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
When not to use ACE inhibitors
-Hypotension or shock
-Bilateral renal artery stenosis or history of worsening renal function with ACEi or ARB exposure
-Acute renal failure
-Drug allergy/angioedema
What to monitor when on ACEi
-Scr
-Potassium
-Blood pressure
-Angioedema
ACEi counseling
-This medication helps you live longer not just control bp
-May cause hypotension and side effects such as dizziness especially when standing. If dizziness or lightheadedness persists let your doctor know
-May cause a dry cough
-Angioedema then STOP taking and seek medical attention
Which patients may require an additional oral anticoagulation along with the dual antiplatelet therapy (triple antithrombotic therapy)?
-Patients with arterial fibrillation
-STEMI and asymptomatic LV mural thrombi
-STEMI and anterior apical akinesis or dyskinesis (abnormal wall movement)
How do you give triple antithrombotic therapy after ACS?
-Duration should be minimized
-Assess benefit vs bleeding risk
-In patients with AF: discontinue aspirin after 1-4 weeks after PCI and continue P2Y12 inhibitor and anticoagulant
-NOAC preferred over warfarin to reduce bleed risk
Dose for SL nitroglycerin
0.3-0.4 mg every 5 min 3 times then call 911
Nitroglycerin patient counseling
-Keep bottle of tabs or spray with you at all times
-Tabs must be stored in an air tight, amber vial
-Good for 3-6 months once opened
-Sublingual spray must be primed before spraying
How to prevent recurrent MI?
-Stop smoking
-Adherence to meds
-Control BP
-Healthy diet and exercise
