ACS Part 5 Flashcards

1
Q

Long term goals of ACS therapy

A

-Control CAD risk factors
-Prevent MACE
-Improve quality of life

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2
Q

When should beta blockers be initiated?

A

Within the first 24 hours of ACS

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3
Q

Reasons not to start beta blocker

A

-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

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4
Q

Which beta blockers should be used in patients with HFrEF?

A

-Metoprolol succinate
-Carvedilol
-Bisoprolol

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5
Q

When should IV BB be considered?

A

When hypertensive or ongoing ischmia

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6
Q

Starting dose of metoprolol

A

25-50 mg q6-12h (tartrate)

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7
Q

Target dose of metoprolol

A

-100 mg bid (tartrate)
-200 mg daily (succinate)

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8
Q

Starting dose of carvedilol

A

6.25 mg bid

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9
Q

Target dose of carvedilol

A

25 mg bid

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10
Q

Starting dose of propranolol

A

40 mg bid-tid

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11
Q

Target dose of propranolol

A

80 mg qid

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12
Q

Starting dose of atenolol

A

25-50 mg daily

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13
Q

Target dose of atenolol

A

100 mg daily

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14
Q

IV metoprolol dosing

A

5 mg IV every 5 min for 3 doses

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15
Q

Which beta blocker should you use on a patient suffering from cocaine-induced chest pain?

A

Non-selective beta blocker such as carvedilol

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16
Q

Is it safe to continue maintenance beta blockers in a patient suffering from a heart failure exacerbation?

A

Yes, worse outcomes have been shown when they are discontinued

17
Q

Beta blocker patient counseling

A

-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

18
Q

Hold parameters for beta blocekrs

A

-HR less than 50
-BP less than 90/60

19
Q

When should non-DHP CCBs be used?

A

Patients who are contraindicated to beta blockers

20
Q

When should you not use non-DHP CCBs?

A

-LV dysfunction
-Increased risk for cardiogenic shock
-Pr interval greater than 0.24
-Second or third degree atrioventricular block without a cardiac pacemaker

21
Q

When should you give a statin?

A

Everyone should be on a high intensity statin

22
Q

Most common side effect for statins

A

Muscle pain

23
Q

Statin counseling

A

-Must be taken lifelong
-Continue to take even if your cholesterol is normal
-Let your doctor know if you experience unexpected muscle pain

24
Q

When should an ACE be given?

A

Recommended in all patients but especially those with HFrEF, DM, or CKD

25
Q

When not to use ACE inhibitors

A

-Hypotension or shock
-Bilateral renal artery stenosis or history of worsening renal function with ACEi or ARB exposure
-Acute renal failure
-Drug allergy/angioedema

26
Q

What to monitor when on ACEi

A

-Scr
-Potassium
-Blood pressure
-Angioedema

27
Q

ACEi counseling

A

-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

28
Q

Which patients may require an additional oral anticoagulation along with the dual antiplatelet therapy (triple antithrombotic therapy)?

A

-Patients with arterial fibrillation
-STEMI and asymptomatic LV mural thrombi
-STEMI and anterior apical akinesis or dyskinesis (abnormal wall movement)

29
Q

How do you give triple antithrombotic therapy after ACS?

A

-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

30
Q

Dose for SL nitroglycerin

A

0.3-0.4 mg every 5 min 3 times then call 911

31
Q

Nitroglycerin patient counseling

A

-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

32
Q

How to prevent recurrent MI?

A

-Stop smoking
-Adherence to meds
-Control BP
-Healthy diet and exercise