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The Macstrak Project

Medication Classification. The Macstrak Project. Issues. Macstrak follows drug interventions by drug class rather than the specific agent (e.g. B blocker po rather than metoprolol) to get reliable data first need to ensure understanding of where data captured on Macstrak form

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The Macstrak Project

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  1. Medication Classification The Macstrak Project

  2. Issues • Macstrak follows drug interventions by drug class rather than the specific agent (e.g. B blocker po rather than metoprolol) • to get reliable data first need to ensure understanding of where data captured on Macstrak form • need to know proper drug classes • need to know the generic as well as trade names • accuracy in form completion improves as staff become more comfortable with knowing the drug classes • teaching resources available for staff on Macstrak website The Macstrak Project

  3. In this presentation • Review – where data collected on Macstrak forms • Understand – description of each drug class • Review– tables of generic versus brand name • Learn – resources available for on-going support The Macstrak Project

  4. YesThrombolysis Here EMS Other Hosp Dose:(mg/units) Duration:(min) Pt.Weight:(kg) Review - Macstrak Form Reperfusion Therapy: NoNot Indicated: ECG Not Diag. ST Up Transient Too Late Given (Other Hosp) Risk:  Risk of ICB Risk Other Bleed Other: ……………...... YesThrombolysis Here EMS Other Hosp Drug:TNK/rtPA SK r-PA (reteplase) Other Adjuvant: ASA Heparin GP2b/3a Inhibitor  blocker IV Clopidogrel Other ............................... and/orPrimary/Rescue PCI Here Transfer Reperfusion Therapy Decided by: EP Consultant Dose:(mg/units) Duration:(min) Pt.Weight:(kg) Three sections where medications tracked on the CCU form: 1. ACS Initial Management – Adjuvant Therapy The Macstrak Project

  5. Diuretics……………………… Inotropes IV………………….. ETT/Vent…………………….. PA Line………………………. TTVP………………………… IABP…………………………. ACS: RSCP - Ischemia – Definite…. – Probable… CK (+ve)………………...…… Troponin (+ve)……………….. NTG IV………………………. Heparin – UFH……………..... – LMWH……………. Other Antithrombin………...… GP 2b/3a Inhibitor IV……...… Clopidogrel (or thienopyridne)..… Cardiac Cath……………….... PCI…………………………... Outcomes: VF/Sustained VT………….… Infarction (new/repeat)*(1) …... Thrombolysis (new/repeat)*(2).. Stroke*(3) ……………………. Major Bleed*(4) ……………… Transfusion………………….. Crs1: ……………………….... Crs2: ……………………..….. None of the Above……….….. RN Initials ………………..…. Review - Macstrak Form Date: • Three sections where medications tracked on the CCU form: • ACS Initial Management – Adjuvant Therapy • Course in CCU D N D N N D Acuity: Shift: None of the Above needs to be marked if no medication/treatments are given – lets us know that the information is not missing. The Macstrak Project

  6. Review - Macstrak Form • Three sections where medications are tracked on the CCU form: • ACS Initial Management – Adjuvant Therapy • Course in CCU • CCU Discharge Discharge Meds: ASA Clopidogrel (thienopyridine) Heparin (UF or LMW) Nitrates (po/top) B Blocker ACEI A2 Blocker Statin None of the Above None of the Above needs to be marked if no medication is given – lets us know that the information is not missing. The Macstrak Project

  7. Review - Macstrak Form ACS Management: (all) • One section where medications are tracked on the ER form: • Course in ER ASA Heparin UFH Heparin LMWH Clopidogrel (thienopyridine) GP2b/3a Inhibitor IV Other Antithrombin NTG IV NTG topical/po b Blocker IV b Blocker po None of the Above needs to be marked if no medication is given – lets us know that the information is not missing. Calcium Antagonist (any) ACEI A2 Blocker Research Protoc ol None of the Above Optional fields are available to track specific medications if your unit wishes. The Macstrak Project

  8. Drugs: PTA PTW Ward Disch ASA ……………………………………………………. Coumadin ………………………………………. Heparin UFH ……………………………. Heparin LMWH ………………………… Clopidogrel (thienopyridine) ……..……. GP 2b/3a Inhibitor (IV) …………… Other Antithrombin …….…………… Oral Hypo glycemic ………………… Insulin ………………………………………………. Statin …………………………………………………. Other Antilipid …………………………... Bronchodilator …………………………… Digoxin …………………………………… ………. Any Antiarrhythmic ………………. Calcium Antag …………………………… ACEI .…………………………………………………… A2 blocker ………………………………………. Other Vasodilator ……...………………. Diuretic ……………………….……………………... Nitrates top/oral ………………………….. Nitrates IV ……………………………….……... b Blocker - Any …………………………... b Blocker - Carvedilol …………... Study Drug - antiplatelet …... - antithrombin . - other …………………. Smoking ………………………………………….. ……………………………..….. HRT ……………………………………………………. ……………… ……………..….. Optional Fields: Crs1: …………………………….. Crs2: …………………………….. Crs3: …………………………….. Crs4: …………………………….. None of the Above ………………….. RN Initials …………………………………….. Review - Macstrak Form • One section where medications are tracked on the Ward form: • Course in Ward Optional fields are available to track specific medications if your unit wishes. None of the Above needs to be marked if no medication is given – lets us know that the information is not missing. The Macstrak Project

  9. Thienopyridines - What & How • oral anti platelet therapy • indications: • ACS • stents • aspirin is not tolerated • dual anti platelet therapy desired • ADP-receptorantagonist • binds irreversiblyto P2Y12 receptors, modify the plateletP2Y12 receptor therefore ADP can’t bind to it • reduces platelet aggregationthat persists for the life of the platelets The Macstrak Project

  10. Thienopyridines -Who * Drug has not yet come to market. The Macstrak Project

  11. GP2b/3a inhibitors -What anti platelet therapy IV indications: ACS PCI final step in platelet aggregation - binding of fibrinogen between two platelets at the GP2b/3a receptor, inhibitors block this final pathway, decreasing platelet aggregation regardless of the mechanism by which the platelets are activated issue for all these therapies has been determining effective dosing The Macstrak Project

  12. GP2b/3a inhibitors - How The Macstrak Project

  13. GP2b/3a inhibitors - Who The Macstrak Project

  14. UF Heparin - What & How antithrombin indications: ACS atrial fibrillation deep vein thrombosis pulmonary embolism UF Heparin binds to the enzyme inhibitor antithrombin (AT) causing a conformational change that results in its activation through an increase in the flexibility of its reactive site loop activated AT then inactivates thrombin, with also a lesser effect on factor Xa The Macstrak Project

  15. LMW Heparins - What & How antithrombin indications: ACS atrial fibrillation deep vein thrombosis pulmonary embolism sub group of proteins included in UFH although all different protein groups - they have a greater effect on anti factor Xa PT/PTT cannot be used to follow they are not bound to acute phase reactants therefore dose response is more predictable The Macstrak Project

  16. Heparins - Who The Macstrak Project

  17. mostly direct thrombin inhibitors but a variety of targets indications: heparin-induced thrombocytopenia (HIT) PCI ACS most are intravenous only exception coumadin new oral agents in development Other Antithrombins–What & How The Macstrak Project

  18. Other Antithrombins - Who * Drug has not yet come to market. The Macstrak Project

  19. β-blockers - What & How beta (alpha) adrenergic receptor antagonists indications: arrhythmias AMI cardioprotection decrease incidence of occlusion events fight or flight  block the action of endogenous catecholamines (epinephrine – adrenalin and norepinephrine – noradrenaline) on β-adrenergic receptors part of the sympathetic nervous system cardioprotection, management of cardiac arrhythmias, blocks activation of clotting system reduces the sympathetic activation of platelets, and the clotting system (PAI-1) The Macstrak Project

  20. β-blockers - Who The Macstrak Project

  21. ACE inhibitors - What Angiotensin-Converting Enzyme inhibitor decreasing the activation of the renin/angiotensin system indications: prevention of cardiovascular events CHF hypertension left ventricular dysfunction Reduces PAI-1 levels to decrease clot formation reduces afterload, lowers arteriolar resistance, decreases cardiac work and oxygen demand lowers renovascular resistance, increases natriuresis (excretion of sodium in urine) The Macstrak Project

  22. ACE inhibitors - How The Macstrak Project

  23. ACE inhibitors - Who The Macstrak Project

  24. A2 blockers - What & How angiotensin receptor blocker indications: hypertension - intolerance to ACE inhibitors modulate the renin-angiotensin-aldosterone system by blocking activation of angiotensin II AT1 receptors  causes vasodilation effects are similar to ACEI but no cough as do not inhibit the breakdown of bradykinin or other kinins The Macstrak Project

  25. A2 blockers - Who The Macstrak Project

  26. Statins - What & How cholesterol lowering agent - reduces inflammation indications: reducing LDL cholesterol ACS secondary prevention CAD primary prevention high-risk groups statins block an enzyme (HMG-CoA reductase) involved in producing cholesterol within liver cells stimulates LDL receptor  results in an increased clearance of low-density lipoprotein (LDL) from the bloodstream and a decrease in blood cholesterol levels The Macstrak Project

  27. Statins - Who The Macstrak Project

  28. Diuretics - What & How • Increase natriuresis – renal excretion of sodium • indications: • heart failure • hypertension • act at a variety of targets within the nephron • each class has a different specific mechanism of action, but typically share outcome of changing the way the kidneys handle salt - inhibit sodium re-absorption lowering blood pressure and cardiac workload The Macstrak Project

  29. Diuretics - Who The Macstrak Project

  30. Nitrates - What • vasodilation - venous • indications: • AMI • ischaemic heart disease • heart failure • pulmonary edema • hypertension • increase venous capacitance  reduces venous return, reducing preload • dilate coronary blood vessels  improves O2 supply to the myocardium • dilate peripheral arteries  reduces afterload and work done by the heart The Macstrak Project

  31. Nitrates - How The Macstrak Project

  32. Nitrates - Who The Macstrak Project

  33. Inotropes - What & How • positive inotropic agents increase myocardial contractility • indications: • cardiogenic shock - hypotension • AMI • CHF • effects are dose-dependant • increases cardiac output and blood pressure The Macstrak Project

  34. Inotropes - Who The Macstrak Project

  35. Calcium Antagonists - What & How • negative inotropic effect - decreases myocardial contractility, increases vasodilation • indications: • hypertension • angina • atrial fibrillation/flutter • block volt-gated calcium channels in muscle cells – calcium levels drop – less muscle contraction • Decrease blood pressure, reduces afterload decreasing amount of oxygen required by heart • does not decrease the responsiveness of the heart to input from the sympathetic nervous system The Macstrak Project

  36. Calcium Antagonists - Who The Macstrak Project

  37. Resources The following are ways to ensure staff knowledge of drug classifications and drug penetrance is at suggested guideline levels: Macstrak unit manual – make available at nursing station – available on website Medication List – post in rooms or nursing station – available on website Macstrak Quarterly or Macstrak Nursing News – available on website Reports – review penetrance Audits – Project Office will notify coordinator if on-going issues The Macstrak Project

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