week 2 (counseling points)

Bumetanide

counseling points

• dose conversion: furosemide = bumetanide 1 mg

furosemide

counseling points:

• furosemide IV: PO ratio 1:2

chlorothiazide

counseling points

• only thiazide available IV

nicardipine

counseling points

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

diltiazem

counseling points

• Atrial fibrillation/other arrhythmias (rate control)

• May worsen symptoms of HF; bradycardia

• side effects: constipation (more with verapamil than diltiazem), gingival hyperplasia

  
  

verapamil

counseling points

• indication: Atrial fibrillation/other arrhythmias (rate control)

• warnings: May worsen symptoms of HF; bradycardia

• side effects: constipation (more with verapamil than diltiazem), gingival hyperplasia

  
  

enalaprilat

counseling points

• BBW: Fetal toxicity, avoid in pregnancy

• Warnings: Angioedema

• side effects: cough hyperkalemia

• Notes: do not use within 36 hours of entresto

esmolol

counseling points

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

• Notes: 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/t

metoprolol

counseling points

• BBW: Do not discontinue abruptly

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

• Notes:Metoprolol tartrate IV is not equivalent to PO (IV:PO ratio is 1:2.5)

propranolol

counseling points

• 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.

• Notes: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

counseling points:

• 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): Commonly used IV agent for acute severe hypertension in pregnancy

hydralazine

counseling points:

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

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

nitroglycerin

counseling points:

• 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

counseling points

• BBW: Metabolism produces cyanide

• Warning(s): Increased intracranial pressure

• Note(s): Requires light protection during administration;

milrinone

N/A

dobutamine

counseling points

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

digoxin

counseling points

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

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

• Antidote: DigiFab

amiodarone

counseling points

• 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

counseling points:

• 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

counseling points:

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

adenosine

counseling points:

• Indication(s): Supraventricular re-entrant tachycardias.

• Note(s): Half-life <10 seconds.

atropine

counseling points:

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