Dosing for Exam 1 (Angina and ACS)

Question 1

How is aspirin dosed chronically? Upon ACS presentation?

Answer 1

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

Question 2

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

Answer 2

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

Question 3

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

Answer 3

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

Do not use if TIA/stroke hx

Question 4

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

Answer 4

Chronic: 90mg BID
LD: 180mg once

Question 5

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

Answer 5

False–prasugrel and ticagrelor are only indicated following ACS

Question 6

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

Answer 6

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

Question 7

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

Answer 7

Consider anticoagulant for a year.

Question 8

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

Answer 8

Nitrates

Question 9

What is the dosing for NTG SL tabs?

Answer 9

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

Question 10

What is the dosing for NTG translingual spray?

Answer 10

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

Question 11

What is the dosing for NTG buccal tabs?

Answer 11

1-3mg buccally once

Question 12

What is the dosing for ISDN chewable tabs?

Answer 12

5-10mg once, chewed

Question 13

What is the dosing for ISDN sublingual tabs?

Answer 13

2.5-10mg SL once

Question 14

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

Answer 14

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

Question 15

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

Answer 15

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.

Question 16

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

Answer 16

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

Question 17

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

Answer 17

25-50mg BID; no–eliminated hepatic

Question 18

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

Answer 18

50-100mg BID; eliminated hepatically

Question 19

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

Answer 19

100-200mg daily

Question 20

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

Answer 20

80-160mg daily; hepatic

Question 21

At what doses do atenolol and metoprolol lose their cardioselectivity?

Answer 21

Atenolol 100mg daily

Metoprolol 200mg total daily dose

Question 22

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

Answer 22

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

Question 23

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

Answer 23

10-20mg TID

Question 24

How is nicardipine (Cardene) dosed for angina prevention?

Answer 24

20-40mg TID

Question 25

How is amlodipine (Norvasc) dosed for angina prevention?

Answer 25

5-10mg daily

Question 26

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

Answer 26

60-90mg TID-QID

Question 27

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

Answer 27

240mg daily

Question 28

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

Answer 28

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

Question 29

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

Answer 29

180-360mg daily | 540 max for XR

Question 30

How is isosorbide dinitrate IR dosed for angina prevention?

Answer 30

5-40mg BID-TID | e.g. 7am, 1pm or 8am, 12pm, 4pm

Question 31

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

Answer 31

40-80mg daily-BID (7 hours apart) | e.g. 8am and 3pm

Question 32

How is isosorbide mononitrate IR dosed for angina prevention?

Answer 32

10-20mg BID 7 hours apart

Question 33

How is isosorbide dinitrate SR dosed for angina prevention?

Answer 33

30-240mg daily

Question 34

How is ranolazine dosed for angina prevention?

Answer 34

500-1000mg BID

Question 35

How is morphine dosed in acute coronary syndromes?

Answer 35

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

Question 36

How are IV nitrates dosed in ACS?

Answer 36

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

Question 37

How is cangrelor dosed in PCI?

Answer 37

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

Question 38

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

Answer 38

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

Question 39

How is bivalirudin (Angiomax) dosed during PCI?

Answer 39

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

Question 40

How is UFH dosed for PCI?

Answer 40

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

Question 41

How is streptokinase dosed in medical reperfusion?

Answer 41

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

Question 42

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

Answer 42

15mg IV bolus 0. 75mg/kg over 30 minutes [max 50mg] 0. 5mg/kg over 60 minutes [max 35mg]

Question 43

How is reteplase (Retavase) dosed in medical reperfusion?

Answer 43

10 units IV | 10 units IV 30 minutes later

Question 44

How is tenecteplase (TNKase) dosed in medical reperfusion?

Answer 44

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

Question 45

How is UFH dosed when adjunctive anticoagulant for medical reperfusion?

Answer 45

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

Question 46

How is enoxaparin dosed for medical reperfusion?

Answer 46

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]

Question 47

How is metoprolol dosed IV in ACS?

Answer 47

5mg IV q5min x3 doses then 50mg PO q6h

Question 48

How is atenolol dosed IV in ACS?

Answer 48

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

Question 49

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

Answer 49

2.5-5mg -- target 10-20mg daily

Question 50

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

Answer 50

2.5-5mg -- target 10mg BID

Question 51

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

Answer 51

1.25-2.5mg -- 5mg BID or 10mg daily

Question 52

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

Answer 52

40mg -- target 160mg BID

Question 53

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

Answer 53

12.5-25mg -- target 150mg daily

Question 54

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

Answer 54

Initial 25mg -- target 50mg daily

Question 55

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

Answer 55

Initial 12.5mg -- target 25-50mg daily

Question 56

How is enoxaparin dosed for ischemia-guided?

Answer 56

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

Question 57

How is fondaparinux dosed for ischemia guided?

Answer 57

2.5mg SQ once daily