Stable Ischemic HD, ACS, and HF Flashcards
cardiac stress test medications
adenosine, dipyridamole, dobutamine or regadenoson (Lexiscan)
Non-drug treatment for SIHD
BMI 18.5-24.9
waist circumference of < 35 in in females and < 40 in males
drug regimen for SIHD
aspirin 81 mg and beta blockers (clopidogrel if allergy to aspirin)
when do you suggest clopidogrel + aspirin
history of bare metal stent placement (DAPT 1 month), drug-eluting stent (DAPT 6 month) or CABG (DAPT 12 months)
alternatives when beta-blockers are contraindicated in patients
CCB (both DHP and non-DHP), long-acting nitrates, ranolazine (in addition or instead of)
SIHD preventative medications
- SLNG for immediate relief
- high intensity statin
-antihypertensives with HTN, HF, and DM
how long should aspirin be used in patients with SIHD
indefinitely - use non-enteric coated chewable aspirin
Clopidogrel
avoid use with omeprazole and esomeprazole
ranolazine
not for acute treatment of chest pain
has little to no effect on HR and BP
QT prolongation
nitroglycerin
hypotension, headache, tachyphylaxis
ISDN + hydralazine
preferred combo for HFrEF
nitrates
do not use with PDE-5s and riociguat
-avanafil in the past 12 hours
-sildenafil or vardenafil in the past 24 hours
- tadalafil in the past 48 hours
NG TL Spray
do not shake
spray onto or under the tongue
do not inhale the spray or try to swallow
do not spit or rinse mouth for 5-10 min after
Unstable angina (UA)
chest pain
negative cardiac enzymes
none/transient ischemic changes in ECG
partial blockage
NSTEMI
chest pain
positive cardiac enzymes
none/transient ischemic changes in ECG
partial blockage
STEMI
chest pain
positive cardiac enzymes
ST-segment elevation on ECG
complete blockage
NSTEMI-ACS
can be treated with medications alone or with PCI
STEMI
PCI or fibrinolytic
Time to PCI
90 minutes (door to balloon time) or within 120 minutes of first medical contact
Time to fibrinolytic
30 minutes
MONA-GAP-BA
MONA: morphine, oxygen, nitrates, asa
GAP: GPIIb/IIIa antagonists, anticoagulants, P2Y12 inhibitors
BA: beta-blockers, ACEi
when not to use IV nitroglycerin in ACS
SBP < 90 mmHg
when should beta-blockers be given post ACS?
within 24 hours to increase long term survival
P2Y12 inhibitors
prodrugs that irreversibly bind to the P2Y12 receptor
*not ticagrelor
Clopidogrel
LD: 300-600 mg (600 mg PCI)
MD: 75 mg
-bleeding risk (stop 5 days prior to surgery) di not use with omeprazole or esomeprazole
Prasugrel
LD: 60 mg (no later than 1 hour after PCI)
MD: 10 mg (5 mg < 60 kg)
-dispense in original container
-do not initiate if CABG is likely - stop at least 7 days prior to elective surgery
Ticagrelor
LD: 180 mg
MD: 90 mg BID x 1 year then 60 mg BID
- do not exceed 100 mg of ASA
-avoid use when CABG likely, stop 5 days before any surgery