Pharm

Question 1

Nitrates indicated for acute CP:

Answer 1

• IV NTG

- SL NTG

Question 2

IV NTG onset of action, duration, and initial dose

Answer 2

• 1-2 min
• 3-5 min
  Dose: 5-10 mcg/min

Question 3

SL NTG onset of action, duration, and initial dose:

Answer 3

• 1-3 min
• 30-60 min
• 0.4 mg PRN

Question 4

Isosorbide dinitrate onset of action, duration, and initial dose:

Answer 4

• 20-40 min
• 4-6 hours
• 10-20 mg TID

Question 5

NTG patch onset of action, duration, and initial dose:

Answer 5

• 40-60 min
• > 8 hrs
• 1 patch

Question 6

Isosorbide mononitrate onset of action, duration, and initial dose:

Answer 6

• 30-60 min
• 6-8 hrs
• 30 mg QD

Question 7

Nitrates for chronic CP:

Answer 7

Isosorbide dinitrate
Isosorbide mononitrate
NTG patch

Question 8

SE w/ NTG use:

Answer 8

1- tolerance (tachyphylaxis- reduction in tissue C-GMP)
2- flushing
3- orthostasis
4- HA

Question 9

C/I w/ NTG:

Answer 9

• PDE-5 inhibitor use (taken w/in 24h)

- HCM

Question 10

Ranolazine dosage:

Answer 10

500 mg PO BID (max: 1000 mg QD)

Question 11

Morphine dosage:

Answer 11

2-5 mg IV Q5-15 min until pain relief or ADR occurs

Question 12

Naloxone (Narcan) dosage:

Answer 12

0.4 mg IVP

Morphine reversal agent

Question 13

Clopidogrel (plavix) loading dose and QD dosing:

Answer 13

300 mg loading dose

75 mg QD doses

Question 14

Ticagrelor (Brillinta) loading dose and QD dosing:

Answer 14

180 mg loading dose

90 mg BID dosing for the first year; 60 mg BID following stable state

Question 15

Prasugrel (Effient) loading dose and QD dosing:

Answer 15

Loading dose: 60 mg

5-10 mg QD dosing

Question 16

Apixaban dosage:

Answer 16

• 5 mg BID

- 2.5 mg BID if 2/3: SCr <1.5, wt: <60 kg or age >80 y.o.

Question 17

Rivaroxaban

Answer 17

20 mg QD

Unless GFR < 15-50 mL/min- then rq. 15 mg QD

Question 18

Dabigatran dosage:

Answer 18

150 mg BID

Question 19

Edoxaban dosage:

Answer 19

60 mg QD

Unless GFR <50, then 30 mg QD

Question 20

Epinephrine dosage:

Answer 20

1 mg IV push repeat every 3-5 minutes

Question 21

Amiodarone dosage:

Answer 21

300 mg IV push (first dose), then 150 mg IV push (second dose)

Question 22

Atropine dosage:

Answer 22

0.5 mg IV push every 3-5 minutes; max dose 3 mg

Question 23

Adenosine dosage:

Answer 23

6 mg IV push (first dose), 12 mg (repeat dose x2)

Question 24

Magnesium dosage:

Answer 24

2 mg IV push

Question 25

Diltiazem dosage:

Answer 25

10-20 mg IV bolus w/ titrated IV drip

Question 26

BB benefits and C/I in stable angina tx:

Answer 26

Decreased mortality in post-MI patients; MC used | Shouldn’t be used in pts with vasospastic angina; unopposed alpha-receptor activity

Question 27

Use for nitrates off-label:

Answer 27

Esophageal spasm

Question 28

Nitrates should be used with caution in these pts:

Answer 28

Volume depletion | Aortic stenosis

Question 29

SL nitroglycerin dosing recommendations:

Answer 29

Take on PRN basis Max: 3 tablets or 3 sprays (5 minutes apart over 15 minutes) Pt should sit down; monitor HA; do not swallow!

Question 30

CCB use in stable angina:

Answer 30

When BB are C/I or stopped due to an ADR | If BB and nitrates are not alleviated stable angina sxs

Question 31

Ranolazine MOA:

Answer 31

``` Prolongs ventricular AP Does not affect HR and BP Reduces ventricular tension Decreases myocardial oxygen demand *last resort after BB, nitrates and CCB ```

Question 32

Ranolazine SE:

Answer 32

HA Dizziness Constipation Nausea

Question 33

Ranolazine DDI’s:

Answer 33

DANGS Digoxin (increases levels) Antifungals (azoles)- avoid Non-DHP CCB (verapamil/diltiazem)- limit doe of ranolazine Grape fruit juice- avoid Simvastatin- should not exceed 20 mg, limit does of ranolazine

Question 34

Ranolazine metabolism:

Answer 34

Extensive hepatic metabolism; 75% renal excretion Avoid in pts w/ cirrhosis Pt. W/ CKD likely 40-50% dose increase

Question 35

Drugs that should be avoided in an acute MI: (6)

Answer 35

``` DO NOT CONSIDER in AN EMERGENT SETTING Digoxin Nitroprusside CCB NSAIDs Enalaprilat Steroids ```

Question 36

NTG use should be avoided in these pts (2)

Answer 36

SBP <90 mm Hg | C/I w/ RV infarction

Question 37

NTG use beyond 48 hours should be reserved for these pts: (3)

Answer 37

- persistent HF, CP, or HTN

Question 38

Morphine dosage and concerns:

Answer 38

2-5 mg IV over 5-15 minutes | - may interfere w/ anti-platelet Drugs and common w/ allergic rx

Question 39

Indicated immediately in ACS

Answer 39

BB Reduce mortality Decreases incidence of ventricular arrhythmias and cardiac death Improve perfusion to the heart

Question 40

C/I to BB: (5)

Answer 40

``` 1- hypotension, cardiogenic shock 2- AV heart block (more than first degree) 3- active asthma, bronchospasm 4- signs of HF 5- bradycardia <55 BPM ```

Question 41

BB should be titrated w/ these goals in mind:

Answer 41

HR: 70 BPM w/ SBP > 90 mm Hg

Question 42

CCB do not decrease progression in an acute MI, but should be used w/ these pts: (2)

Answer 42

- NSTEMI pts. W/ persistent or recurrent CP (despite BB and nitrate TX) - sxs ACS pts. Unable to tolerate BB

Question 43

UFH is preferred for anticoagulation w/:

Answer 43

PCI

Question 44

LMWH, enoxaparin, is preferred in these pts:

Answer 44

Unstable angina NSTEMI (Though UFH can be used as well)