Acute Coronary Syndrome Medications to Master

Collection of flashcards covering mechanisms of action, dosages, side effects, and nursing assessments for medications used in Acute Coronary Syndrome (ACS) anti-ischemic and antithrombotic therapy.

Nitroglycerin

An arterial and vasodilator that works on vascular smooth muscle fibers causing a relaxing of veins (and arteries at higher doses), which lowers preload and afterload to improve coronary blood flow and reduce myocardial oxygen demand.

Nitroglycerin Dosage (Sublingual)

$0.3$ to $0.4\,mg$ every $3$ to $5\,minutes$ with a maximum dose of three tablets in $15\,minutes$.

Nitroglycerin Dosage (Intravenous)

Start infusion at $5\,mcg/min$ and titrate every $3$ to $5\,minutes$ until the desired response is achieved, maintaining systolic BP above $90\,mmHg$.

Nitroglycerin Nursing assessments-responsibilities

Giver correct dosing and follow up on vital checks every 3-5 minutes until chest pain improves and pt is stable.

Use IV nitro very cautiously in patients who already have low blood pressure; closely watch for changes in level of consciousness and abnormal heart rhythms.

When the patient is on an IV nitro drip, check blood pressure about every 3–5 minutes and try to keep systolic BP above 90 mmHg

If the blood pressure drops, lower the head of the bed, increase IV fluids as ordered, or temporarily decrease the nitro dose until the pressure improves.

Assess and document headaches, which are very common with nitro, and manage them as ordered

Morphine sulfate

A strong opioid analgesic used for severe chest pain not relieved by nitroglycerine, which helps open vessels to improve coronary blood flow and lower preload, potentially causing respiratory depression or sedation.

Metoprolol

A beta blocker that blocks cardiac effects of beta-adrenergic stimulation to slow heart rate, lower blood pressure, and contractility, thereby decreasing myocardial oxygen demand.

Metoprolol MI Stabilizing Dosage

An initial intravenous dose of $5\,mg$ followed by two additional doses at $5\text{-minute}$ intervals for a total of $15\,mg$.

Metoprolol Expected side effects

Bradycardia, hypotension, and heart blocks are serious side effects. Bronchospasm and dyspnea may also occur as may indications of poor perfusion such as syncope, confusion, or dizziness.

Metoprolol Nursing assessments-responsibilities

Do not give if HR is under 60, systolic BP under about 100, with moderate–severe LV failure or shock, PR interval over 0.24 sec, 2nd/3rd‑degree heart block, or active asthma/reactive airway disease.

Check apical heart rate and blood pressure before giving; hold the dose and notify the provider if HR is less than 60 or SBP is low (for example under 90–100).

Monitor for signs of worsening heart failure (increasing shortness of breath, crackles, edema, weight gain) or signs of poor perfusion/shock.

Assess for history of asthma, COPD, conduction blocks, or very low output states, and avoid or use extreme caution in these patients.

After giving IV beta blockers, closely monitor heart rate, rhythm, and blood pressure because effects begin within minutes.

Aspirin

An antithrombotic that irreversibly blocks platelet COX-1, decreasing thromboxane A2 and platelet clumping to stop platelets from clumping at the plaque rupture site; typical acute loading dose is $160$ to $325\,mg$.

Salicylate toxicity

A condition signaled by tinnitus (ringing in the ears) associated with aspirin use.

Clopidogrel (P2Y12 inhibitor)

A drug that blocks platelet P2Y12 receptors to reduce platelet aggregation and prevent recurrent MI, typically given as a $300$ to $600\,mg$ loading dose followed by $75\,mg$ daily.

Ticagrelor is another type.

Clopidogrel Nursing assessments-responsibilities

Give a proper loading and maintenance dose: clopidogrel 300–600 mg loading, then 75 mg once daily; ticagrelor 180 mg loading, then 90 mg twice daily.

Watch closely for bleeding, especially GI bleeding (black or bloody stools, coffee‑ground emesis, easy bruising, nosebleeds).

Monitor periodic platelet count, bleeding time, and other labs (e.g., CBC) and lipid profile as ordered.

Hold clopidogrel or ticagrelor for at least about 5 days before planned CABG or other high‑bleeding‑risk surgery, per provider orders.

Ticagrelor Dosage

$180\,mg$ loading dose followed by $90\,mg$ twice daily.

Heparin (UFH)

An anticoagulant that works with antithrombin to block clotting factors, preventing new clots from forming and existing clots from enlarging, monitored via aPTT.

Heparin Nursing assessments-responsibilities

Give an IV bolus of 60 units/kg (max 4000 units), then start an infusion at 12 units/kg/hr (max 1000 units/hr) and adjust based on aPTT to keep the level in the therapeutic range. Monitor aPTT and platelet count (HIT screening) and adjust or stop if abnormal. Watch closely for any bleeding and take safety precautions to reduce bleeding risk

Unfractionated Heparin (UFH) Weight-Based Dosing

An IV bolus of $60\,units/kg$ (maximum $4000\,units$), followed by an infusion at $12\,units/kg/hr$ (maximum $1000\,units/hr$).

Integrilin GP IIb/IIIa inhibitors

A class of drugs including abciximab, eptifibatide, and tirofiban that block receptors on platelets so fibrinogen and von Willebrand factor cannot bind, strongly inhibiting platelet aggregation.

Integrilin GP IIb/IIIa inhibitors Nursing assessments-responsibilities

Give eptifibatide as ordered: IV bolus 180 mcg/kg followed by a continuous infusion of 2 mcg/kg/min; some protocols give a second 180 mcg/kg bolus 10 minutes after the first, and infusion can continue up to 18–72 hours depending on ACS/PCI strategy.

Check baseline platelet count and hemoglobin/hematocrit, then monitor platelets during therapy to detect thrombocytopenia.

Watch very closely for bleeding (especially at invasive sites, GI/GU, gums, and intracranial signs such as sudden headache or neuro changes) and stop the infusion/notify the provider if significant bleeding occurs.

Statins (HMG-CoA reductase inhibitors)

Medications like simvastatin, rosuvastatin, and atorvastatin that block a key liver enzyme to lower LDL and total cholesterol, used to reduce the risk of recurrent MI and stroke.

Statins Side Effects

Common adverse reactions include muscle pain, weakness, dark urine, myopathy, rhabdomyolysis, and liver injury (jaundice or RUQ pain).

Lipitor Nursing assessments-responsibilities

Give the ordered statin dose (lovastatin, simvastatin, atorvastatin, or rosuvastatin) once daily, often in the evening for some agents, and reinforce that it must be taken consistently long‑term.

Check baseline lipid panel and liver function tests before starting, then recheck lipids and LFTs after a few weeks and periodically to monitor response and hepatotoxicity.

Assess for muscle pain, weakness, or dark urine (possible myopathy/rhabdomyolysis) and for liver symptoms (jaundice, RUQ pain); report and hold the drug if serious symptoms appear.

ACE Inhibitors

Drugs such as lisinopril or ramipril that block ACE in the RAAS to cause vasodilation, reduce afterload, and limit harmful ventricular remodeling after an MI.

ACE Inhibitors Adverse Reactions

Persistent dry cough, hyperkalemia (high potassium levels), and serious reactions such as angioedema (swelling of face, lips, or airway).

Lisinopril ACE Inhibitors Nursing assessments-responsibilities

Give the ordered ACE inhibitor dose (e.g., benazepril, captopril, enalapril, lisinopril, or ramipril) and titrate as prescribed.

Monitor blood pressure and pulse regularly and watch for postural/orthostatic hypotension, especially with the first few doses; teach the patient to change positions slowly.

Check kidney function (BUN/creatinine) and electrolytes, especially potassium, because ACE inhibitors can decrease GFR and cause hyperkalemia.

Assess for common adverse effects like a dry, persistent cough and serious reactions like angioedema (swelling of face, lips, tongue, or airway), and hold the drug/notify the provider if these occur.

Enoxaparin

A low molecular weight heparin with more predictable anticoagulant effects and a lower risk of HIT compared to UFH, typically dosed at $1\,mg/kg$ SC every $12\,hours$ for ACS.

Fibric Acid Derivatives (Fibrates)

Medications like gemfibrozil or fenofibrate that mainly lower triglycerides and VLDL production in the liver and modestly raise HDL.