■ Carbamezapine (Tegretol) and phenytoin (Dilantin): monitor blood levels.
■ Levothyroxine: monitor TSH.
■ Lithium: monitor blood levels, TSH (risk of HYPOthyroidism).
Beers Criteria - CORRECT ANSWER Antipsychotics: Quetiapine, clozapine, and pimavanserin may be
used with caution.
Rivaroxaban and dabigatran: Higher bleeding risk than warfarin and other direct oral anticoagulants.
Tramadol: Risk of hyponatremia from syndrome of inappropriate antidiuretic hormone secretion.
,Opioids: Do not combine with benzodiazepines or gabapentinoids, as they increase the risk of severe
respiratory depression.
s/sx of digoxin toxicity - CORRECT ANSWER Initial symptoms are GI (nausea/vomiting), hyperkalemia,
and bradydysrhythmias (atrioventricular [AV] blocks) or tachydysrhythmias (ventricular
tachycardia/fibrillation or atrial tachycardia with 2:1 block). Others include confusion and visual changes
(yellowish-green-tinged color vision).
Digoxin therapeutic range - CORRECT ANSWER 0.5-2 mg
Warfarin INR range issues - CORRECT ANSWER Consistently Stable INR
Check every 2 to 4 weeks up to every 12 weeks.
Single Out-of-Range INR
If patient has stable INR and has a single out-of-range INR ≤0.5 below or above therapeutic INR (2-3),
experts suggest continuing current warfarin dose; retest INR within 1 to 2 weeks.
INR <5 With No Significant Bleeding Risk
Omit one dose and/or reduce maintenance dose slightly; recheck INR.
DOACs: Antidotes - CORRECT ANSWER idarucizumab and andexanet alfa: reverse the anticoagulant
effects of dabigatran and FXa inhibitors, respectively. Fresh frozen plasma and prothrombin complex
concentrate can also be used for rapid reversa
2017 ACC/AHA stages of hypertension - CORRECT ANSWER Normal BP: Systolic <120 mmHg and
diastolic <80 mmHg
Elevated BP: Systolic 120 to 129 mmHg and diastolic <80 mmHg
Stage 1: Systolic 130 to 139 mmHg or diastolic 80 to 89 mmHg
Also loop diuretics contraindicated with sulfa allergy
, Patients with both ____, and ______ receive an extra benefit from thiazides. - CORRECT ANSWER
hypertension, osteoporosis
Potassium sparing diuretics black box warning - CORRECT ANSWER Hyperkalemia, which can be fatal;
higher risk with renal impairment, diabetes, elderly, severely ill
With severe__________ disease, all ACEIs, ARBs, and aliskiren are contraindicated because of high risk
of hyperkalemia. - CORRECT ANSWER renal /CKD
Loop Diuretics Adverse Effects - CORRECT ANSWER Electrolytes (hypokalemia, hyponatremia,
hypomagnesemia, and low levels of chlorine)
Hypovolemia and hypotension (dizziness, lightheadedness)
Pancreatitis, jaundice, and rash
Ototoxicity (worsens aminoglycoside ototoxicity effect if combined)
-Don't give to person w/ resp illness including asthma, emphysema, chronic bronchitis
-If block beta 2 receptors → causes bronchoconstriction, increased airway resistance → creates bigger
problem than already have if resp problem
Beta blockers will blunt the _________ effect, warn diabetics. - CORRECT ANSWER Hypoglycemic
Alpha blockers - CORRECT ANSWER Terazosin (Hytrin): Can lower BP and treat BPH
Doxazosin (Cardura): Can lower BP and treat BPH
Tamsulosin (Flomax): For BPH treatment
Alfuzosin (Uroxatral): For BPH treatment
Silodosin (Rapaflo): For BPH treatment
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