acs pt4-5 Flashcards
what are the long term goals of ACS therapy?
control CAD risk factors
prevent MACE
improve QOL
when should a bb be initiated?
within first 24 hours of ACS
what would be reasons to not start a BB?
bradycardia
HF or low output state
risk for cardiogenic shock
other CI to beta blockage
what would be other CI to beta blockade?
PR interval over 0.24s
second or third degree heart block
active asthma or reactive airway disease
at what HR, do patients usually become symptomatic?
under 60, some
under 50, most
what is the dosing of metoprolol tartrate?
start: 25-50mg q6-12h
target: 100mg BID
what is the dosing of metoprolol succinate?
no starting
target: 200mg daily
what is the dosing of carvedilol?
start: 6.25mg BID
target: 25mg BID
what is the dosing of propranolol?
starting: 40mg BID-TID
target: 80mg QID
what is the dosing of atenolol?
starting: 25-50mg daily
target: 100mg daily
what BB should be used in HFrEF?
metoprolol succinate ER
carvedilol
bisoprolol
when should IV beta blockers be used?
when hypertensive or ongoing ischemia
metoprolol tartrate 5mg IV q5min up to 3 doses
what beta blockers have B2 selectivity (lungs)?
propranolol
nadolol
sotalol
labetalol
carvedilol
pindolol
what BB have ISA selectivity (partial agonist)?
pindolol
acebutolol
what BB have alpha selectivity (arteries)?
labetolol
carvedilol
what type of receptors does cocaine stimulate?
alpha and beta
why should beta blockers not being given when someone has cocaine induced chest pain?
cardioselective BB only block B1 receptors so cocaine can still stimulate alpha receptors without opposition
this can increase troponin or hypertensive complications
if a beta blocker must be used to treat cocaine induced CP, which one should be used?
non selective BB like carvedilol
why should BB be avoided during an acute HF exacerbation?
BB can decrease cardiac output so starting or increasing dose can cause flash pulmonary edema where sudden fluid can fill the heart
during an acute HF exacerbation, should maintenance BB be continued?
yes, worse outcomes are possible if D/C
continue at home does but do not increase in euvolemic
comet trial
what are counseling points of BB?
will lower BP and HR
use even if BP under control to help prevent future heart attacks and help you live longer
can mask symptoms of hypoglycemia except for cold sweat
what are the hold parameter SBP, DBP, and HR for BB and ACEis in hospital?
SBP under 90
DBP under 60
HR under 60
when should non-DHP CCBs be administered?
in patients with recurrent ischemia and CI to BB
in what pts should CCBs not be used?
LV dysfunction
increased risk for cardiogenic shock
PR interval over 0.24s
second or third degree AV block without a cardiac pacemaker
