Study sets, textbooks, questions
Upgrade to remove ads
Chap 5 - Key Points and Black Box
Terms in this set (40)
Although indicated for the treatment of ______, doxazosin is not often used as a _____. It is more commonly used for the treatment of ___. Watch for signs of orthostatic ____ and signs of _____.
The extended-release formula is a nondeformable matrix that is expelled in the stool. Be cautious when using for patients with known ______ of the GI tract.
-hypertension; first-line agent; BPH; hypotension; dizziness
Although indicated for the treatment of ______, terazosin is not often used as a ______. It is more commonly used for the treatment of _____.
Monitor for orthostatic ........
-hypertension; first-line agent; BPH
-hypotension and signs of dizziness
Black Box Warning: ■ Must _____ concentrated epidural injectable (500 mcg/ml) solution prior to use. Epidural clonidine is not recommended for perioperative, obstetric, or postpartum pain due to risk of ______.
Clonidine is a very effective blood pressure-lowering agent. It is often added to other antihypertensive therapies in patients with _____. The risk of rebound hypertension is high if the patient ......
The transdermal route takes ____ days for full therapeutic effect.
Clonidine is commonly used for _____ other than the treatment of hypertension.
-dilute; hemodynamic instability
-resistant hypertension; discontinues clonidine abruptly
-2 to 3
-a variety of indications
Only indicated for use in patients with severely ______ and _____.
Its use in stable heart failure patients is associated with increased ____.
Concomitant administration of a beta blocker may decrease effectiveness of dobutamine in ______ as it relies on _____ for its MOA.
Close ____ monitoring is necessary
-decompensated heart failure; reduced cardiac output
-decompensated heart failure; beta-1 receptors
Black Box Warning: ■ If extravasation occurs, infiltrate area with _______ with a fine hypodermic needle. Phentolamine should be administered as soon as possible after extravasation is noted to prevent _____.
Dopamine is primarily used as adjunctive therapy in patients with ______. Doses used depend on the goal of therapy, and patient response varies, depending on the clinical situation.
Close ____ monitoring and dose adjustment is necessary
-diluted phentolamine; sloughing/necrosis
Epinephrine is used for a variety of acute indications, often in situations requiring ......
Its actions on _____ receptors result in effective treatment of _____.
Close _____ monitoring and dose adjustment is necessary when administering as ......
-alpha and beta; anaphylaxis, wheezing, and arrhythmias/circulatory shock
-hemodynamic; continuous infusion
Black Box Warning: ■ If extravasation occurs, infiltrate area with _____ with a fine hypodermic needle. Phentolamine should be administered as soon as possible after extravasation is noted to prevent _____.
Norepinephrine is used primarily to ____ in patients with ____.
Close ____ monitoring and dosage adjustment is necessary
-diluted phentolamine; sloughing/necrosis
-increase blood pressure; hypotension and shock
Phenylephrine is a potent _____ used intravenously in the treatment of _____. Oral formulations, often in combination with other ingredients, exist for treatment of ______.
Close _____ monitoring and dosage adjustment are necessary when administering as continuous infusion
The properties of phenylephrine administered intravenously compared with administration via other routes are so different that they resemble different drugs. The oral and nasal spray formulations of phenylephrine do have some _____, although their systemic effects are minimal compared with the ____.
Oral OTC preparations should be avoided in patients with hypertension, narrow-angle glaucoma, BPH;
use within ___ of MAOI therapy
-vasoconstrictor; hypotension and shock; congestion
-systemic absorption; IV form
-hypertension, narrow-angle glaucoma, BPH
Key Points for the Drug Class
ACE inhibitors are widely used for the treatment of ____.
Monitoring parameters should include renal function (serum creatinine), potassium, cough, angioedema, and blood pressure.
Those agents should not be used if ____.
-hypertension, HFrEF, and diabetic nephropathy.
-renal function (serum creatinine), potassium, cough, angioedema, and blood pressure.
The use of captopril is typically used for ____.
It is often limited to the inpatient setting because it is administered times a day
Other ACE inhibitors with more convenient dosing regimens (once or twice daily) are preferentially used
-urgent acute hypertension.
-Other ACE inhibitors with more convenient dosing regimens (once or twice daily) are preferentially used
Enalaprilat is a more potent activated form of ____ with an extended half-life that is administered via IV.
It should be used cautiously because it can decrease ____ precipitously for prolonged periods of time
Ramipril is also indicated to reduce the risk of ________ in patients who are at increased risk of those events.
myocardial infarction, stroke, and death from cardiovascular causes
Key Points for the Drug Class
ARBs are used widely for the treatment of cardiovascular diseases
They are often used in patients intolerant of _____ who have heart failure (candesartan, losartan, valsartan only)
What are the ARBs studied in this chapter?
Irbesartan, losartan, olmesartan, valsartan
Preferred ARB in patients with .....
Ranolazine is used for the treatment of chronic ____ symptoms. Because it does not affect _______, it is used when patients cannot tolerate other antianginal agents.
EKG must be monitored closely because the ____ can be prolonged
-angina; heart rate or blood pressure
Black Box Warning: ■ _____ is common, but is usually mild with evidence of only increased liver enzymes; severe liver toxicity can occur and has been fatal in a few cases. Amiodarone can exacerbate ______ by making them more difficult to ______. Pulmonary toxicity (hypersensitivity pneumonitis or interstitial/ alveolar pneumonitis and abnormal diffusion capacity without symptoms) may occur. Amiodarone is only indicated for patients with life-threatening arrhythmias because of risk of substantial _______. ______ should be tried first before using amiodarone. Patients should be _____ when amiodarone is initiated.
Although amiodarone is the most commonly used antiarrhythmic agent for atrial and ventricular arrhythmias, it should be reserved for patients with life-threatening arrhythmias because of ______
Patients should be hospitalized for initiation of therapy and need to be monitored and counseled appropriately to limit _____.
-Liver Toxicity; arrhythmias; tolerate or reverse; life threatening arrhythmias; drug-related toxicity; Alternative therapies; hospitalized.
Although digoxin is not a first-line choice, it is often used in the treatment of ______.
Digoxin has a narrow therapeutic index, and dosing must be adjusted for ______________. Appropriate monitoring of renal function and electrolytes is necessary to avoid toxicity.
_______ are typically not necessary for patients with heart failure
-symptomatic heart failure and atrial fibrillation
-renal function, weight, and heart failure status
● Black Box Warning: ■ Severe life-threatening ______ associated with QT interval prolongation. Do not initiate if baseline QTc interval is ______. If QTc interval prolongs to 500 msec or exceeds 500 msec during therapy, ______, ____ the interval between doses, _____ the duration of the infusion, or discontinue agent. Also, adjust dose based on _____.
Initiation of therapy and dosage adjustments should occur in a _______ with continual monitoring
____________ should not be substituted for each other
_______________ must be determined prior to initiation and monitored closely throughout therapy. Dosing adjustments should be made accordingly
_________________ should be corrected prior to initiation ●
Avoid use in patients with ______.
-ventricular tachycardia; QT prolongation; less than 450 msec; reduce the dose; prolong; prolong; discontinue; CrCl.
-Betapace and Betapace AF
- Renal function and QTc interval;
-Electrolyte abnormalities (hypokalemia, hypomagnesemia)
- heart failure
Atropine is a potent _______ used primarily in the management of _______.
Ophthalmic formulations are also commonly used to produce ____.
-anticholinergic agent; bradycardia/heart block
Close ______ monitoring and titration of dose is necessary
Beta Blockers - Key Points for the Drug Class
-Black Box Warning: ■ Abrupt withdrawal: Beta blockers should not be withdrawn abruptly (particularly in patients with coronary artery disease), but gradually ....
-Beta blockers are one of the most widely used cardiovascular agents because they are very effective for the treatment of many cardiovascular diseases. They are also used for some off-label uses not associated directly with .....
-_____________ have been shown to reduce morbidity and mortality in patients with HFrEF and should be used preferentially over other beta blockers in those patients
-When used in patients with heart failure, those medications should be initiated only in ___ patients or_____.
-_______ should be avoided in patients with ______ because they can lead to asthma exacerbations. Selective agents should be used cautiously.
-tapered to avoid acute tachycardia, hypertension, and/or ischemia
-Bisoprolol, carvedilol, and metoprolol succinate
-stable; hospitalized patients after volume status has been optimized
-Nonselective beta blockers; asthma;
Recommended for patients with HFrEF to reduce ______.
Conversion from immediate-release to extended release is not ...
Inhibits ____ receptors as well, unlike most other _____, which provides added _______.
-HFrEF; morbidity and mortality
-alpha-1; beta blockers; blood pressure lowering
Often used for hypertension and hypertensive emergencies, in part, due to the availability of an IV form
Labetalol is considered a drug of choice in patients presenting with hypertensive emergencies in the setting of ___________.
Labetalol is a preferred agent in the treatment of hypertension in pregnant patients, despite its pregnancy category ? status
Inhibits alpha-1 receptors as well, unlike most other beta blockers; however, the ratios of alpha- to beta blockade differ, depending on the route of administration: ____________
- ischemic stroke and subarachnoid hemorrhage
-1:3 (oral) and 1:7 (IV)
Only the _________ (metoprolol succinate) is recommended for use in patients with ______ to reduce ______.
When switching from immediate release (metoprolol tartrate) to extended release (metoprolol succinate), the same _______ of metoprolol should be used
When switching between oral and intravenous dosage forms, in most cases, equivalent beta-blocking effect is achieved with a _______ dosing ratio
-ER formulation; HFrERF; mortality
-Total Daily Dose
Propranolol is the beta blocker of choice for treatment of _______ because it is thought to ________
Propranolol is also used for the ______, although other beta blockers also are used
-thyroid storm; conversion of T4 to T3.
-treatment of performance anxiety and migraine prophylaxis
Diltiazem is used for the treatment of ____
It should be avoided in patients with _____ because it is a _____.
Extended-release formulations are either _______. Check with specific manufacturer recommendations
-hypertension, angina, and atrial fibrillation
-myocardial infarction and/or HFrEF; negative inotrope
-daily or twice-daily dosing
Key Points for the CALCIUM CHANNEL BLOCKERS, DIHYDROPYRIDINES
The dihydropyridine calcium channel blockers are used primarily for the treatment of _____. They also have a role in the treatment of chronic stable _____.
Immediate-release formulations of _____ are no longer recommended due to increased _____ compared with extended-release formulations, although both forms are still available
Use with extreme caution in patients with _____; may reduce ______, resulting in ______.
-severe aortic stenosis; coronary perfusion; ischemia
Amlodipine has a long half-life and, therefore, can be dosed .......
It is not an extended-release formulation and, therefore, can be ......
Peak antihypertensive effect is delayed due to long half-life; dosage titration should occur after _____ on a given dose
_____ is a dose-dependent side effect and more common in females and patients with heart failure
-7 to 14 days
The ______ formulation is not recommended for use. Serious adverse events (e.g., death, cerebrovascular ischemia, syncope, stroke, acute myocardial infarction, and fetal distress) have been reported. Considered contraindicated in patients with ______.
Extended-release formulations contain a nondeformable matrix, which is expelled in stool. Use caution in patients with a known ......
Nifedipine has _____ and may worsen ____.
-immediate-release formulation; ST-elevation myocardial infarction.
-stricture/narrowing of the GI tract
-negative inotropic effects; heart failure symptoms
Verapamil is used for the treatment of _________.
It should be avoided in patients with _______ because it is a .........
Patients must be counseled on the side effects, particularly ......
Dosing intervals vary based on the product
-hypertension and atrial fibrillation
-acute myocardial infarction and/or HFrEF; negative ionotrope
Black Box Warning: ■ Fluid/electrolyte loss: If given in excessive amounts, furosemide, similar to other loop diuretics, can lead to ....
Furosemide is commonly used to treat _____ in patients with ____.
Furosemide is the most commonly used ______, but sometimes, concerns regarding _______ necessitate use of other loop diuretics
Approximate dose equivalency for patients with normal renal function: Furosemide 40 mg PO = Furosemide 20 mg IV = bumetanide 1 mg IV/PO = torsemide 20 mg IV/PO = ethacrynic acid 50 mg IV/PO
Cross-reactivity between antibiotic sulfonamides and nonantibiotic sulfonamides is extremely low; however, _____ is the drug of choice in patients with a true allergy to loop diuretics because it does not contain a ____.
-profound diuresis, resulting in fluid and electrolyte depletion
-edema/fluid overload; heart failure
-loop diuretics; oral BioA
-ethacrynic acid; sulfonamide substituent.
Key Points for the Drug Class
Nitrates are the drug of choice for quick relief of ______ symptoms
They are also used for long-term prevention of angina symptoms. However, they are not recommended as firstline treatment in patients with recent .....
-myocardial infarction (beta blockers are preferred).
Used for long-term treatment of chronic _____
Sublingual tablets are used for the relief of angina attacks only. They are not used for ....
Sublingual tablets must be stored in original containers away from ....
Patients should not ____ sublingual tablets; they should just place under tongue and allow to dissolve
-long-term treatment of angina.
-humidity and moisture
Milrinone is commonly used for the treatment of ______ and ______
It increases ______ and is a potent _______. _____ must be monitored closely
Use is associated with ______; therefore, the benefit must outweigh the risk
Milrinone is the preferred ______ (over dobutamine) for patients also receiving _____.
-acute decompensated HF and end-stage HF.
-cardiac output; vasodilator; Blood pressure
- increased risk of arrhythmias/ mortality
-inotrope; beta blockers
Key Points ● Black Box Warning: ■ Tumorigenic: Shown to be tumorigenic in chronic toxicity animal studies. Avoid unnecessary use.
Spironolactone is used as a diuretic in patients with cirrhosis of the liver. Use in those patients requires much higher dosing (up to 200 mg daily) than what is recommended in patients with heart failure (maximum 50 mg daily).
The main role of spironolactone in patients with ____ is to reduce _______ when used in combination with _____ and _____ or ____
Eplerenone is the preferred agent in patients who develop ______.
Patients must be monitored closely for ___________ because those could result in potentially fatal adverse effects (hyperkalemia-induced arrhythmias)
- diuretic; higher dosing; heart failure
-HFrEF; morbidity; mortality; beta blockers; ACEIs or ARBs
-hyperkalemia and renal dysfunction
The thiazide diuretics are recommended as ....
They can also be used for edema; however, they often only work for mild edema, and a _____ is often required for more severe edema associated with heart failure
The 50-mg dose of hydrochlorothiazide has increased adverse effects without ______ and should generally be avoided
-first-line in the treatment of hypertension
● Black Box Warning: ■ Cyanide toxicity: Except when used briefly or at low (< 2 µg/kg/minute) infusion rates, nitroprusside gives rise to large cyanide quantities. Do not use the maximum dose for more than 10 minutes; if blood pressure is not controlled by the maximum rate (i.e., 10 µg/kg/minute) after 10 minutes, discontinue infusion. Monitor for cyanide toxicity via acid-base balance and venous oxygen concentration; however, clinicians should note that those indicators may not always reliably indicate cyanide toxicity. ■ Hypotension: Excessive hypotension, resulting in compromised perfusion of vital organs may occur; continuous blood pressure monitoring by experienced personnel is required ■ Appropriate administration: Solution must be further diluted with 5% dextrose in water. Do not administer by direct injection
Nitroprusside is a very effective antihypertensive and vasodilator. Its _______ allow for immediate effects and ______.
Severe toxicities are associated with increased dose and prolonged use. Therefore, transition to oral therapy should occur ________ (avoid infusions > 72 hours).
-fast onset and short half-life; close titration of dose
Hydralazine is typically reserved for the treatment of ______. It is also used for the treatment of heart failure in combination with nitrate therapy
Duration of blood pressure effects may vary, depending on _____ (i.e., slow, intermediate, or rapid metabolism) of patient, which could result in either prolonged hypotension or a lack of therapeutic response
_______ may be an issue because it must be taken multiple times a day
Hydralazine is a classic example of a drug that causes ______. This adverse effect abates with discontinuation
Sets found in the same folder
Chap 3 - Key Points and Black Box Warning
Chap 6 - Review
Chap 10 - Review
Chap 3 - Review Questions
Other sets by this creator
Chap 10 - Key Points
Chap 10 - MDI
Chap 10 - ADRs
Chap 10 - Usages/Indications
Other Quizlet sets
Alteration in Metabolism/Endocrine Disor…
LS. 1.10 : Basic Concepts, Equations and Double En…
Article Quiz 5 - Racism and Ethnic Prejudice Artic…