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Asa dose for STEMI/NSTEMI
162-325 mg
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Platelet receptor Asa acts on
Thromboxane A2 receptor
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Time frame for Asa for STEMI/NSTEMI
< 24 hrs
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Beta blocker for STEMI/NSTEMI
Lopressor
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Contraindications for beta blocker
- Bradycardia
- 1st degree AV block
- Hypotensive
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Benefit for beta blocker in ACS
Decreased morfality/anti-ischemic
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Myocardial benefits of IV nitro with ACS
Anti-ischemic
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Why minimize morphine for ACS
Masks symptoms
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IV nitro dose if inadequate pain relief
Increase 10-20mg q3-5min
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Eptifibitide/Abciximab platelet receptor site
GP IIb/IIIa receptor
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Plavix platelet site
Adenosine diphosphate
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Plavix functioning with a stent
Decrases restenosis rate
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Beta blocker with EF > 40%
Metoprolol
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Beta blocker with EF < 40%
Coreg
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ACS pharmacotherapy without cath
Thrombolytics
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Desirable total cholesterol
< 200
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Borderline total cholesterol
200-239
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High Total Cholesterol
>= 240
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High risk of CHD
- Multiple risk factors
- Severe/poorly controlled risk factors
- ACS
- Metabolic syndrome
- Tri > 200, Non HDL > 130, HDL < 40
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LDL goal for high risk factor CHD
< 70 mg/dL
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Major side effect of statins
- Myopathy
- Increased liver enzymes
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Time when statin-induced myopathy occurs
1st 12 months
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FDA simvastatin dose
80mg
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Statin pearls
- increase in transaminases - watch
- SE are agent specific
- myalgias - change statin
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MOA of Bile Acid Sequestrants
Bind dietary cholesterol - prevent absorption
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SE of Bile Acid Sequestrants
- GI distress/constipation
- Decreased absorption of other drugs
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SE of niacin
- Flushing
- Hyperglycemia
- hyperuricemia
- Upper GI distress
- Hepatotoxicity
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Flushing reduction (Niacin SE)
ASA/NSAID 30-60 min prior
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AIM-HIGH trial ended
Increased stroke in patients
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Niacin pt population
Statin-intolerant patients
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SE of Fibric Acid
- Dyspepsia
- Gallstones
- Myopathy
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Zetia MOA
decreased intestinal absorption of cholesterol
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1st line Anti-HTN
ACE Inhibitors
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1st antihypertensives for Stage 1 HT w/o compelling indiciations
Thiazide diuretic
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Diuretic HTN scheduling
AM & Afternoon - decreases nocturnal diuresis
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Loop diuretics population
1st line in patients with edema
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Potassium sparing diuretics
- Weak anti-HTN
- Additive with loop diuretics/thiazide
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Complications of Potassium Sparing diuretics in DM/CKD
Hyperkalemia
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Serious SE in males on Aldactone
gynecomastia
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Cardioselective Beta Blockers
- B1 - one heart
- B2 - two lungs
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Lopressor
Immediate Release
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Toprol XL
Extended Release
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Noncardioselective Beta Blocker
- Propranolol
- Labetalol
- Carvedilol
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Contraindications of Beta-blockers
- Wheezing
- AV Block
- Hypotension
- Bradycardia
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Intrinsic Sympathomimetic Activity (ISA)
- Adrenergic agonist activity with Beta Blocking
- If Beta Blocking causes bradycardia
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Thiazide HTN stage
- All
- Uncomplicated HTN - Monotherapy
- Complicated - Additive therapy
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SE of Beta blockers
- Sexual dysfunction
- Lethargy
- Suddenly stop - reflex tachycardia, ischemia & angina
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Why Beta Blocker used with hydralazine or minoxidil
Counter reflex tachycardia
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Antihypertensive in pregnancy
Methyldopa
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Low dose Dopamine use
Renal & DA
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Intermediate dose Dopamine
Beta effects and DA
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High dose Dopamine
Alpha effects
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