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Pharm > Acute coronary syndrome meds > Flashcards

Acute coronary syndrome meds Flashcards

1
Q

List all meds used in acute MIs

A 
Oxygen
Nitrates (anti-ischemics)
Analgesia
BB
CCB
Cholesterol lowering agents
RAAS inhibitors
Anti-platelet agents
Parenteral anticoagulation
Other anti-ischemics
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2
Q

When do you give O2 to AMI pts?

A

O2 sat < 90%
Respiratory distress
Other high risk features of hypoxemia

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3
Q

When might O2 have negative effects in coronary pts?

A

Increased coronary vascular resistance
Reduced coronary blood flow
Increased risk of mortality
Significantly larger infarct sizes than those w/o O2 therapy

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4
Q

What do nitrates do for AMI?

A

Dilate capacitance vessels which decreases preload

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5
Q

For what do you administer nigtoglycerin and how do you give it?

A

Continued pain

SL

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6
Q

How do you dose SL nitro?

A

0.3-0.4 mg q 5 minutes x3

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7
Q

After the q5 dosing, then what do you do with nitro?

A

Evaluate for need for IV nitro

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8
Q

When do you NOT give nitro?

Why?

A

If on phosphodiesterase inhibitor
(If taken sildenafil in last 24 hours, or tedalafil in last 48 hours)
Decrease in BP

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9
Q

What is a common analgesia given to AMI pts for continued CP? How is it administered?

A

Morphine sulfate

IVP

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10
Q

Why do you give morphine sulfate for continued cp?

A

If pt is already on max tolerated nitro

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11
Q

What is another analgesia combo that is actually not given to AMI pts?

A

NSAIDS (not asprin) + COX2 inhibitors

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12
Q

Why are NSAIDS + COX2 inhibitors not given to AMI pts?

A

Enhances platelet aggregation by inhibiting PG synthesis

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13
Q

What NSAID can be used for its anti-platelet effects?

A

Aspirin

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14
Q

When do you begin BB for AMI pts?

A

WIthin 24 hours

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15
Q

Are there some exceptions to starting BB in AMI pts?

A

Yes

signs of HF, low output state, etc.

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16
Q

What BB should AMI pts w/ stable HF be continued on?

A

Metorpolol succinate
Carvedilol
Bisoprolol

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17
Q

Why do we avoid IV BBs in AMI pts?

A

May increase risk of shock

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18
Q

When do you give CCB?

A

Ischemic/continued pain pts with:
Contraindications to BBs
Unacceptable side-effects from BBs
Continued pain after appropriate use of BBs and nitrates

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19
Q

Which non-dihydropyridine CCBs are used as initial therapy for AMI pts?

A

Verapamil (PO)

Diltiazem (PO)

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20
Q

What CCB shouldnt be used for AMI pts? Why?

A

Imediate release nifedipine

Causes a dose-related increase in mortality in CAD and harm in ACS pts

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21
Q

What antianginal with minimal effects on HR and BP do we have for AMI pts?

A

Ranolazine

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22
Q

What are the AEs of ranolazine?

A

Constipation

Dose related QTc prolongation

23
Q

What must you start AMI pts on?

A

Benign high-intensity statin therapy

24
Q

Give the two high intensity statins that we give AMI pts and their dosing

A

Atorvastatin titrate 10-80 mg po once daily

Rosuvastatin titrate 5-40 mg po once daily

25
Q

When do you start AMI pts on ACEI? How long do you keep them on this?

A

When LVEF < 40%

Indefinitely

26
Q

What ACEI do you start AMI pts on in the hospital? When do you switch to a long acting ACEI?

A

Catopril (tid) or enalaprin (bid)

Switch to long acting @ max dose

27
Q

What do you use in AMI pts intolerant to ACEIs?

A

ARBs

28
Q

What do you add to pharmacotherapy for AMI pts who are on therapeutic doses of ACEIs and BB?

A

ARA

29
Q

What two drugs do you never combine for heart pts?

A

ACEI and ARB

30
Q

What is your acute anti-platelet agent? What is the dose?

A

Non-enteric-coated chewable aspirin

162-324 mg

31
Q

Why do you not order enteric coated ASA acutely?

A

It delays absorption

32
Q

Does 325 mg ASA = 324 mg ASA in the computerized dispensing systems?

A

No

33
Q

What do you give to pts who are allergic or intolerant to aspirin?

A

Clopidogrel

34
Q

What is the chronic dosing of aspirin for anti-platelet therapy for AMI pts?

A

81-325 mg indefinitely

35
Q

What else do you add to anti-platelet therapy for AMI pts? For how long?

A

P2Y12 aspirin receptor inhibitor

12 months

36
Q

What are the two P2Y12 aspirin agents used post AMI? How often are they dosed

A

Clopidogrel: daily
Ticegralor: bid

37
Q

Why is pasugrel not recommended for chronic anti-platelet therapy?

A

Increased risk of spontaneous, life-threatening, and fatal bleeding

38
Q

What other category of therapy related to blood is recommended in addition to antiplatelet therapy for all AMI pts?

A

Anticoagulation

39
Q

What LMWH is preferred for ACS?

A

Enoxaparin

40
Q

What is the dosing of enoxaparin for pts with CrCl > 30 mL/min for ACS?

A

1 mg/kg SC q 12 hours

actual body weight

41
Q

What is the dosing of enoxaparin for pts with CrCl < 30 mL/min for ACS?

A

1 mg/kg SC q 24 hours

actual body weight

42
Q

When do you avoid giving LMWH?

A

In dialysis pts w/ ACS

43
Q

Where is anticoagulant bivalrudin often used?

A

Cath labs

44
Q

What are the two advantages of bivalrudin over UFH or LMWH?

A

Will bind to clot bound thrombin (unlike heparin)

No significant protein binding (more predicatble anticoagulant response)

45
Q

What kind of drug is fondaparinux?

A

A synthetic pentasaccharide

selective factor Xa inhibitor

46
Q

Is there a risk of HITT with fondaparinux?

A

Minimal if any

47
Q

When is fondaparinux contraindicated? Why?

A

CrCl < 30 mL/min

Increased risk of bleeding

48
Q

When do you use fondaparinux with caution?

A

CrCl 30-50 mL/min

49
Q

Is the half life of unfractionated heparin (UFH) long or short?

A

Short

1.5 hours

50
Q

Can you simply d/c IV UFH or do you need to taper it in urgent interventions?

A

Just d/c it

51
Q

How do you indicate to the pharmacist how much UFH you need?

A

You specify the indication (DVT, PE, NSTEMI, STEMI, PCI)

52
Q

What is the initial bolus max dose of weight based UFH regimens?

A

4000 units

53
Q

What is the initial maintenance infusion max dose for weight based UFH regimens?

A

1000 units/hour

54
Q

When do we use the anticoagulant argatroban for ACS pts?

A

In pts w/ h/o HITT undergoing PCI

Pharm (32 decks)

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