Critical Care Exam 1

MAP

70-100 mmHg

CO

4-8 L/min

CVP

2-6 mmHg

short-acting nitrates (nitroglycerin)

• Vasodilator of peripheral and coronary BVs

• Sublingual/spray

• If no relief in 5 minutes x3 max doses, call EMS

• Can be used prophylactically

long-acting nitrates

• Vasodilator of peripheral and coronary BVs

• Used to reduce incidence of angina

• Side effects: Headache, orthostatic hypotension

• Oral, ointment, or transdermal controlled release

morphine sulfate

• If 3 doses of NTG do not work, give this med.

• Pain reliever of choice for STEMI

• Check BP, respiration, and use caution with elderly

beta blockers (-lol)

• Antihypertensive medications that reduce heart rate and myocardial oxygen demand

• Used for hypertension, heart failure, and prevention of angina

• Monitor BP and HR

• Metoprolol, Propranolol, Atenolol

calcium channel blockers (-ipine)

• Inhibit contraction of myocardial and smooth muscle, vasodilation, and slow HR

• Give if symptoms persist despite NTG and B-blockers

• Used for Prinzmetal’s Angina to stop spasm

• Nifedipine, Verapamil, Diltiazem

ace inhibitors (-pril)

• Administer in the first 24 hours if pt has pulmonary congestion or LV EF of less than 40%

• Helps reduce long term mortality/complications

• Monitor BP, K+, renal function, coughing (can give ARB instead)

• Lisinopril, captopril

Aspirin

• Antiplatelet medication

• Give ASAP! 162-325 mg

Thienopyridines (Clopidogrel, Plavix)

• Antiplatelet

• Expensive, but used in percutaneous coronary intervention (PCI) and with CABG

glycoprotein IIb/IIIa inhibitors

• Antiplatelet; potent platelet aggregation inhibitors

• Adjunct therapy with percutaneous coronary intervention

• Abciximab, Eptifibatide

Unfractionated heparin

• Anticoagulant

• Prevents thrombus by accelerating antithrombin, which inactivates Factors IIa, IXa, and Xa

• IV infusion

• Monitor aPTT or anti-factor Xa

Low molecular weight heparin

• More predictable anticoagulant effect

• Weight based, lower incidence of heparin-induced thrombocytopenia (HIT), and easier to administer

• Enoxaparin prevents conversion of fibrinogen and prothrombin

• SQ injection

Statins

• Lipid-lowering med

• Take at bedtime

• AVOID GRAPEFRUIT

Niacin

• Lowers LDL and increases HDL

• Side effects: flushing of the face, GI problems

Bile acid binding resins

• Lipid-lowering med

• Questran