hospital lab - quiz 2 counseling pts

bumetanide/Bumex

Note(s): Dose Conversion: furosemide 40 mg = bumetanide 1 mg

furosemide/Lasix

Note(s): Furosemide IV:PO ratio 1:2 (furosemide 20mg IV = furosemide 40mg PO)

chlorothiazide/Diuril

Note(s): Only thiazide available IV

nicardipine/Cardene

Warning(s): Hypotension (especially with severe aortic stenosis), nicardipine should not be used in advanced aortic stenosis

diltiazem/Cardizem

Warning(s): May worsen symptoms of HF; bradycardia;

Side effect(s): constipation (more with verapamil than diltiazem), gingival hyperplasia

verapamil

Indication(s): Atrial fibrillation/other arrhythmias (rate control)

Warning(s): May worsen symptoms of HF; bradycardia; increased LFTs

Side effect(s): Edema, constipation (more with verapamil than diltiazem), gingival hyperplasia

enalaprilat/Vasotec IV

BBW: Fetal toxicity, avoid in pregnancy

Warning(s): Angioedema,

Side effect(s): cough, hyperkalemia,

Note(s): Do not use within 36 hours of sacubitril/valsartan (Entresto)

esmolol/Brevibloc

Warning(s): Caution in pts with diabetes; can worsen hyperglycemia or hypoglycemia and mask hypoglycemic conditions. Caution in bronchospastic diseases (asthma and COPD) and Raynaud’s

Note(s): Ultra-short-acting IV beta-1 selective blocker. Effects usually resolve within 10–20 minutes after stopping the infusion; commonly used for rapid heart rate control and perioperative hypertension/tachycardia

metoprolol/Lopressor

BBW: Do not discontinue abruptly;

Warning(s): Caution in pts with diabetes; can worsen hyperglycemia or hypoglycemia and mask hypoglycemic conditions. Caution in bronchospastic diseases (asthma and COPD) and Raynaud’s

Note(s): Metoprolol tartrate IV is not equivalent to PO (IV:PO ratio is 1:2.5)

propranolol/Inderal

BBW: Do not discontinue abruptly;

Contraindication(s): Asthma

Warning(s): Caution in pts with diabetes; can worsen hyperglycemia or hypoglycemia and mask hypoglycemic conditions. Caution in Raynaud’s.

Note(s): High lipid solubility, crosses BBB, associated with more CNS side effects, but makes it useful for other conditions (migraine prophylaxis). Non-selective BBs are used in portal HTN

labetalol

BW: Do not discontinue abruptly;

Contraindication(s): Asthma

Warning(s): Caution in pts with diabetes; can worsen hyperglycemia or hypoglycemia and mask hypoglycemic conditions. Caution in Raynaud’s.

Note(s): Commonly used IV agent for acute severe hypertension in pregnancy.

hydralazine

Indication(s): Chronic hypertension, hypertensive emergency (off-label), HFrEF (off-label)

Warning(s): Drug-induced lupus erythematosus (DILE - dose and duration related)

nitroglycerin

Contraindication(s): SBP <90 mmHg, DO NOT USE in combination with PDE5 inhibitors

Note(s): MOA: low doses: venous vasodilator, high doses: arterial vasodilator.

Requires non-PVC container (e.g. glass bottle).

nitroprusside/Nipride

Warning(s): Increased intracranial pressure

Note(s): Requires light protection during administration;

dobutamine

Note(s): Dobutamine may turn slightly pink due to oxidation but potency is not lost

digoxin/Lanoxin

Note(s): Narrow therapeutic index (monitor digoxin level);

Toxicity: s/sx blurred/double vision, greenish-yellow halos signs of toxicity

Antidote: DigiFab

amiodarone/Nexterone

BBW: Pulmonary toxicity, hepatotoxicity; proarrhythmic effects. Amiodarone is used for life-threatening arrhythmias only.

Note(s): Infusions >2 hours require a non-PVC container. Use 0.22 micron filter. Antiarrhythmic drug of choice in heart failure. Very long half-life; numerous drug interactions.

procainamide

BBW: Potentially fatal blood dyscrasias (agranulocytosis). Long term use leads to positive antinuclear antibody (ANA) in 50% of patients, which can result in drug-induced lupus erythematosus (DILE) in 20-30% of patients

lidocaine/Xylocaine

Indication(s): Ventricular arrhythmias (refractory VT/ cardiac arrest)

adenosine

Indication(s): Supraventricular re-entrant tachycardias.

Note(s): Half-life <10 seconds.

atropine

Indication(s): Bradycardia, inhibition of salivation and secretions, organophosphate poisoning