ACS pt4-5 contd Flashcards
when is an ACE inhibitor especially important?
in pts with HFrEF, diabetes, and CKD
how should ACEI be used in AMI?
cautiously in the first 24hrs
may result in hypotension or renal dysfunction
what ACEi are indicated for ACS?
captopril
enalapril
lisinopril
ramipril
trandolapril
what is the dosing of captopril?
start: 6.25-12.5mg TID
target: 25-50mg TID
what is the dosing of lisinopril?
start: 2.5-5mg daily
target: over 10mg daily
what is the dosing of rampiril?
starting: 2.5mg BID
target: 5mg BID
what is the dosing of trandolapril?
start: 0.5mg daily
target: 4mg daily
what is the dosing of valsartan?
start: 20mg BID
target: 160mg BID
what should be monitored while on an ACEi?
K
BP
Scr
when should ACEi not be used?
hypotension/shock
bilateral renal artery stenosis or history of worsening of renal function with ACEi/ARB exposure
acute renal failure
drug allergy/anigoedena
why should serum creatinine be monitored while taking an ACEi?
angiotensin II (which is blocked by an ACEi) causes efferent arteriole vasoconstriction
vasodilation occurs with ACEi use thus increasing SCr
what are the counseling points of ACEi?
helps you live longer
decreases BO
may cause dry cough (switch to ARB)
angioedema (stop taking and seek medical attention)
what is the recommended therapy from PCI to SIHD to DES?
at least 6 months of aspirin plus clopidogrel
if develop high risk, d/c P2Y12 after 3 months
if no high risk, may over 6 months of DAPT
what is the recommended therapy of PCI to SIHD to BMS?
at least 1 month of aspirin plus clopidogrel
no risk, continue DAPT
what is the recommended therapy of PCI to ACS?
at least 12 months of aspirin plus clopidogrel, prasugrel, or ticagrelor
if high risk, d/c P2Y12 after 6 months
if no risk, continue over year maybe
in what population should triple antithrombotic therapy (with oral anticoag) be used?
atrial fibrillation (CHADSVASc 2+)
VTE
mechanical heart valve
what is the duration of triple antithrombotic therapy after ACS?
minimized
in pts with AF, d/c aspirin after 1-4 weeks after PCI and continue P2Y12 inhibitor and anticoagulant
what type of anticoagulant is preferred in triple antithrombotic therapy?
NOAC (rivaroxaban) over warfarin to decrease bleeding risk
what is the dosing of NTG?
0.3-0.4mg under tongue every 5 minutes for three doses max then call 911
every pt should have RX
what is the priming of SL NTG spray?
nitrolingual - 5 sprays into air
nitro mist - 10 sprays into air
what are lifestyle modifications to prevent recurrent MI?
stop smoking
adherence to medications
control BO
healthy diet and exercise
