ACS pt 5 Flashcards
beta blocker should be started within ____
24 hours
when shouldnt we give beta blocker ACS?
bradycardia, HF, risk cardiogenic shock, PR >0.24 s, second or third degree block, asthma
metoprolol tartrate starting/maintenance
start: 25 mg BID
main: 50-100 mg BID
metoprolol succinate maintenance
100-200 mg daily
carvedilol starting/maintenance
start: 6.25 mg BID
main: 25-50 mg BID
propranolol starting/maintenance
start: 40 mg BID-TID
main: 80 mg qid
atenolol starting/maintenance
start: 25-50 mg daily
main: 100 mg daily
patients with HF drugs of choice
metoprolol succinate, carvedilol, bisoprolol
bisoprolol dose
5-10 mg daily
when to consider IV beta blocker?
hypertensive, ongoing ischemia
IV beta blocker of choice
metoprolol tartrate 5 mg IV q5min (up to 3 doses)
beta 1 selective drugs
bisoprolol, metoprolol, atenolol
non selective beta drug
propranolol
beta blocker with alpha activity
carvedilol, labetalol
beta blockers with ISA
pindolol, acebutolol
beta blockers eliminated renally
bisoprolol and atenolol
which beta blocker should be used in cocaine patients?
carvedilol
should you give a beta blocker to a pt with HF?
no, do not start or increase but can keep same dose if they were already on one
hold parameters for beta blockers
HR <50-60
BP < 90/60
captopril starting and main
start: 6.25-12.5 mg TID
main: 25-50 mg TID
lisinopril starting and main
start: 2.5-5 mg daily
main: 10+ mg
ramipril starting and main
start: 2.5 mg BID
main: 5 mg BID
trandolapril starting and main
start: 0.5 mg daily
main: 4 mg daily
valsartan starting and main
start: 20 mg BID
main: 160 mg BID
when to not use ACE inhibitors
hypotension / shock
renal stenosis
acute renal fail
angioedema
ACE monitoring effects
increased SCr
increased K+
decreased BP
angioedema
why does SCr increase?
efferent arteriole vasodilation
SCr concerning increase
> 30% increase
who needs triple anticoag?
afib or CHADSVASC 2+
stemi and asymptomatic LV thrombi
stemi and abnormal heart wall movement
how long should pts with afib be on triple therapy?
stop ASA 1-4 weeks post PCI and continue P2Y12 and anticoag
nitroglycerin tabs need to be replaced how often
ever 3-6 months once opened
nitrolingual spray priming?
5 sprays
nitromist spray priming?
10 sprays
where to spray sublingual sprays?
under tongue
