A list of cardiac medications used locally - a teaching resource.

A list of cardiac medications used locally and in what context - a teaching resource ideal for student nurses and newly qualified nurses.

Transcript

1. S i m o n M a r k D a l e y ( 2 0 1 9 ) MEDICATIONS - commonly used in cardiology*; Angina (stable); Aspirin / Clopidogrel Atorvastatin Anti-anginal (multiple agents may be needed) GTN spray A teaching resource. *developed for teaching at ULH cardiology; practice may vary Acute coronary syndrome; Aspirin Ticagrelor Atorvastatin Bisoprolol Ramipril Fondaparinux s/c for 48hrs (if LV impairment <40% then + eplerenone) } "dual antiplatelet therapy" Anti-anginals (in order of heirarchy); 1. Bisoprolol 2. Amlodipine (calcium channel blocker w/out any rate-limiting effect) - if HR >80 may select rate-limiting CCB such as diltiazem/verapamil 3. Isosorbide Mononitrate 4. Ranolazine 5. Ivabridine (if in sinus rhythm, HR >70, normal QTc) 6. Nicorandil. Hypertension; Ramipril (<55yrs) / Amlodipine (>55yrs) If urgent control of BP needed then IV nitrate infusion) Anticoagulation; Apixiban, Rivaroxiban, Dabigatran, Endoxiban (direct oral anticoagulants) Warfarin (vit K antagonist) Lipid modification; Atorvastatin 20mg - primary prevention (pre-event) Atorvastatin 80mg - secondary prevention (post-event) If unable to tolerate a statin then Ezetimibe
2. S i m o n M a r k D a l e y ( 2 0 1 9 ) MEDICATIONS - commonly used in cardiology*; A teaching resource. *developed for teaching at ULH cardiology; practice may vary AF & Atrial flutter; Primarily rate-control but with potential for rhythm-control; Bisoprolol, Sotolol, Metoprolol Digoxin (generally for the elderly/those with pulmonary congestion) Primarily rhythm-control; IV amiodarone IV/oral Flecainide (if structurally normal heart) SVT; IV Adenosine IV Verapamil Heart failure; Bisoprolol/Carvedilol Ramipril or Losartan/Candesartan Furosemide/Bumetanide Spironolactone/Eplerenone/Metolazone Ivabridine/Digoxin (if HR on high side) Entresto (valsartan + salcubitrol) Pericarditis; 3 months colchicine High dose NSAID (ibuprofen 600mg) "Emergency" drugs; IV amiodarone +/- IV lidocaine +/- IV magnesium (VT) IV furosemide +/- IV isoket (pulmonary oedema) IV metaraminol +/- IV dobutamine/dopamine (cardiogenic shock) STAT IV atropine +/- IV adrenaline (bradycardia) IV isoprenaline (bradycardia) IV alteplase for thrombolysis of unstable PE or for STEMI (in event of cath lab failure) IV esmolol/sodium nitroprusside (for BP control in thoracic dissection) IV levosamendin (severe cardiogenic shock/HF transplant candidate) Cath lab only drugs; IV phenylephrine (profound hypotension) IV integrillin (potent blood thinner to break down thrombus) IV bivalirudin (same as integrillin, v.rarely used)