Table 12. Selected Routine Medical Therapies
Indications
Dose/Administration
Beta-Receptor Antagonists
Oral:
Individualize:
• All patients without • Metoprolol tartrate
contraindication
25-50 mg every 6-12 h
IV:
orally, then transition over
• Patients with
next 2-3 d to bid dosing
refractory
of metoprolol tartrate
hypertension
or to daily metoprolol
or ongoing
succinate; titrate to
ischemia without
daily dose of 200 mg as
contraindication
tolerated
• Carvedilol 6.25 mg bid,
titrate to 25 mg bid as
tolerated
• Metoprolol tartrate IV
5 mg every 5 min as
tolerated up to 3 doses;
titrate to heart rate and BP
Avoid/Caution
Signs of HF
• Low output state
• Increased risk of
cardiogenic shock
• Prolonged first-degree
or high-grade atrioventricular (AV) block
• Reactive airways disease
ACE Inhibitors
For patients with
anterior infarction,
post-MI LV systolic
dysfunction
(EF ≤0.40) or HF
• May be given
routinely to all
patients without
contraindication
Individualize:
• Lisinopril 2.5-5 mg/d to
start; titrate to 10 mg/d or
higher as tolerated
• Captopril 6.25-12.5 mg
tid to start; titrate to
25-50 mg tid as tolerated
• Ramipril 2.5 mg bid to
start; titrate to 5 mg bid as
tolerated
• Trandolapril test dose
0.5 mg; titrate up to 4 mg
daily as tolerated
• Hypotension
• Renal failure
• Hyperkalemia
• Valsartan 20 mg bid to
start; titrate to 160 mg bid
as tolerated
• Hypotension
• Renal failure
• Hyperkalemia
• High-dose atorvastatin
80 mg daily
• Caution with drugs
metabolized via CYP3A4,
fibrates
• Monitor for myopathy,
hepatic toxicity
• Combine with diet and
lifestyle therapies
• Adjust dose as dictated
by targets for low-density
lipoprotein (LDL)
cholesterol and non-HDL
cholesterol reduction
ARB
For patients intolerant
of ACE inhibitors
Statins
All patients without
contraindications
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