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Flashcards in Acute coronary syndrome meds Deck (54):
1

List all meds used in acute MIs

Oxygen
Nitrates (anti-ischemics)
Analgesia
BB
CCB
Cholesterol lowering agents
RAAS inhibitors
Anti-platelet agents
Parenteral anticoagulation
Other anti-ischemics

2

When do you give O2 to AMI pts?

O2 sat < 90%
Respiratory distress
Other high risk features of hypoxemia

3

When might O2 have negative effects in coronary pts?

Increased coronary vascular resistance
Reduced coronary blood flow
Increased risk of mortality
Significantly larger infarct sizes than those w/o O2 therapy

4

What do nitrates do for AMI?

Dilate capacitance vessels which decreases preload

5

For what do you administer nigtoglycerin and how do you give it?

Continued pain
SL

6

How do you dose SL nitro?

0.3-0.4 mg q 5 minutes x3

7

After the q5 dosing, then what do you do with nitro?

Evaluate for need for IV nitro

8

When do you NOT give nitro?
Why?

If on phosphodiesterase inhibitor
(If taken sildenafil in last 24 hours, or tedalafil in last 48 hours)
Decrease in BP

9

What is a common analgesia given to AMI pts for continued CP? How is it administered?

Morphine sulfate
IVP

10

Why do you give morphine sulfate for continued cp?

If pt is already on max tolerated nitro

11

What is another analgesia combo that is actually not given to AMI pts?

NSAIDS (not asprin) + COX2 inhibitors

12

Why are NSAIDS + COX2 inhibitors not given to AMI pts?

Enhances platelet aggregation by inhibiting PG synthesis

13

What NSAID can be used for its anti-platelet effects?

Aspirin

14

When do you begin BB for AMI pts?

WIthin 24 hours

15

Are there some exceptions to starting BB in AMI pts?

Yes
(signs of HF, low output state, etc.)

16

What BB should AMI pts w/ stable HF be continued on?

Metorpolol succinate
Carvedilol
Bisoprolol

17

Why do we avoid IV BBs in AMI pts?

May increase risk of shock

18

When do you give CCB?

Ischemic/continued pain pts with:
Contraindications to BBs
Unacceptable side-effects from BBs
Continued pain after appropriate use of BBs and nitrates

19

Which non-dihydropyridine CCBs are used as initial therapy for AMI pts?

Verapamil (PO)
Diltiazem (PO)

20

What CCB shouldnt be used for AMI pts? Why?

Imediate release nifedipine
Causes a dose-related increase in mortality in CAD and harm in ACS pts

21

What antianginal with minimal effects on HR and BP do we have for AMI pts?

Ranolazine

22

What are the AEs of ranolazine?

Constipation
Dose related QTc prolongation

23

What must you start AMI pts on?

Benign high-intensity statin therapy

24

Give the two high intensity statins that we give AMI pts and their dosing

Atorvastatin titrate 10-80 mg po once daily
Rosuvastatin titrate 5-40 mg po once daily

25

When do you start AMI pts on ACEI? How long do you keep them on this?

When LVEF < 40%
Indefinitely

26

What ACEI do you start AMI pts on in the hospital? When do you switch to a long acting ACEI?

Catopril (tid) or enalaprin (bid)

Switch to long acting @ max dose

27

What do you use in AMI pts intolerant to ACEIs?

ARBs

28

What do you add to pharmacotherapy for AMI pts who are on therapeutic doses of ACEIs and BB?

ARA

29

What two drugs do you never combine for heart pts?

ACEI and ARB

30

What is your acute anti-platelet agent? What is the dose?

Non-enteric-coated chewable aspirin
162-324 mg

31

Why do you not order enteric coated ASA acutely?

It delays absorption

32

Does 325 mg ASA = 324 mg ASA in the computerized dispensing systems?

No

33

What do you give to pts who are allergic or intolerant to aspirin?

Clopidogrel

34

What is the chronic dosing of aspirin for anti-platelet therapy for AMI pts?

81-325 mg indefinitely

35

What else do you add to anti-platelet therapy for AMI pts? For how long?

P2Y12 aspirin receptor inhibitor

12 months

36

What are the two P2Y12 aspirin agents used post AMI? How often are they dosed

Clopidogrel: daily
Ticegralor: bid

37

Why is pasugrel not recommended for chronic anti-platelet therapy?

Increased risk of spontaneous, life-threatening, and fatal bleeding

38

What other category of therapy related to blood is recommended in addition to antiplatelet therapy for all AMI pts?

Anticoagulation

39

What LMWH is preferred for ACS?

Enoxaparin

40

What is the dosing of enoxaparin for pts with CrCl > 30 mL/min for ACS?

1 mg/kg SC q 12 hours
*actual body weight*

41

What is the dosing of enoxaparin for pts with CrCl < 30 mL/min for ACS?

1 mg/kg SC q 24 hours
*actual body weight*

42

When do you avoid giving LMWH?

In dialysis pts w/ ACS

43

Where is anticoagulant bivalrudin often used?

Cath labs

44

What are the two advantages of bivalrudin over UFH or LMWH?

Will bind to clot bound thrombin (unlike heparin)
No significant protein binding (more predicatble anticoagulant response)

45

What kind of drug is fondaparinux?

A synthetic pentasaccharide
(selective factor Xa inhibitor)

46

Is there a risk of HITT with fondaparinux?

Minimal if any

47

When is fondaparinux contraindicated? Why?

CrCl < 30 mL/min
Increased risk of bleeding

48

When do you use fondaparinux with caution?

CrCl 30-50 mL/min

49

Is the half life of unfractionated heparin (UFH) long or short?

Short
(1.5 hours)

50

Can you simply d/c IV UFH or do you need to taper it in urgent interventions?

Just d/c it

51

How do you indicate to the pharmacist how much UFH you need?

You specify the indication (DVT, PE, NSTEMI, STEMI, PCI)

52

What is the initial bolus max dose of weight based UFH regimens?

4000 units

53

What is the initial maintenance infusion max dose for weight based UFH regimens?

1000 units/hour

54

When do we use the anticoagulant argatroban for ACS pts?

In pts w/ h/o HITT undergoing PCI