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PHRM 845 > ACS pt5 > Flashcards

ACS pt5 Flashcards

1
Q

What are the long term goals of ACS therapy?

A
  • Control CAD risk factors
  • Prevent MACE
  • Improve QOL
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2
Q

When should BBs be initiated in ACS?

A

Within first 24 hours of ACS

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3
Q

What are reasons to not start a BB in ACS?

A
  • Bradycardia
  • HF
  • Risk for cardiogenic shock
  • Uncontrolled asthma or reactive airway disease
  • 2nd or 3rd degree heart block
  • PR interval >0.24 seconds
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4
Q

What should be done in pts that have initial CI to BBs?

A

Re-evaluate to determine eligibility

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5
Q

What is the starting dose of metoprolol tartrate?

A

25-50 mg q6-12h

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6
Q

What is the target dose of metoprolol?

A
  • 100mg BID w tartrate
  • 200 mg daily w succinate
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7
Q

What is the starting dose of carvedilol?

A

6.25 mg BID

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8
Q

What is the target dose of carvedilol?

A

25 mg BID

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9
Q

What is the starting dose of propranolol?

A

40 mg BID-TID

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10
Q

What is the target dose of propranolol?

A

80 mg QID

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11
Q

What is the starting dose of atenolol?

A

25-50 mg daily

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12
Q

What is the target dose of atenolol?

A

100 mg daily

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13
Q

Which BBs should be used in pts w HFrEF?

A

SR metoprolol succinate, carvedilol, bisoprolol

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14
Q

When should IV BB be considered?

A

Hypertensive or ongoing ischemia

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15
Q

When using IV BB, which BB, strength, and frequency should be used?

A

Metoprolol tartrate 5 mg IV q5min (up to 3 doses)

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16
Q

What happens when a cocaine user uses while on BB?

A

Allows cocaine to stimulate alpha receptors, possibly leading to:
- Hypertensive complications or increased troponin

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17
Q

Is it ok to give a BB to a pt w cocaine use hx?

A

Use a nonselective BB + make sure there is no cocaine in pt’s system

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18
Q

Should BBs be started or dose be adjusted during acute HF exacerbation?

A

Avoid starting or increasing BBs

19
Q

Why are BBs avoided in HF that’s not stable?

A
  • BBs can slow down heart and decrease cardiac output
  • Starting/increasing BBs during exacerbation can cause pulmonary edema
20
Q

Is it safe to continue a pt on their maintenance BBs?

A

Yes, if pt has ALREADY been on BBs:
- Continue at home dose, but do not increase until euvolemic

21
Q

What are HR and BP “hold orders” for BBs?

A
  • HR <50 bpm
  • BP <90/60
22
Q

When are CCBs given?

A

Non-DHP CCBs are given to pts w recurrent ischemia and CI to BBs

23
Q

When should CCBs not used?

A

Do not use in pts w:
- LV dysfunction (aka HFrEF)
- Increased risk for cardiogenic shock
- PR interval >0.24 seconds
- 2nd or 3rd degree AV block w/o pacemaker

24
Q

What are the high intensity statins?

A
  • Atorvastatin 40-80 mg daily
  • Rosuvastatin 20-40 mg daily
25
Q

What is the starting dose of captopril?

A

6.25-12.5 mg TID

26
Q

What is the target dose of captopril?

A

25-50 mg TID

27
Q

What is the starting dose of lisinopril?

A

2.5-5 mg daily

28
Q

What is the target dose of lisinopril?

A

> = 10 mg daily

29
Q

What is the starting dose of ramipril?

A

2.5 mg bid

30
Q

What is the target dose of ramipril?

A

5 mg bid

31
Q

What is the starting dose of trandolapril (Mavik)?

A

0.5 mg daily

32
Q

What is the target dose of trandolapril?

A

4 mg daily

33
Q

What is the starting dose of valsartan?

A

20 mg bid

34
Q

What is the target dose of valsartan (Diovan)?

A

160 mg bid

35
Q

When is an ACEi not used?

A
  • Hypotension/shock
  • Unilateral/bilateral renal artery stenosis
  • Hx of worsening renal function on ACEi/ARB
  • Acute renal failure
  • Drug allergy/angioedema
36
Q

What are the monitoring parameters of ACEi?

A
  • SCr (increase)
  • K (increase)
  • BP (decrease)
  • Angioedema
37
Q

Why must SCr be monitored w ACEi?

A
  • Causes an initial increase in SCr
  • Initial SCr increase of up to 30% is ok; d/c ACEi if initial increase >30%
38
Q

Why does ACEi initially increase SCr?

A

ACEi causes efferent arteriole vasodilation

39
Q

Which pts require oral anticoag in addition to DAPT?

A
  • Pts w afib (CHADSVASc >=2)
  • STEMI and asymptomatic LV mural thrombi
  • STEMI and anterior apical akinesis or dyskinesis (abnormal heart wall mvnt)
40
Q

How long should triple antithrombotic therapy last after ACS?

A

Duration should be minimized

41
Q

What should be done w ASA in pts on triple antithrombotic therapy + afib?

A

D/c ASA after 1-4 weeks after PCI and continue P2Y12i and anticoag (NOAC > warfarin)

42
Q

What prn NTG should be given to ACS pts?

A

0.3-0.4 mg SL NTG q5min for chest pain

43
Q

What are ways to prevent recurrent MI?

A
  • Stop smoking
  • Adherence to meds
  • Control BP
  • Healthy diet and exercise

PHRM 845 (48 decks)

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