ABLE III Quiz 3 Monitoring Parameters

Nebivolol Monitoring Parameters

Efficacy Monitoring Parameters. Decreased BP and HR.

Toxicity Monitoring Parameters. Decreased HR, bronchospasm, blood glucose levels in diabetic patients.

Niacin Monitoring Parameters

Efficacy Monitoring Parameters. Reduction in total cholesterol, LDL, and triglycerides levels; increase in HDL.

Toxicity Monitoring Parameters. Signs/symptoms of rhabdomyolysis (myalgias, dark urine, arthralgias, fatigue), yellowing of eyes or skin, severe abdominal pain, monitor LFT, CBC; serum creatine kinase if muscle pain occurs, FBG or HbA_1c, uric acid.

Nifedipine Monitoring Parameters

Efficacy Monitoring Parameters. BP, reduction in chest pain, decreased number of angina attacks, reduction in use of nitroglycerin to relieve chest pain.

Toxicity Monitoring Parameters. Signs/symptoms of peripheral edema, angina, tachycardia, heart failure.

Nitroglycerin Monitoring Parameters

Efficacy Monitoring Parameters. Decreased use of sublingual nitroglycerin to treat anginal episodes, reduction in angina episodes, reduction in anginal pain.

Toxicity Monitoring Parameters. Signs/symptoms of hypotension, problematic headaches, or decreasing efficacy (drug tolerance). BP and HR.

Olmesartan Monitoring Parameters

Efficacy Monitoring Parameters. Decreased BP.

Toxicity Monitoring Parameters. Report signs/symptoms of hypotension. Baseline and periodic potassium, SCr, prior to initiating therapy and periodically thereafter.

Omega-3-Ethyl Esters Monitoring Parameters

Efficacy Monitoring Parameters. Reduction in triglyceride levels.

Toxicity Monitoring Parameters. LDL, LFTs.

Prasugrel Monitoring Parameters

Efficacy Monitoring Parameters. Stent patency and prevention of clotting.

Toxicity Monitoring Parameters. Monitor for signs and symptoms of bleeding. Consider periodic hematocrit/hemoglobin, as well as platelet function testing.

Pravastatin Monitoring Parameters

Efficacy Monitoring Parameters. Baseline fasting lipid panel (total cholesterol, LDL, HDL, and triglycerides), repeat 4-12 wk after initiation or dose adjustment.

Toxicity Monitoring Parameters. Signs/symptoms of rhabdomyolysis (myalgias, dark urine, arthralgias, fatigue) or hepatotoxicity; LFTs at baseline and if concern for hepatotoxicity; check serum creatine kinase in patients experiencing myopathy.

Propranolol Monitoring Parameters

Efficacy Monitoring Parameters. Decreased BP, chest pain, number of angina attacks, nitroglycerin use, signs/symptoms of CHF, reduction in tremors, frequency of migraines.

Toxicity Monitoring Parameters. Signs/symptoms of CHF, decreased HR, bronchospasm, increased FPG, exacerbations of angina pectoris, or acute coronary insufficiency. Monitor HR and BP.

Quinapril Monitoring Parameters

Efficacy Monitoring Parameters. BP, signs/symptoms of heart failure.

Toxicity Monitoring Parameters. Signs/symptoms of angioedema, persistent dry cough, hypotension; monitor baseline and periodic electrolytes, SCr, BUN, urine protein.

Ramipril Monitoring Parameters

Efficacy Monitoring Parameters. BP, progression of heart failure.

Toxicity Monitoring Parameters. Angioedema (swelling of the face, eyes, lips, tongue, or throat), persistent dry cough, hypotension; baseline and periodic potassium, SCr, BUN, and urine protein.

Ranolazine Monitoring Parameters

Efficacy Monitoring Parameters. Improvement in angina symptoms, improved exercise tolerance.

Toxicity Monitoring Parameters. Baseline and follow-up ECG to evaluate QTc if concerns for prolongation; monitor BP and renal function at baseline and periodically.

Rivaroxaban Monitoring Parameters

Efficacy Monitoring Parameters. Prevention of clotting or recurrence of clotting. Routine monitoring of anticoagulation tests is not necessary with rivaroxaban. If used, anti–Xa activity is the preferred test.

Toxicity Monitoring Parameters. Signs and symptoms of bleeding, renal function for potential dose adjustment, CBC, vital signs.

Rosuvastatin Monitoring Parameters

Efficacy Monitoring Parameters. Total cholesterol, LDL-cholesterol, and triglycerides levels; HDL-cholesterol levels.

Toxicity Monitoring Parameters. Signs/symptoms of rhabdomyolysis (myalgias, dark urine, arthralgias, fatigue) or hepatotoxicity; LFTs should be performed at baseline, 12 wk after initiation of therapy, and every 6 mo thereafter; serum creatine kinase should be measured in patients experiencing muscle pain and in those receiving other drugs associated with myopathy.

Sacubitril/Valsartan Monitoring Parameters

Efficacy Monitoring Parameters. Decreased BP, signs/symptoms of heart failure.

Toxicity Monitoring Parameters. Signs/symptoms of hypotension, tachycardia, angioedema (swelling of the face, eyes, lips, tongue, or throat), hyperkalemia (confusion, body weakness, uneven heartbeat, or numbness/tingling in hands or feet), reduction in urination, jaundice, or skin rash. Monitor vital signs, weight, LFTs.

Simvastatin Monitoring Parameters

Efficacy Monitoring Parameters. Reduction in total cholesterol, LDL-cholesterol, and triglycerides levels; increase in HDL-cholesterol levels. Obtain baseline lipid panel, fasting lipid panel 4-12 wk after initiation of therapy and every 3-12 mo thereafter.

Toxicity Monitoring Parameters. Obtain baseline LFTs, SCr, and BUN. Repeat LFTs if signs of hepatotoxicity (fatigue, abdominal pain, yellowing of skin, or sclera). Consider CPK in patients with symptoms of myopathy (pain cramping, weakness).

Spironolactone Monitoring Parameters

Efficacy Monitoring Parameters. Decreased BP, reduction in edema, weight.

Toxicity Monitoring Parameters. Monitor SCr, potassium levels, ECG if symptoms of hyperkalemia occur.

Terazosin Monitoring Parameters

Efficacy Monitoring Parameters. Decreased BP, improvement in obstructive urinary symptoms.

Toxicity Monitoring Parameters. Sign/symptoms of hypotension, increased HR, LFTs.

Ticagrelor Monitoring Parameters

Efficacy Monitoring Parameters. Prevention of thrombotic events.

Toxicity Monitoring Parameters. Signs/symptoms of bleeding, especially with concomitant anticoagulant therapy.

Tiotropium Monitoring Parameters

Efficacy Monitoring Parameters. Monitor pulmonary function tests, shortness of breath.

Toxicity Monitoring Parameters. Seek medical attention if severe anticholinergic side effects occur, including bladder obstruction, narrow-angle glaucoma, prostatic hyperplasia, and urinary retention or difficulty.

Tolvaptan Monitoring Parameters

Efficacy Monitoring Parameters. If using for hyponatremia, monitor serum sodium levels carefully; normalization of serum sodium. If using for autosomal dominant polycystic kidney disease, monitor SCr.

Toxicity Monitoring Parameters. Monitor for dehydration, serum electrolytes, neurologic status, signs and symptoms of syndrome of inappropriate antidiuretic hormone secretion. Monitor LFTs and discontinue if increased.

Torsemide Monitoring Parameters

Efficacy Monitoring Parameters. Decreased BP, increased urine output, reduction in edema, daily weights. For treating renal failure, increase in urine volume, CrCl, BUN, and electrolytes.

Toxicity Monitoring Parameters. Severe volume depletion can occur. Monitor serum and urine electrolytes, uric acid, and blood glucose at baseline and every 3-6 mo after therapy.

Triamterene/Hydrochlorothiazide Monitoring Parameters

Efficacy Monitoring Parameters. Decreased BP, reductions in edema.

Toxicity Monitoring Parameters. Altered serum and urine electrolytes (calcium, magnesium, potassium, sodium), decreased renal function (increased SCr or decreased urine output), increased serum uric acid or blood glucose. Seek medical attention if skin rash, yellowing of eyes or skin, decreased urine output, or symptoms of gout occur.

Varenicline Monitoring Parameters

Efficacy Monitoring Parameters. Abstinence from tobacco.

Toxicity Monitoring Parameters. Mental status changes.

Valsartan Monitoring Parameters

Efficacy Monitoring Parameters. Decreased BP, signs/symptoms of heart failure, decreased proteinuria

Toxicity Monitoring Parameters. Signs/symptoms of hypotension, tachycardia, angioedema (swelling of the face, eyes, lips, tongue, or throat), hyperkalemia (confusion, body weakness, uneven heartbeat, or numbness/tingling in hands or feet), reduction in urination, jaundice, or skin rash. Monitor vital signs, weight, LFTs.

Verapamil Monitoring Parameters

Efficacy Monitoring Parameters. Decreased BP, improvement in HR and rhythm, reduction in chest pain, decreased number of weekly angina attacks, reduction in use of nitroglycerin for chest pain.

Toxicity Monitoring Parameters. Signs/symptoms of heart failure, decreased HR, signs/symptoms of liver toxicity. Exacerbations of angina pectoris or acute coronary insufficiency; while tapering chronic therapy, especially in patients with ischemic heart disease. Monitor LFTs, ECG, and vital signs.

Warfarin Monitoring Parameters

Efficacy Monitoring Parameters. Measure initial INR after the first 2-3 doses and subsequently at intervals no longer than every 4 wk, once stable dose has been achieved; may monitor every 12 wk in stable patients, use clinical judgment; patients at high risk of bleeding require more frequent monitoring. INR target and therapeutic range depend on indication. Atrial fibrillation/atrial flutter: target 2.5 (range 2-3); prosthetic heart valves: target 2.5 (range 2-3); mechanical mitral or aortic valve: target 3 (range 2.5-3.5); AMI, ST-segment elevation: target 3 (range 2.5-3.5, with aspirin); venous thromboembolism, prophylaxis and treatment (including PE, DVT, hip/knee arthroplasty): target 2.5 (range 2-3).

Toxicity Monitoring Parameters. Signs/symptoms of bleeding, CBC, LFT, stool guaiac test.