Lauren Lacoursiere

PGY-2 Cardiology Pharmacy Resident 🫀@NorthwesternMed

[Maya Chilbert (Holsen) @MayaHolsen]

Is anyone else worried about cardiogenic shock when initiating a BB after ACS? Our study found low rates after PCI, even in those with anterior MI! Watch for elevated troponin as a potential risk factor for shock development. So proud of @llacours23 for her hard work! @UBPharm

[Lauren Lacoursiere @llacours23]

Thank you!!

I had so much fun sharing our research and learning about others! 🤓🫀💊

[Maya Chilbert (Holsen) @MayaHolsen]

So proud of all of our residents and students showcasing their research! @llacours23 @OliviaaDenny @Chelsea_barvian

[Lauren Lacoursiere @llacours23]

I’M GOING TO BE A PHARMACY RESIDENT 🥺

Beyond ecstatic to have matched with @NorthwesternMed 👩🏻‍⚕️💜

See you soon Chicago! 🌟

#RxMatchDay #MatchDay2023
@UBPharm

[Journal of Cardiovascular Pharmacology @JCVPOnline]

Early initiation of a beta-blocker in patients with STEMI and PCI with risk factors for cardiogenic shock does not appear to be associated with shock in most patients
https://t.co/XnAR01uwQq
@mayachilbert @llacourse23 @UBPharm

#pharmacology #medicine #cardiovascular #troponin

[Lauren Lacoursiere @llacours23]

Had so much fun presenting our project on beta-blocker use in STEMI patients with risk factors for cardiogenic shock 💊🫀

HUGE thank you to my mentor @MayaHolsen for the endless guidance and support you have given me over the past year ❤️

#ACCPGC22 #Cardiotwitter #twitteRx

[Lauren Lacoursiere @llacours23]

#OTILT

Coagulase-negative staphylococcus = #1 cause of cardiovascular implantable electronic device infections 🦠

Vancomycin (1st line) or daptomycin/linezolid/telavancin (2nd line options) 💊

Obtain 2️⃣ sets of blood cultures prior to initiating antibiotics‼️🧫

@MayaHolsen

[Lauren Lacoursiere @llacours23]

#OTILT

Vericiguat 💊

Patients w HFrEF optimized on GDMT but who have worsening HF (recent hospit/need for outpatient IV diuretics).

VICTORIA trial
- Primary outcome: composite of death from CV causes/HF hosp.
- Incidence among pts using vericiguat was lower

@MayaHolsen

[Lauren Lacoursiere @llacours23]

#OTILT

Anticoagulation & NSTEMI 🩸

Fondaparinux (a parenteral factor Xa inhibitor) can be used for the duration of hospitalization or until PCI is performed in patients with an NSTEMI.

Risk of catheter thrombosis w PCI: must give UFH/bivalirudin w Fondaparinux🚨

@MayaHolsen

[Lauren Lacoursiere @llacours23]

#OTILT

ISAR-REACT 5 Trial

Ticagrelor vs. prasugrel use in ACS 💊

Primary endpoint: composite of death, MI, or stroke at 1 year

Secondary endpoint: bleeding

The primary endpoint was significantly lower in those who received prasugrel w/o an ⬆️ in bleeding 🩸

@MayaHolsen

[Lauren Lacoursiere @llacours23]

#OTILT

HTN Emergency 🆘

In general: ⬇️ BP by 25% within the first 1-6hrs, then normalize within 24hrs

Lower BP ASAP:
1️⃣ Brain bleeds 🧠
2️⃣ Aortic dissection 🫀

Fun fact: Type A aortic dissections have a 5% mortality rate/hr ➡️ GET TO OR 🚨

@MayaHolsen

[Lauren Lacoursiere @llacours23]

#OTILT

🚨 Sumatriptan is contraindicated in patients with h/o CAD, coronary artery vasospasm, CVD, & PVD‼️

MOA: selective 5-HT (1B&1D) receptor agonist ➡️ vasoconstriction of cerebral/coronary vessels 🧠🫀

Use has been associated with MI and cardiac arrest 🛑

@MayaHolsen

[Lauren Lacoursiere @llacours23]

#OTILT

Acute VT Tx 🫀

💉Procainamide (1st line, thank you PROCAMIO trial)
💉IV sotalol
💉Amiodarone
- Stable w pulse: 150 mg bolus
- Pts w no pulse: 300 mg IVP
- Both followed by infusions,
1 mg/min x 6hrs
0.5 mg/min x18hrs

@MayaHolsen

[Lauren Lacoursiere @llacours23]

#OTILT

PRORATA Trial 🚨

Using procalcitonin levels to guide antimicrobial therapy can decrease a patient’s exposure to antibiotics 🦠💊

Non-specific like D-dimer:
(➖) = No infection
(➕) = Infection possible

Clinical application remains controversial 🤷🏻‍♀️

@MayaHolsen

[Lauren Lacoursiere @llacours23]

#OTILT

Class Ic anti-arrhythmics flecainide and propafenone are anticholinergic and can cause heart block 🫀🚫

The higher a patients HR, the tighter they bind.
✅ Good when used in Afib ➡️ rhythm control
❌ Bad when used in sinus tachycardia ➡️ Heart block

@MayaHolsen

[Lauren Lacoursiere @llacours23]

#OTILT

Potential candidates for ICD placement include patients with:

🫀An ACS event due to irreversible causes
🫀 HF (low ejection fraction) with other ECG changes
🫀 An MI and EF 35% or less (Life Vest 1st, then reassess after 45 days. ICD if EF still <35%)

@MayaHolsen

[Lauren Lacoursiere @llacours23]

#OTILT

CABG has better outcomes than stenting with:

Triple vessel disease 🫀
High-risk stenting ⚠️
Blockage in the left main artery + DM

P2Y12-I use = worse outcomes in CABG 🚨 Hold clopidogrel/ticagrelor 5 days before surgery, and prasugrel 7 days before ‼️

@MayaHolsen

[ACCP Cardiology PRN @accpcardprn]

#TBT Today's Spotlight: PLATO 🚨

- Patients with ACS +/- ST-elevation ❤️
- Ticagrelor vs. Clopidogrel 💊
- Ticagrelor significantly improved the primary composite outcome (9.8% vs. 11.7%) w/o ⬆️ bleeding

@NEJM #CardioTwitter

Creator: @llacours23 ⭐

https://t.co/ZLFp3X5Ipf

[Lauren Lacoursiere @llacours23]

#OTILT In HF it is useful to know a pt’s baseline BNP bc it can be helpful in determining whether or not they are experiencing an exacerbation. If they are fluid overloaded their BNP will ⬆️

Remember to get a new baseline BNP when starting Entresto‼️💊
#twitteRx
@MayaHolsen

[Lauren Lacoursiere @llacours23]

#OTILT using nitroprusside can result in cyanide toxicity and metabolic acidosis due to impaired oxidative phosphorylation, shifting the production of ATP to anaerobic metabolism. Routine ABG monitoring is necessary with use! ☠️🩸 #twitteRx @MayaHolsen