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| Thrombolytics: Relative Contraindications |
Severe uncontrolled HTN (> 180/110 mmHg)
Current use of anticoagulants in therapeutic doses, Recent trauma (<2-4 weeks, esp. head), Prolonged CPR (>10 min), Recent major surgery (<3 weeks), Non-compressible vasculature puncture
Recent internal bleed (<2-4 weeks), Active peptic ulcer, Pregnancy, History of chronic severe HTN |
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ladyer86 Wed, 08 Feb 2012 03:00:05 GMT |
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| Thrombolytics: Absolute Contraindications |
Previous hemorrhagic stroke at any time
Previous ischemic stroke within 1 year
Known intracranial neoplasm
Active internal bleed (does not include menses)
Suspected aortic dissection |
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ladyer86 Wed, 08 Feb 2012 03:00:05 GMT |
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| The Open-Artery Theory |
Early reperfusion of the infarct-related coronary artery results in myocardial salvage. |
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ladyer86 Wed, 08 Feb 2012 02:15:54 GMT |
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| Acute Coronary Syndromes (ACS) ST-segment Elevation Treatment |
ST-segment elevation-->MONA+BB-->
Fibrinolytic (UFH/LMWH) or PCI |
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ladyer86 Wed, 08 Feb 2012 02:15:54 GMT |
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| Contraindications to GP IIb/IIIa Rx |
Active or recent bleeding (4-6 weeks)
Severe hypertension (SBP >180-200 mm Hg; DBP >110 mm Hg)
Any hemorrhagic CVA (+/- intracranial neoplasm, AVM, or aneurysm)
Any CVA within 30 days–2 years
Major surgery or trauma within 4-6 weeks
Thrombocytopenia ( <100,000/mm3 )
Bleeding diathesis/warfarin with elevated INR
Avoid in patients with renal insufficiency or failure |
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ladyer86 Wed, 08 Feb 2012 02:15:54 GMT |
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| Nitroglycerin Sublingual Patient Education |
For patients with previous STEMI
Take one tablet and wait 5 minutes
If pain persists, call 911 and take a second tablet
If pain persists, take a third tablet (3 in 15 min) |
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ladyer86 Wed, 08 Feb 2012 02:15:54 GMT |
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| Management of ACS: Agents to target thrombus and reperfusion |
Heparin
Glycoprotein (GP) IIb/IIIa receptor inhibitors
Thrombolytics |
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ladyer86 Wed, 08 Feb 2012 02:04:05 GMT |
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| Management of ACS: Routine Measures (MONA + BB) |
Analgesics, nitrates, antiplatelets, and B-blockers
Bed rest, IV access, oxygen to maintain SaO2 >90%, serial ECGs and cardiac enzymes |
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ladyer86 Wed, 08 Feb 2012 02:04:05 GMT |
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| modifiable risk factors for artherosclerosis and ischemic heart disease |
Dyslipidemia, Hypertension, Cigarette smoking, Diabetes, Overweight/obesity, Physical inactivity, Atherogenic diet |
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ladyer86 Wed, 08 Feb 2012 02:04:05 GMT |
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| Non-modifiable risk factors for artherosclerosis and ischemic heart disease |
Age (men>45 years; women >55 years)
Gender
Family history of premature CHD (male first degree relative <55 or female <65) |
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ladyer86 Wed, 08 Feb 2012 02:04:05 GMT |
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| Contraindications for ACEI and ARB |
Pregnancy: ACEI and ARB can cause injury and death to the developing fetus when used in the second and third trimesters
Bilateral renal artery stenosis
History of angioedema to another ACEI
Do not start in volume depleted patients |
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ladyer86 Wed, 08 Feb 2012 01:10:53 GMT |
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| ARB adverse effects |
Side effects similar to ACEI (cough is less likely)
Less angioedema, cross-reactivity is possible |
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ladyer86 Wed, 08 Feb 2012 01:10:53 GMT |
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| ACEI adverse effects |
Cough (mediated by bradykinin accumulation), Hyperkalemia (hold if K+ >5.5 mEq/L), Worsen renal function (hold if SCr increases >1 mg/dL above baseline), Angioedema (rare, but life threatening), Hypotension (first dose), Rash |
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ladyer86 Wed, 08 Feb 2012 01:10:53 GMT |
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| Non-dihydropyridines (CCB) Adverse Effects |
Bradycardia, heart block
Worsen heart failure
Constipation (verapamil) |
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ladyer86 Wed, 08 Feb 2012 01:10:53 GMT |
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| Dihydropyridines (CCB) Adverse effects |
Edema
Headache
Dizziness
Tachycardia |
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ladyer86 Wed, 08 Feb 2012 00:59:39 GMT |
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| what is the most effective lifestyle modification for HTN (how much decrease) |
weight reduction 5-20 mmHG/ 10-kg weight loss |
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ladyer86 Wed, 08 Feb 2012 00:59:39 GMT |
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| LVD <120/80 |
ACEI or ARB and β-blocker and aldosterone antagonist and thiazide or loop diuretic and hydralazine/isosorbide dinitrate (blacks) |
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ladyer86 Wed, 08 Feb 2012 00:59:39 GMT |
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| STEMI <130/80 |
β-blocker (if stable) and ACEI or ARB |
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ladyer86 Wed, 08 Feb 2012 00:59:39 GMT |
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| UA/NSTEMI <130/80 |
β-blocker (if stable) and ACEI or ARB |
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ladyer86 Wed, 08 Feb 2012 00:05:44 GMT |
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| Stable angina <130/80 |
β-blocker and ACEI or ARB |
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ladyer86 Wed, 08 Feb 2012 00:05:44 GMT |
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| High CAD risk (DM, CKD, CAD, PAD, AAA, Framingham >10%) <130/80 |
ACEI or ARB, or CCB, or thiazide
(If SBP >160, or DBP >100, then
start 2 drugs) |
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ladyer86 Wed, 08 Feb 2012 00:05:43 GMT |
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| General CAD prevention <140/90 |
Any (If SBP >160, or DBP >100, then start 2 drugs) |
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ladyer86 Wed, 08 Feb 2012 00:05:43 GMT |
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| Stage 2 HTN tx |
two-drug combination for most
usually thiazide diuretic + ACEI, ARB, BB, CCB |
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ladyer86 Tue, 07 Feb 2012 23:56:43 GMT |
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| Stage 2 HTN |
SBP >160 or DBP >100 mm Hg) |
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ladyer86 Tue, 07 Feb 2012 23:56:43 GMT |
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| Stage 1 HTN tx |
thiazide diuretic for most
may consider ACEI, ARB, BB, CCB, or combination |
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ladyer86 Tue, 07 Feb 2012 23:56:43 GMT |
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| Stage 1 hypertension |
SBP 140–159 or DBP 90–99 mm Hg) |
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ladyer86 Tue, 07 Feb 2012 23:56:43 GMT |
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