intensity statins
name them and their doses (2)
SE: muscle pain
atorvastatin 40-80 mg
rosuvastatin 20-40 mg
Statins
if a patinet is experiencing muscle pain, switch to ___ bc it is hydrophilic and will have less SE
rosuvastatin
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
HFrEF, DM, CKD
MACE
hypotension, renal
ACEi Dosing
captopril
Starting Dose: ___ - ___ mg ___
Target Dose: ___ - ___ mg ___
6.25-12.5, TID
25-50, TID
ACEi Dosing
lisinopril
Starting Dose: ___ - ___ mg daily
Target Dose: greater than or equal to ___ mg daily
2.5-5
10
ACEi Dosing
ramipril
Starting Dose: ___ mg ___
Target Dose: ___ mg ___
2.5, BID
5, BID
ACEi Dosing
trandolapril
Starting Dose: ___ mg daily
Target Dose: ___ mg daily
0.5
4
ARB Dosing
valsartan
Starting Dose: ___ mg ___
Target Dose: ___ mg ___
20, BID
160, BID
ACEi
When not to use an ACEi
- ___ /shock
- bilateral renal artery ___
- acute ___ failure
- drug allergy/angioedema
hypotension
stenosis
renal
ACEi
Monitoring
- SCr (increases due to ___ arteriole vasodilation)
- Potassium (increases)
- BP (decreases)
- Angioedema
- may cause dry cough
blocks angiotensin II from causing vasocontriction
efferent
Maintenance DAPT
ASA __ mg daily indefinitely and P2Y12 inhibitor for ___ months
- clopidorel ___ mg daily
- ticagrelor ___ mg ___
- prasugrel ___ mg daily
81 , 12
75
90, BID
10
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)
AFib
STEMI,LV
STEMI, wall
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)
ASA, P2Y12i
- ASA, P2Y12i, NOAC
NTG
every patient should be given a prescription for ___ - ___ mg under tongue q ___ min for chest pain
- max ___ doses, then call 911
0.3-0.4
5
3
T or F: NTG spray needs to be primed before spraying under tongue
T
- nitrolingual: 5 sprays
- nitromist: 10 sprays
