Exam 1 Flashcards
1
Q
Menarche
A
The start of menstruation, ends at menopause
2
Q
What does estrogen do in CHC
A
Prevents: Formation of dominant follicle, ovulation, LH surge
Stabilizes uterine endometrium
Inhibits proliferation and secretory changes
Decreases irregular/heavy menstruation
3
Q
Where is mestranol used in CHC
A
Used in older products or ones with high concentrations of estrogen (higher doses only in certain cases)
4
Q
Preferrable dose of estrogen
What are other doses associated with (3)
What is preferred
A
Low!
Higher doses are associated with MI, VTE, and strokes
Low estrogen products with estradiol are preferred
5
Q
Progestin
A
Natural or synthetic with progesterone-like effects
Most are derivatives of testosterone
Balance estrogen effects
Make endometrium less favorable for implantation
Suppress LH surge, prevent ovulation and pregnancy
6
Q
Progesterone
A
Naturally occurring hormone produced in the ovaries
7
Q
Progestin in CHC (1st gen 3 examples and what to remember)
A
Norethindrone, norethindrone acetate, ethynodiol
ETHIN or ETHYN
8
Q
Progestin in CHC (2nd gen example)
A
Norethisterone and levonorgestrel (LNG)
MOST COMMON
9
Q
Progestin in CHC (3rd gen 3 examples, perks, and what to remember)
A
Desogestrel, gestodene, norgestimate
Higher efficacy, fewer effects on lipids and carb metabolism, fewer androgenic side effects
ESO or EST
10
Q
SE of increased estrogen in CHC (5)
A
cyclic breast changes (soreness and tenderness)
dysmenorrhea
menorrhagia (increased bleeding)
chloasma (hyperpigmentation of skin)
VTE (clots)
11
Q
SE of decreased estrogen in CHC (2)
A
Amenorrhea
Spotting
12
Q
SE of increased progestin in CHC (4)
A
Weight gain, depression, fatigue, decreased libido
13
Q
SE of decreased progestin in CHC (2)
A
breakthrough bleeding (between cycles)
headaches
14
Q
How can CHC be administered
A
Orally (most common)
Transvaginal and transdermal (not used for high-risk patients, but there is less N/V, heart and circulatory risks, and easier compliance?)
15
Q
Effectiveness of oral CHC
A
99.3% if completely correct
92% with typical use
16
Q
Advantages of oral CHC
A
Decreases blood loss, cramps, less pain on ovulation (mittelschmerz)
Reduction of ovarian cysts, benign breast disorders, pelvic inflammatory disease, ectopic pregnancy, endometrial and ovarian CA
17
Q
Monophasic (non-phasic) CHC
A
Fixed ratio of estrogen:progesterone
18
Q
Biphasic CHC and example
A
Fixed amount of estrogen but less progestin in beginning of cycle: this allows for normal physiologic process of menstruation without ovulation
Ex: ortho-novum
19
Q
Triphasic CHC, perk and 1 example
A
Low estrogen and progestin, ratios change during 3 phase in the cycle
LEAST SIDE EFFECTS BC LOW HORMONES
Ex. Ortho tri-cyclenLo (Also for acne)
20
Q
Four phasic CHC
A
Ratios change 4 times in cycle
21
Q
Yasmin
A
Monophasic pill with ethinyl estradiol and drospirenone (K+ sparing, hyperkalemia, vfib and v-tach)
22
Q
Yasmin contraindications
A
Contraindicated in liver, kidney, or adrenal insufficiency, NSAIDS, k+ sparing meds, ACE, ARBS
23
Q
Oral CHC pack
A
21 or 28 day packs (in the 28 day, 7 of them are empty or inactive)
Last 7 days are decreasing estrogen to cause withdrawal bleeding (not true menses)
24
Q
what does Loestrin FE do
A
Gives iron during withdrawal bleeding to prevent anemia
25
Mircette
2 days of Fe and 5 days low-dose estrogen to help prevent HA from estrogen withdrawal
26
Extended cycle products and 3 examples
shortened period of inactive pills reduces number of withdrawal bleeding days
Ex. Loestrin 24, YAZ, beyaz
YAZ and 24 because 24 hours in a day and days are long so it's a longer period of active pills idk
27
Continuous dosing products
Seasonale (jolessa): 91 days with 84 active days and 7 inactive. Withdrawal bleeding only 4x/year
Lybrel: 28 days with no withdrawal bleeding
28
Ortho-evra transdermal patch (where and how is it worn, advantages)
Worn on stomach, buttocks, outer arm, upper torso (fatty areas)
Worn for 3 weeks, 1 week off for withdrawal bleeding
Similar advantages to oral
29
Ortho-evra transdermal patch disadvantages and who shouldn't use it
skin irritation, menstrual cramps, change in vision or inability to wear contact lenses, not as effective in women over 198 lbs, weight gain or loss, nausea
Increased risk of VTE
Do not use women >35, smoke bc of constricted arteries and clots easily form
30
NuvaRing
2 inch indwelling ring with estrogen/progesterone
Inserted during first 5 days of menstruation
Indwelling for 3 weeks, removed for 1 for withdrawal bleeding
31
NuvaRing considerations
1st 7 days after insertion, use backup method
If it falls out, must be put in within 3 hours. If not, use backup for 7 days
Increased risk for: VTE, vaginal irritation, discharge or infection
Risks increased if pt smokes
32
Who uses progestin-only pills
Used for women who can't take estrogen:
History of VTE
Heart disease
Breast feeding (estrogen can be excreted in breast milk)
Smokers (Spasms of blood vessels)
Over 35
HTN
Or those who experience HA, chloasma, Lipid changes
33
Progestin pill side effects (5)
Higher incidence of irregular bleeding
Fatigue
Decreased libido
Depression/mood changes
Weight gain
34
Routes of progestin only (4)
Oral, IM, SQ, implantable
35
3 oral progestin only
Micronor, nor QD, aygestin
NOR or ends in estin just like progestin
36
injectable progestin only rules
depo-provera (depo=deep like an injectable)
Injected every 11-13 weeks (negative test needed for next injection)
Suppresses ovulation
If late injection, 13 weeks and one day must be ruled out for pregnancy
37
Progestin only considerations (injectable)
Stop after 2 continuous years (risk of decreased bone density)
Increase intake of Ca and vit d
38
Implantable progestin only
Nexplanon similar to implanon
Inserted for up to 3 years
Nexeplon contains barium which shows up on X-rays, US, CT, and MRI
Not used in women with BMI>30
39
What to do with 1-3 missed doses of BC
Missed 1: take as soon as you remember
Missed 2: take 2 when you remember and 2 the next day
Missed 3: discard pack, use backup, and restart
40
What hormone is in plan B
Progestin only
41
What does a copper-releasing IUD do
prevents implantation, not fertilization
42
Perimenopause S&S
Cycles can become longer or shorter, irregular, insomnia, hot flashes, irritability, H/A, memory lapse, decreased libido, vaginal dryness, joint aches and pain
43
Premarin
Conjugated estrogens
44
Indications of premarin and MOA
HRT for menopause symptoms
Mod-severe vasomotor symptoms of menopause, vaginal dryness/atrophy
MOA: develops and maintains female genital system, breasts, and secondary sex characteristics
45
Contraindications of premarin
Known drug allergy
Any estrogen dependent cancers
Undiagnosed abnormal vaginal bleeding
Pregnancy, lactation
Active thrombolytic disorder (Stroke, thrombophlebitis, hypercoagulable states, CVD, smokers)
46
Adverse effects of premarin
Most serious: thromboembolic events
Common: N/V/D/C, photosensitivity, HTN/thrombophlebitis, amenorrhea/breakthrough bleeding, chloasma/hirsutism/alopecia, tender breasts/fluid retention/HA
47
Interactions of premarin
Decreased activity of oral anticoagulants
Concurrent use of rifampin and St. John’s wort can decrease effectiveness
Use with tricyclic antidepressants (TCA) can cause toxicity of TCA
Smoking can increase risk of thrombosis
48
SSRI for menopause
Reduce severity of vasomotor symptoms, reduce depression, may relieve irritability, and mood changes
49
Clonidine for menopause
reduces vasomotor symptoms, sedative effect, must monitor BP (antihypertensive)
50
Gabapentin for menopause
May relieve vasomotor symptoms, should be limited to those who can not take HRT, may cause drowsiness
51
Soy, red clover, black cohosh for menopause
caution in who (2)
Helps decrease hot flashes. Caution with women who have breast cancer and liver disease
52
11 therapies for menopause
SSRI, clonidine, gabapentin, soy, red clover, black cohosh, Vit E, primrose, St. John’s wort, ginseng, melatonin
53
WHI and their opinion on HRT
Some ppl are having bad reactions so lets completely get rid of HRT. Oh wait, there's a pattern with the people who had bad reactions, ok nvm only SOME people get HRT
54
What do the testes do
produce male sex hormones
55
What happens in the seminiferous tubules
Spermatogenesis (mature sperm cells are produced)
56
Androgens
Primarily testosterone which is an anabolic steroid
Controls the development and maintenance of male primary and secondary sex characteristics
Decreases fat mass, helps with hair placement
57
Testosterone
Produced from interstitial cells between the seminiferous tubules
Androgenic activity
Anabolic activity
Involved in development of bone and muscle tissue
Inhibition of protein catabolism
Erythropoietic effects (produces RBCs)
58
Synthetic derivatives of testosterone
Improves pharmacokinetics/dynamics of endogenous hormone
Combined esters with testosterones, poor PO absorption
59
Uses of synthetic derivatives of testosterone
Decreased libido and fatigue due to low levels
60
Examples of synthetic derivatives of testosterone
Testosterone propionate: oily solution lasting 2-3 days, administered every 2-4 weeks
Methyltestosterone/fluoxymesterone: effective with oral administration, buccal tablet, or injectable
Transdermal forms: Gel and skin patches
61
Anabolic steroids
Possess high anabolic activity
Not used in US a lot bc of potential for misuse in muscle people
62
Indications of anabolic steroids
Anemia, hereditary angioedema, metastatic breast cancer, wasting syndrome due to HIV
Four products available in the US
Schedule III drug: can lead to psychological or physical dependence (DEA number needed)
63
4 names of anabolic steroids
Anadrol-50
Oxandrin
Winstrol
Nandrolone
64
Indications of testosterone (androgen)
Primary and secondary hypogonadism
Treatment of oligospermia
Inoperable breast cancer in women (relieving symptoms, not a cure)
65
Why are androderm and testoderm patches used
to mimic natural circadian cycles in males
66
Where are andro and testoderm patches applied
Androderm: not scrotal skin
testoderm: scrotal skin
67
Who shouldn't touch androderm patches and why
Children
Inappropriate enlargement of genitalia, premature development of pubic hair, advanced bone aging, increased libido, aggressive behavior
68
Nursing considerations of androderm patches
Baseline lab testing BUN/Cr, LFT, CE/s, lipids (MI or CVA)
Watch for weight gain or electrolyte disturbances
69
What do androgens maintain
Secondary health characteristics
70
When does BPH process start
30
71
MOA of 5-Alpha reductase inhibitor (Proscar) finasteride
Reduces prostate size by inhibiting the enzyme that converts testosterone to 5-alpha dihydrotestosterone (DHT)
Eases the passage of urine
72
What is 5-Alpha reductase inhibitor (Proscar) finasteride used for
BPH
73
Additional effects of 5-Alpha reductase inhibitor (Proscar)
May increase hair growth in men
teratogenic in pregnant women and children (Don't touch)
74
Indications of 5-Alpha reductase inhibitor (Proscar)
Androgenic alopecia in men
BPH shrinks prostate in 3-6 months
75
Contraindications of 5-Alpha reductase inhibitor (Proscar) (2)
Hypersensitivity
Pregnant women, category X
76
Examples and pattern of erectile dysfunction medications
Sildenafil (viagra), vardenafil (levitra), tadalafil (cialis)
Ending -afil
77
What does sildenafil (viagra) do
Inhibits the enzyme phosphodiesterase, causing the buildup of guanosine monophosphate, causing the relaxation of smooth muscle in the penis and permits inflow of blood
Nitric oxide is released inside the corpora cavernosa during sexual stimulation and contributes to the erectile effect
78
Indications of sildenafil (viagra)
Take 1 hour before intercourse
79
Contraindications of sildenafil (viagra)
Hypersensitivity
Can potentiate hypotensive effects of nitrates, avoid concurrent use
NO NITROGLYCERINS because of significant hypotension (vasodilator)
80
Adverse effects of sildenafil (viagra)
Hypotension
headache
Dyspepsia
Priapism (erection for >4 hours)
Visual loss
81
Oxytocin (Pitocin) use and mode of action
Use: To induce labor
MOA: increases uterine contractility
82
SE and AR of oxytocin (pitocin)
SE: HTN, dysrhythmias, hypercontraction of uterus
AR: Seizures, water intoxication
83
Terbutaline use and SE
Use: Decreases uterine contractions to stop preterm labor
SE: tachycardia in mother and fetus, SOB
84
Magnesium sulfate
Can be used for preterm labor to decrease contractions
may be safer than terbutaline because it increases blood flow to uterus (less tachy)
Can also be used for preeclampsia (high BP and proteinuria)
85
Cholinergic drugs (which part of the CNS)
Parasympathetic (rest and digest)
86
neurotransmitter of PNS
acetylcholine
CHOLINE for CHOLINErgic drugs
87
Direct acting cholinergic drugs
Stimulate postsynaptic nerve cell release of acetylcholine at the receptor site (agonists)
88
Indirect acting cholinergic drugs
has something helping it
inhibits acetylcholinesterase (breaks down acetylcholine)
89
cholinergic stimulation (GI and urinary)
frequent gastric secretions, mobility, urinary frequency (bladder contracts, sphincter relaxes)
90
Cholinergic stimulation (miosis)
constriction of pupil, opening of canal of schlemm, decreased intraocular pressure
91
cholinergic stimulation (cardiovascular)
decreased HR, vasodilation
92
cholinergic stimulation of lungs
increased secretion and restriction
93
cholinergic stimulation (skeletal)
increased contraction (nicotonic)
94
Bethanechol (urecholine) use
cholinergic
Direct acting
post-op and post-partum non obstructive urinary retention
urinary retention r/t neurogenic atony of the bladder
95
Routes of bethanechol
PO/SQ
IV and IM contraindicated
96
contraindications of bethanechol
intestinal or urinary obstruction
bradycardia
hypotension
peptic ulcer bc of increased GI secretions
active bronchial asthma and COPD (bc of bronchoconstriction)
parkinsonism (bc we want a DECREASE in acetylcholine, not in increase)
97
side effects of bethanechol
N/V/D
abd cramps, salivation, sweating, frequent urination, blurred vision, miosis
98
adverse effects of bethanechol
orthostatic hypotension, bradycardia, muscle weakness, heart block/cardiac arrest, acute asthma attacks
99
drug interactions of bethanechol
Decreased effect of bethanechol with antidysrhythmics, ganglionic blocking agents cause significant hypotension, atropine counteracts
100
nursing considerations of bethanechol
ambulation and increased fluid intake
monitor VS, urine output >1500ml
atropine antidote
change position slowly, 1 hr before or 2hrs after meals
cholinergic crisis: muscular weakness and increased salivation
101
pilocarpine
cholinergic
102
reversible cholinesterase inhibitors
produce pupillary constriction in glaucoma
cholinergic
103
cholinesterase
breaks down into acetylcholine
small amount needed
cholinergic effects
smooth muscle stimulation
104
Physostigmine (antilirium) what is it and indications
anticholinesterase (indirect-acting)
myasthenia gravis, reversal of anticholinergic drug effects
105
Physostigmine (antilirium) contraindications
known drug allergy, prior severe cholinergic reactions, asthma gangrene, hypothyroidism, CAD, mechanical obstruction of GI or GU tracts
106
adverse reactions of Physostigmine (antilirium)
GI upset, excessive salivation
107
interactions and routes of Physostigmine (antilirium)
anticholinergics (opposites)
IM or IV
108
parasympatholytics
opposite of parasympathetic
anticholinergic
sympathetic nervous system
109
Cardio effects of anticholinergics
increased HR, dysrhythmias (used for symptomatic brady)
110
CNS effects of anticholinergics
restlessness, irritability, disorientation, hallucinations, delirium
111
Eye effects of anticholinergics
dilates pupils, decreased visual accommodation, increased intraocular pressure
112
GI and GU effects of anticholinergics
GI: decreased salivation, gastric secretions, and motility
GU: increased retention
113
glandular and resp effects of anticholinergics
glandular: sweating
resp: decreased secretions
114
atropine indications
bradycardia (bradycardia ends in A)
pre-op control of secretions, treatment of insecticide poisoning
code or rapid response
115
contra of atropine
closed angle glaucoma
adhesions between iris and lens
certain types of asthma
severe hepatic and renal dysfunction
reflux esophagitis
intestinal atony
hiatal hernias
obstructive GI or GU conditions
severe ulcerative colitis
116
side effects of atropine
dry mouth, nausea, headache, constipation, dry skin, blurred vision, palpitations, urinary retention
117
adverse effects and life threatening of atropine
AE: tachy and hypotension
LT: v-fib, stevens johnson, coma
118
Dicyclomine (Bentyl) use
antispasmodic cholinergic blocker
treatment of IBS, colic and enterocolitis in infants
119
contraindications of Dicyclomine (Bentyl)
KDA
angle closure glaucoma
GI tract obstruction
myasthenia gravis
paralytic ileus
GI atony
toxic megacolon
120
indications of Cogentin
anticholinergic
decreases rigidity, tremors of parkinson
inhibits release of acetylcholine
121
side effects of Cogentin
dry mouth, dry secretions, urinary retention, constipation, blurred vision, increased HR, restlessness, confusion
122
life threatening and contra of Cogentin
LT: paralytic ileus
contra: glaucoma
123
indications of Oxybutynin (ditropan)
overactive bladder, antispasmodic for neurogenic with spinal injuries
124
contra of Oxybutynin (ditropan)
KDA, GI/GU retention, uncontrolled angle-closure glaucoma
125
Oxybutynin (ditropan) nursing considerations
PATCH!
and take 1 hr before meals or 2 hours after w fluids
126
Tolterodine (detrol) indications
urinary frequency, urgency, urge incontinence caused by bladder overactivity
Used more often bc less dry mouth since it's more specific to bladder
127
Tolterodine (detrol) contra
angle-closure glaucoma, urinary retention, decreased hepatic function
128
what to do if Tolterodine (detrol) is taken with cytochrome P-340 3A4 (ketoconazole, erythromycin)
start with 1mg 2x day (1/2 normal dose)
129
how to take Tolterodine (detrol) and side effects
PO without food and no grapefruit juice
SE: dry mouth, eyes and skin, HA, dizziness, vertigo, nervousness, N/V/D/C, abdominal pain, urinary retention
130
anticholinergic for motion sickness and side effects
scopolamine
-patch behind ear or wrist band
-Used for 3 days
Dramamine, antivert, marzine
SE: dry mouth, blurred vision, constipation, urinary retention
131
nursing considerations for anticholinergics
assess urinary output (bc it causes retention)
check hx (contra of glaucoma)
monitor VS (HR increases)
bowel sounds (decreased peristalsis)
mouth care (dry)
132
What do agonists of a drug do
increase activity
133
neurotransmitters of sympathetic nervous system
norepinephrine, epinephrine, dopamine
134
Beta 1
heart
135
beta 2
lungs
136
dopaminergic receptors
arterial dilation, increasing blood flow to organs
137
sympathomimetic drugs indirect acting
causes a release of catecholamine from storage site in nerve endings, then binds to receptors
138
sympathomimetic drugs mixed acting
acts directly by binding to receptor site and then indirectly by stimulating release of neurotransmitters
139
+ inotrope
increases contractility, increases CO
140
(-) inotrope
decreases contractility and CO
141
+ chronotrope
HR increases
142
(-) chronotrope
HR decreases
143
alpha-1 locations and responses (3)
pupils: dilation
GU: constriction of bladder
vessels: constriction
144
beta 1 locations and responses (4)
cardiac: increased contractility (+ inotrope)
AV node: increased HR (+ chronotrope)
SA node: increased HR
kidney
145
beta-2 locations and responses (2)
lungs: vasodilation
bronchial muscles: dilation
146
alpha-1 beta-1 location and response
GI muscle: decreased motility (relaxation of muscle)
147
alpha-1 beta-2 location and response
liver: glycogenolysis
148
Dobutamine (dobutrex) class and indication
class: beta-1 adrenergic
cardiac decompensation (increases)
149
dobutamine (dobutrex) MOA and AE
MOA: increases CO by increasing contractility (+ inotrope), increases SV and perfusion to kidneys
AE: H/A, restlessness, HTN, tachy, palpitations, dysrhythmias
150
dopamine (inotropin) use (low vs high dose)
beta-1 adrenergic
low dose dilates vessels in kidneys, brain, heart, mesentery, increasing blood flow
high dose increases contractility and CO
151
dopamine (inotropin) indications, contra and antidote
indications: shock, cardiopulmonary arrest
contra: catecholamines secreting tumor of adrenal gland
if extravasation: phentolamine (alpha blocker)
152
epinephrine (adrenaline) use
acts on receptors by the SNS, strengthens cardiac contraction, bronchodilation, increased HR and CO
beta-1 (increased HR), beta-2 (bronchodilation)
153
epinephrine (adrenaline) indications
anaphylaxis, cardio shock, severe hypotension, cardiac arrest
154
epinephrine (adrenaline) side and adverse effects and LT
SE: anorexia, N/V, nervousness, tremors, agitation, HA, weakness, pallor, sweating, dizziness
AE: palpitations, tachy, HTN, dyspnea, necrosis (vasoconstrictor), gangrene if infiltration
LT: vfib and pulmonary edema
155
epinephrine (adrenaline) interactions
Increased effect with TCA, MAOI, decreased effects with BB, methyldopa, digoxin may cause dysrhythmias
156
Norepinephrine (levophed)
Beta-1
not used during allergic reaction, for hypotensive states
157
Neo-synepherine (phenylephrine)
alpha adrenergic
hypotension and SVT
alpha-1 (vasoconstrictor)
more pressure=decreased secretions
158
albuterol (proventil, ventolin)
beta-2 adrenergic agonist
treats bronchospasm, asthma, bronchitis, COPD
159
contra of albuterol
dysrhythmias, CAD
160
caution, SE, AR, LT of albuterol
caution: cardiac disease, HTN, hyperthyroidism, DM, renal dysfunction, elderly, pregnancy
SE: tremor, nervousness, dizziness, restlessness, sweating, blurred vision, flushing, HA, hoarseness, insomnia
AR: palpitations, tachy, HTN, hallucinations, seizures, hyperglycemia
LT: increased effects w sympathomimetics, TCA, MAOI, decreased BB
161
2 centrally acting alpha 2 agonists
clonidine and methyldopa (both for HTN) bc alpha 2 is a vasodilator
162
alpha 1, alpha 2, beta 1, beta 2
alpha 1: vasoconstrictor
alpha 2: vasodilator
beta 1: heart
beta 2: lungs
163
adrenergic blockers
blocks effects of receptors (and SNS at alpha 1 receptors)
vasodilation, reduced BP, miosis (pupil constrict), reduced muscle tone
164
indications of alpha-adrenergic blockers
HTN, BPH, raynauds
165
endings of alpha blockers
-zosin
166
tamsulosin (flomax)
treats BPH
not used with ED drugs, alpha blockers, or Ca+ blockers
167
beta blockers for glaucoma?
yes!
168
beta blockers ending
-olol
169
selective vs non selective BB
selective just for one part
beta-1 selective
beta-1 and 2 for non selective
170
alpha blockers use
HTN except flomax
171
beta and alpha blockers
vasodilate to lower BP, decrease HR, contractility, CO, release of renin
172
indications of BB
MI, angina, dysrhythmias, HTN, heart failure
prevents migraines
173
contra of BB
KDA, uncompensated HF, shock, heart block, brady, pregnancy, pulmonary disease, raynauds
174
SE of BB and acute withdrawal
SE: mild and transient brady, AV block, hypotension, bronchoconstriction, mask hypoglycemia, inhibit glycogenolysis
acute withdrawal: HTN crisis, angina, MI
175
African americans and BB
don't respond well bc low renin
176
asian americans and BB
works very well
177
indian americans and BB
resistance
178
salt amount for HTN
<2g/day
179
stages of HTN
normal: 90/60-119/79
pre: 120/80-139-89
stage 1: 140/90-159/99
stage 2: >160/100
180
6 types of antihypertensives
diuretics
sympatholytics
vasodilators
ACE
ARBS
Ca+ blocker
181
hydrochlorothiazide
diuretic for HTN
avoid in renal insufficiency
182
alpha and beta for HTN
beta-adrenergic blockers
centrally acting alpha 2
alpha adrenergic
adrenergic neuron blockers
alpha 1 beta 1 blockers
183
beta blockers
used for HTN and also decreases HR
for asthma pts, use selective BB
184
metoprolol (lopressor, toprol)
decreases CO
decompensated HF don't use
beta-1 blocker
not for pregnant women
taper down
