ACS Part 5 Flashcards
Long term goals of ACS therapy
-Control CAD risk factors
-Prevent MACE
-Improve quality of life
When should beta blockers be initiated?
Within the first 24 hours of ACS
Reasons not to start beta blocker
-Bradycardia
-HF or low-output state
-Risk of cardiogenic shock
-PR interval greater than 0.24
-Second or third degree heart block
-Active asthma or reactive airway disease
Which beta blockers should be used in patients with HFrEF?
-Metoprolol succinate
-Carvedilol
-Bisoprolol
When should IV BB be considered?
When hypertensive or ongoing ischmia
Starting dose of metoprolol
25-50 mg q6-12h (tartrate)
Target dose of metoprolol
-100 mg bid (tartrate)
-200 mg daily (succinate)
Starting dose of carvedilol
6.25 mg bid
Target dose of carvedilol
25 mg bid
Starting dose of propranolol
40 mg bid-tid
Target dose of propranolol
80 mg qid
Starting dose of atenolol
25-50 mg daily
Target dose of atenolol
100 mg daily
IV metoprolol dosing
5 mg IV every 5 min for 3 doses
Which beta blocker should you use on a patient suffering from cocaine-induced chest pain?
Non-selective beta blocker such as carvedilol
Is it safe to continue maintenance beta blockers in a patient suffering from a heart failure exacerbation?
Yes, worse outcomes have been shown when they are discontinued
Beta blocker patient counseling
-This med lowers bp and cause dizziness especially when standing
-This med should be continued even when your blood pressure is under control
-This medication can mask the signs of hypoglycemia if you have diabetes
Hold parameters for beta blocekrs
-HR less than 50
-BP less than 90/60
When should non-DHP CCBs be used?
Patients who are contraindicated to beta blockers
When should you not use non-DHP CCBs?
-LV dysfunction
-Increased risk for cardiogenic shock
-Pr interval greater than 0.24
-Second or third degree atrioventricular block without a cardiac pacemaker
When should you give a statin?
Everyone should be on a high intensity statin
Most common side effect for statins
Muscle pain
Statin counseling
-Must be taken lifelong
-Continue to take even if your cholesterol is normal
-Let your doctor know if you experience unexpected muscle pain
When should an ACE be given?
Recommended in all patients but especially those with HFrEF, DM, or CKD