ACS pt5 Flashcards
What are the long term goals of ACS therapy?
- Control CAD risk factors
- Prevent MACE
- Improve QOL
When should BBs be initiated in ACS?
Within first 24 hours of ACS
What are reasons to not start a BB in ACS?
- Bradycardia
- HF
- Risk for cardiogenic shock
- Uncontrolled asthma or reactive airway disease
- 2nd or 3rd degree heart block
- PR interval >0.24 seconds
What should be done in pts that have initial CI to BBs?
Re-evaluate to determine eligibility
What is the starting dose of metoprolol tartrate?
25-50 mg q6-12h
What is the target dose of metoprolol?
- 100mg BID w tartrate
- 200 mg daily w succinate
What is the starting dose of carvedilol?
6.25 mg BID
What is the target dose of carvedilol?
25 mg BID
What is the starting dose of propranolol?
40 mg BID-TID
What is the target dose of propranolol?
80 mg QID
What is the starting dose of atenolol?
25-50 mg daily
What is the target dose of atenolol?
100 mg daily
Which BBs should be used in pts w HFrEF?
SR metoprolol succinate, carvedilol, bisoprolol
When should IV BB be considered?
Hypertensive or ongoing ischemia
When using IV BB, which BB, strength, and frequency should be used?
Metoprolol tartrate 5 mg IV q5min (up to 3 doses)
What happens when a cocaine user uses while on BB?
Allows cocaine to stimulate alpha receptors, possibly leading to:
- Hypertensive complications or increased troponin
Is it ok to give a BB to a pt w cocaine use hx?
Use a nonselective BB + make sure there is no cocaine in pt’s system
Should BBs be started or dose be adjusted during acute HF exacerbation?
Avoid starting or increasing BBs
Why are BBs avoided in HF that’s not stable?
- BBs can slow down heart and decrease cardiac output
- Starting/increasing BBs during exacerbation can cause pulmonary edema
Is it safe to continue a pt on their maintenance BBs?
Yes, if pt has ALREADY been on BBs:
- Continue at home dose, but do not increase until euvolemic
What are HR and BP “hold orders” for BBs?
- HR <50 bpm
- BP <90/60
When are CCBs given?
Non-DHP CCBs are given to pts w recurrent ischemia and CI to BBs
When should CCBs not used?
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
What are the high intensity statins?
- Atorvastatin 40-80 mg daily
- Rosuvastatin 20-40 mg daily
