becoming a better Clinician
Common Cardiac Surgery Medications
OHT: orthotopic heart transplant
TAVR: transcatheter aortic valve replacement
Mechanical Valve(s): INR goal 2.5 - 3.5
Bioprosthetic Valve(s): coumadin not typically started in ICU; see chart below
CentriMag: no specific antiplatelet therapy is required (unless required for concomitant disease states)
HMII: not routinely started. Monitor platelet aggregation studies (light transmittance aggregometry and PFA 100) in stable patients no sooner than 14 days post-device implantation (if arachidonic acid activity >50% begin aspirin 81mg three times per week (monday, wednesday, friday)
TAH: start on POD1 and onward if platelets >50,000 and chest tube output <30mL/hr for 4 consecutive hours. Monitor platelet aggregation studies (light transmittance aggregometry and PFA 100) in stable patients no sooner than 14 days post-device implantation; maintain arachiodonic acid activity <50%
Impella: no specific antiplatelet therapy is required (unless required for concomitant disease states)
General Rules
Aspirin
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given within the first 24 hours
Beta-Blockers (once off pressors for several hours)
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metoprolol succinate (sustain release, slow)
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metoprolol tartrate (twice per day)
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carvedilol (coreg)
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labetalol
Atorvastatin
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20, 40, or 80mg PO at bedtime


ENTRESTO (sacubitril/valsartan)
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PARADIGM-HF trial
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ARNI (angiotensin receptor-neprilysin inhibitor); neprilysin
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becareful to use in patient with history of angioedema
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angiotensin II receptor blocker indicated for the treatment of chronic heart failure
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only medicine to show significant mortality benefit compared to Enalapril
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angiotensin receptor neprilysin inhibitor (ARNI) that reduces strain on the failing heart. It contains two active components known as sacubitril, a neprilysin inhibitor, and valsartan, an angiotensin receptor blocker
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inhibits neprilysin and blocks angiotensin II type-I receptor. It increases the levels of peptides that are degraded by neprilysin.
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Valsartan inhibits the effects of angiotensin II by blocking the AT1 receptor and by inhibiting the release of angiotensin II-dependent aldosterone
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follow BNP and proBNP
