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Pharmacotherapy III > Dosing for Exam 1 (Angina and ACS) > Flashcards

Dosing for Exam 1 (Angina and ACS) Flashcards

1
Q

How is aspirin dosed chronically? Upon ACS presentation?

A

Chronic: 75-162mg daily
ACS: 162-325mg chewed and swallowed

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2
Q

How is clopidogrel (Plavix) dosed chronically? What is the loading dose before PCI? What is the loading dose otherwise?

A

Chronic: 75mg daily
PCI LD: 600mg once
LD: 300mg unless >75yo

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3
Q

How is prasugrel (Effient) dosed chronically? What is the loading dose?

A

Chronic: 10mg daily (or 5mg if 75mg unless DM or MI hx

Do not use if TIA/stroke hx

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4
Q

How is ticagrelor (Brilinta) dosed chronically? What is the loading dose?

A

Chronic: 90mg BID
LD: 180mg once

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5
Q

True or false: Clopidogrel, prasugrel, or ticagrelor may be used instead of aspirin for prevention of ACS if the patient is intolerant to aspirin.

A

False–prasugrel and ticagrelor are only indicated following ACS

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6
Q

What is the duration of dual antiplatelet therapy (DAPT) following stent placement? What kind of stent may not need DAPT for as long?

A

At least 12 months. A BMS may be discontinued after 1 month if there is a compelling reason to do so.

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7
Q

What therapy may be considered for DAPT if a patient is allergic to ASA or P2Y12 inhibitors?

A

Consider anticoagulant for a year.

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8
Q

What chronic angina therapy leads to the biggest decrease in LV volume?

A

Nitrates

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9
Q

What is the dosing for NTG SL tabs?

A

0.3-0.5mg SL prn, repeat dose 1-3 times q5minutes

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10
Q

What is the dosing for NTG translingual spray?

A

0.4mg spray SL prn, repeat dose 1-3 times q5min

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11
Q

What is the dosing for NTG buccal tabs?

A

1-3mg buccally once

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12
Q

What is the dosing for ISDN chewable tabs?

A

5-10mg once, chewed

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13
Q

What is the dosing for ISDN sublingual tabs?

A

2.5-10mg SL once

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14
Q

How should a patient be counseled regarding storage of their NTG SL tablets?

A

Nitroglycerin tablets must be replaced every 6 months and kept away from heat, light, and moisture. Replace the cap soon after opening.

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15
Q

How should a patient be instructed to take their NTG tablets?

A

Sit down and then place one tablet under your tongue. If pain does not go away after 5 minutes, call 911 and take second. May take a 3rd after another 5 minutes. Patients may also use them preventatively.

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16
Q

How is atenolol (Tenormin) dosed for angina prevention? How is it eliminated?

A

50-100mg PO daily; eliminated renally (watch!)

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17
Q

How is carvedilol (Coreg) dosed for angina prevention? Does it need to be renally adjusted?

A

25-50mg BID; no–eliminated hepatic

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18
Q

How is metoprolol (Lopressor) dosed for angina prevention? Is it adjusted for renal dysfunction?

A

50-100mg BID; eliminated hepatically

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19
Q

How is metoprolol XL (Toprol XL) dosed for angina prevention?

A

100-200mg daily

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20
Q

How is propranolol LA (Inderal LA) dosed for angina prevention? How is it eliminated?

A

80-160mg daily; hepatic

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21
Q

At what doses do atenolol and metoprolol lose their cardioselectivity?

A

Atenolol 100mg daily

Metoprolol 200mg total daily dose

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22
Q

What are the approximate target heart rates for a CAD patient on a beta blocker?

A

Rest: 50-60 bpm
Exercise: less than 100 bpm

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23
Q

How is nifedipine (Procardia, Adalat) dosed for angina prevention?

A

10-20mg TID

24
Q

How is nicardipine (Cardene) dosed for angina prevention?

A

20-40mg TID

25
Q

How is amlodipine (Norvasc) dosed for angina prevention?

A

5-10mg daily

26
Q

How is verapamil (Calan, Isoptin) dosed for angina prevention?

A

60-90mg TID-QID

27
Q

How is verapamil SR (Calan-SR, Isoptin-SR, Covera-HS, Verelan) dosed for angina prevention?

A

240mg daily

28
Q

How is diltiazem IR (Cardizem) dosed for angina prevention? Diltiazem SR (Cardizem-SR)?

A

IR: 80-120mg TID
SR: 60-120mg BID

29
Q

How is diltiazem CD/XR/ER (Cardizem-CD, Dilacor-XR, Tiamate/Tiazac) dosed for angina prevention?

A

180-360mg daily

540 max for XR

30
Q

How is isosorbide dinitrate IR dosed for angina prevention?

A

5-40mg BID-TID

e.g. 7am, 1pm or 8am, 12pm, 4pm

31
Q

How is isosorbide dinitrate SR caps/tabs dosed for angina prevention?

A

40-80mg daily-BID (7 hours apart)

e.g. 8am and 3pm

32
Q

How is isosorbide mononitrate IR dosed for angina prevention?

A

10-20mg BID 7 hours apart

33
Q

How is isosorbide dinitrate SR dosed for angina prevention?

A

30-240mg daily

34
Q

How is ranolazine dosed for angina prevention?

A

500-1000mg BID

35
Q

How is morphine dosed in acute coronary syndromes?

A

2-4mg IV, repeated every 5-30 minutes in increments of 2-8mg for pain relief (monitor BP and RR after each bolus)

36
Q

How are IV nitrates dosed in ACS?

A

5-10mcg/min titrated to 75-100 (max 200) mcg/min to symptom relief or limiting side effects

37
Q

How is cangrelor dosed in PCI?

A

30mcg/kg IV bolus followed by 4mcg/kg/min IV infusion when PCI performed.

38
Q

When do the doses of Integrelin and Aggrastat need to be reduced?

A

When CrCl under 50mL/min (eptifibitide) or under 30mL/min (tirofiban)

39
Q

How is bivalirudin (Angiomax) dosed during PCI?

A

0.75mg/kg IV bolus followed by 1.75mg/kg/hr until end of PCI (can continue at 0.25mg/kg/hr if desired)
If CrCl is 30-60, 1.4mg/kg/hr
If CrCl under 30, 1mg/kg/hr

40
Q

How is UFH dosed for PCI?

A

50-70 units/kg (ACT 250-350s) or 70-100 units/kg (ACT 200-250s). Continue only until end of PCI.

41
Q

How is streptokinase dosed in medical reperfusion?

A

1.5 million units in 50mL NS or D5W over 60 minutes

42
Q

How is alteplase (tPA, Activase) dosed in medical reperfusion?

A

15mg IV bolus

  1. 75mg/kg over 30 minutes [max 50mg]
  2. 5mg/kg over 60 minutes [max 35mg]
43
Q

How is reteplase (Retavase) dosed in medical reperfusion?

A

10 units IV

10 units IV 30 minutes later

44
Q

How is tenecteplase (TNKase) dosed in medical reperfusion?

A 
Less than or = 60kg: 30mg IV
60-69.9kg: 35mg 
70-79.9kg: 40mg
80-89.9kg: 45mg
90kg or over: 50mg
45
Q

How is UFH dosed when adjunctive anticoagulant for medical reperfusion?

A

60 units/kg IV bolus (MAX 4000 units) then 12 units/kg/hr (MAX 1000 units/hr)
aPTT goal 1.5-2x control

46
Q

How is enoxaparin dosed for medical reperfusion?

A

30mg IV bolus then 1mg/kg SC q12h until discharge
If CrCl under 30mL/min: 1mg/kg SQ q24h
If age over 75: 0.75mg/kg q12h

[generally max 75mg for first 2 doses]

47
Q

How is metoprolol dosed IV in ACS?

A

5mg IV q5min x3 doses then 50mg PO q6h

48
Q

How is atenolol dosed IV in ACS?

A

5mg IV, repeated in 5 minutes, then 50-100mg PO daily

49
Q

How is lisinopril dosed initially in STEMI? What is the target dose?

A

2.5-5mg – target 10-20mg daily

50
Q

How is enalapril dosed initially in STEMI? What is the target dose?

A

2.5-5mg – target 10mg BID

51
Q

How is ramipril dosed initially in STEMI? What is the target dose?

A

1.25-2.5mg – 5mg BID or 10mg daily

52
Q

How is valsartan dosed initially in STEMI? What is the target dose?

A

40mg – target 160mg BID

53
Q

How is losartan dosed initially in STEMI? What is the target dose?

A

12.5-25mg – target 150mg daily

54
Q

How is eplerenone dosed initially in STEMI? What is the target dose?

A

Initial 25mg – target 50mg daily

55
Q

How is spironolactone dosed initially? What is the target dose?

A

Initial 12.5mg – target 25-50mg daily

56
Q

How is enoxaparin dosed for ischemia-guided?

A

1mg/kg SQ q12h or q24h if CrCl under 30

57
Q

How is fondaparinux dosed for ischemia guided?

A

2.5mg SQ once daily

Pharmacotherapy III (6 decks)

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