Pharm final.txt

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Asa dose for STEMI/NSTEMI

162-325 mg
Platelet receptor Asa acts on

Thromboxane A2 receptor
Time frame for Asa for STEMI/NSTEMI

< 24 hrs
Beta blocker for STEMI/NSTEMI

Lopressor
Contraindications for beta blocker
- Bradycardia
- 1st degree AV block
- Hypotensive
Benefit for beta blocker in ACS

Decreased morfality/anti-ischemic
Myocardial benefits of IV nitro with ACS

Anti-ischemic
Why minimize morphine for ACS

Masks symptoms
IV nitro dose if inadequate pain relief

Increase 10-20mg q3-5min
Eptifibitide/Abciximab platelet receptor site

GP IIb/IIIa receptor
Plavix platelet site

Adenosine diphosphate
Plavix functioning with a stent

Decrases restenosis rate
Beta blocker with EF > 40%

Metoprolol
Beta blocker with EF < 40%

Coreg
ACS pharmacotherapy without cath

Thrombolytics
Desirable total cholesterol

< 200
Borderline total cholesterol

200-239
High Total Cholesterol

>= 240
Optimal LDL

< 100
Near Optimal LDL

100-129
Borderline LDL

130-159
High LDL

160-189
High risk of CHD
- Multiple risk factors
- Severe/poorly controlled risk factors
- ACS
- Metabolic syndrome
- Tri > 200, Non HDL > 130, HDL < 40
LDL goal for high risk factor CHD

< 70 mg/dL
Major side effect of statins
- Myopathy
- Increased liver enzymes
Time when statin-induced myopathy occurs

1st 12 months
FDA simvastatin dose

80mg
Greatest decrease in LDL
- Crestor
- Lipitor
- Zocor
Statin pearls
- increase in transaminases - watch
- SE are agent specific
- myalgias - change statin
MOA of Bile Acid Sequestrants

Bind dietary cholesterol - prevent absorption
SE of Bile Acid Sequestrants
- GI distress/constipation
- Decreased absorption of other drugs
SE of niacin
- Flushing
- Hyperglycemia
- hyperuricemia
- Upper GI distress
- Hepatotoxicity
Flushing reduction (Niacin SE)

ASA/NSAID 30-60 min prior
AIM-HIGH trial ended

Increased stroke in patients
Niacin pt population

Statin-intolerant patients
SE of Fibric Acid
- Dyspepsia
- Gallstones
- Myopathy
Zetia MOA

decreased intestinal absorption of cholesterol
1st line Anti-HTN

ACE Inhibitors
1st antihypertensives for Stage 1 HT w/o compelling indiciations

Thiazide diuretic
Diuretic HTN scheduling

AM & Afternoon - decreases nocturnal diuresis
3 common loop diuretics
- Lasix
- Bumex
- Demadex
Loop diuretics population

1st line in patients with edema
Potassium sparing diuretics
- Weak anti-HTN
- Additive with loop diuretics/thiazide
Complications of Potassium Sparing diuretics in DM/CKD

Hyperkalemia
Serious SE in males on Aldactone

gynecomastia
Cardioselective Beta Blockers
- B1 - one heart
- B2 - two lungs
Lopressor

Immediate Release
Toprol XL

Extended Release
Noncardioselective Beta Blocker
- Propranolol
- Labetalol
- Carvedilol
Contraindications of Beta-blockers
- Wheezing
- AV Block
- Hypotension
- Bradycardia
Intrinsic Sympathomimetic Activity (ISA)
- Adrenergic agonist activity with Beta Blocking
- If Beta Blocking causes bradycardia
Thiazide HTN stage
- All
- Uncomplicated HTN - Monotherapy
- Complicated - Additive therapy
SE of Beta blockers
- Sexual dysfunction
- Lethargy
- Suddenly stop - reflex tachycardia, ischemia & angina
Why Beta Blocker used with hydralazine or minoxidil

Counter reflex tachycardia
Antihypertensive in pregnancy

Methyldopa
Low dose Dopamine use

Renal & DA
Intermediate dose Dopamine

Beta effects and DA
High dose Dopamine

Alpha effects

Author

scherk87

147319

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Pharm final.txt

Description

Pharm

Updated

4/13/2012, 12:50:05 AM

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