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Hypertension lec notes Flashcards

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1
Q

Long term risks for having uncontrolled hypertension:

A

heart disease
stroke
kidney disease

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2
Q

Most common form of hypertension is ___________

A

essential hypertension (unknown cause),
- also called primary hypertension

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3
Q

What are the Key drugs that can increase blood pressure?

A

Amphetamines and ADHD drugs/stimulants
cocaine
decongestants

erythropoiesis-stimulating agents (epogen, arinaspt) * remember these drugs increase red blood cell production. So will increase the viscosity of the blood. Causing increased blood pressure.

immunosuppressants (cyclosporine)
NSAIDs
systemic steroids
(increase Na and H2O retention which is going to increase blood volume and correspondingly increase blood pressure)

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4
Q

what drugs makes this individual’s blood pressure elevated?

keep in the back of your mind for NAPLEX questions

A
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5
Q

(RAAS) Renin Angiotensin Aldosterone System
(SNS) Sympathetic Nervous System

A

2 primary neural hormonal systems

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6
Q

Renin is released from the ___________

A

kidneys

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7
Q

Angiotensin I is converted to Angiotensin II via the ________

A

Angiotensin Converting Enzyme

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8
Q

Renin is responsible for ______________

A

the conversion of Angiotensinogen to Angiotensin I

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9
Q

Angiotensinogen is released by ____________

A

the liver

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10
Q

What class of medications do we have to inhibit the conversion of angiotensinogen to angiotensin I ?

give an example of drug

A

Renin inhibitors

Tekturna (aliskiren)

*However not really used for HTN today because ______

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11
Q

What class of medications do we have to inhibit the conversion of angiotensin I to angiotensin II? which also results in what?

give example of medications

A

ACE-inhibitors

decreased vasoconstriction and decreased secretion of aldosterone.

lisinopril

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12
Q

What class of medications do we have that block angiotensin II from binding at the receptor level to angiotensin II type-1 (AT1) receptors on vascular smooth muscle, which prevents vasoconstriction and prevents the release of aldosterone?

give an example of medication

A

(ARBs) Angiotensin Receptor Blockers

losartan

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13
Q

what role does Aldosterone play?

A

causes increased reabsorption of Na and H2O in the kidneys, this increases blood volume, and in turn increases blood pressure.

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14
Q

What medication class also prevents the breakdown of Bradykinin?
What happens as a result?

What is the role of Bradykinin?

A

ACE-inhibitors
Bradykinin levels increase, which is thought to contribute to the vasodilatory effects and Side Effects of a dry and hacking cough.

Bradykinin is a vasodilator, which decreases SVR.

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15
Q

What class of medications do we use to compete with aldosterone at receptor sites in the distal convoluted tubule and collecting ducts of the nephron in order to increase the excretion of water and Na but to preserve potassium?

A

Potassium Sparing Diuretics “aldosterone receptor antagonists”

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16
Q

Which potassium sparring diuretic is a non-selective receptor antagonist?

A

spironolactone

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17
Q

Which potassium sparring diuretic is a selective receptor antagonist?

A

eplerenone

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18
Q

What class of medications inhibit Na reabsorption in the distal convoluted tubules of the nephron and cause increased excretion of Na, Cl, H20 and K?

give an example of medication

A

thiazide type diuretics

hydrochlorothiazide

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19
Q

The (SNS) Sympathetic Nervous System releases catecholamines (like NE & Epi) into the blood stream which go on to stimulate adrenergic receptors and cause an increase in blood pressure. What classes of medications do we use to block stimulation of adrenergic receptor stimulation?

Give examples of medications in class

A

Centrally-acting alpha-2 agonist
ex. clonidine-prevents the release of NE

Beta Blockers

alpha-1 receptors when stimulated cause vasoconstriction

Beta-1 receptors when stimulated causes increased HR and contractility

Beta-2 receptors when stimulated causes

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20
Q

In terms of diagnosing blood pressure, there are 4 categories: Define each

1)
2)
3)
4)

A

1) Normal BP = SBP < 120 mmHg AND DBP < 80 mmHg
2) Elevated BP = SBP 120-129 AND DBP < 80mmHg
3) Stage 1 HTN = SBP 130-139 ooooorrrrr DBP 80-89 mmHg
4) Stage 2 HTN = SBP > or = 140 mmHg ooooorrrr DBP > or = 90 mmHg

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21
Q

What are the Lifestyle Management interventions which are key to prevent HTN and help Tx HTN in conjunction with medications??

A

-Weight loss (1kg of weight loss decreases BP by ~1mmHg)
-Heart-healthy diet (DASH diet) = a diet high in fruits, vegetables, fiber, and low-fat dairy products and low in saturated fats & sugar
-reduce sodium intake to <1500 mg daily
-smoking cessation
-control blood glucose and lipids to decrease cardiovascular disease risk

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22
Q

What are some Natural Products that have some evidence for reducing blood pressure and overall cardiovascular risk, although they are not recommended by guidelines?

A

fish oil
coenzyme Q10
L-arginine
garlic

patients however should be advised that fish oil and garlic increase bleeding risk

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23
Q

What are the four preferred drug classes for treating Hypertension?

A

ACE inhibitors
ARBs
DHP CCBs
thiazide diuretics

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24
Q

Treatment Principles (ACC/AHA)
Hypertension Treatment Guidelines

When to start hypertension treatment?

A

If patient has a SBP > or = to 140mmHg or DBP > or = to 90 mmHg (Stage II hypertension

If a patient has SBP 130-139 mmHg or DBP 80-89 mmHg
AND
Clinical CVD OR ASCVD risk > or = to 10%

*clinical CVD “cardiovascular disease” = stroke, heart failure, coronary heart disease, history of MI

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25
Treatment Principles (ACC/AHA) Hypertension Treatment Guidelines What is blood pressure goal for all patients?
< 130/80 mmHg (all patients) The ADA recommends a goal BP < 130/80 mmHg for patients with diabetes and patients with high ASCVD risk. A BP < 140/90 mmHg for patients at lower risk. The KDIGO guideline recommends a goal SBP <120 mmHg for patients with hypertension and chronic kidney disease (CKD)
26
Treatment Principles (ACC/AHA) Hypertension Treatment Guideline Initial Drug Selection for black patients with hypertension which drugs do we choose from 1st?
thiazide diuretics or DHP CCBs
27
Treatment Principles (ACC/AHA) Hypertension Treatment Guidelines Initial Drug Selection what drugs do we initially want to select in patients?
DHP CCB ACE inhibitors OR an ARBs thiazide diuretics ** But we DO NOT want to use ACE inhibitors and ARBs together**
28
Treatment Principles (ACC/AHA) Hypertension Treatment Guidelines Initial Drug Selection for patients who have albuminuria. what drugs classes should we initially choose from to treat hypertension in a patient who has albuminuria??
ACE inhibitor or ARB
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Treatment Principles (ACC/AHA) Hypertension Treatment Guidelines Initial Drug Selection what drug classes should we initially choose from to treat hypertension in a patient who has CKD? Define CKD parameters.
ACE inhibitor or ARB CKD = GFR < 60mL/min or albuminuria (urine albumin > or = 300mg/day) or albumin: creatine ratio > or = 300mg/g
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Treatment Principles (ACC/AHA) Hypertension Treatment Guidelines Initial Drug Selection what drug classes should we initially choose from to treat hypertension in a patient who has diabetes + albuminuria?
ACE inhibitor or ARB If there is No albuminuria, then can select from any of the 4 preferred drug classes
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When would we want to start two drugs in patient to treat there hypertension?
If there blood pressure is > 150/90 mmHg
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Define Clinical CVD (cardiovascular disease)
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Define Clinical ASCVD (atherosclerotic cardiovascular disease)
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Define CAD (coronary artery disease)
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Define PAD (peripheral arterial disease)
36
Pregnancy and hypertension which drug classes for hypertension are Contraindicated in pregnancy?
ACE inhibitors ARBs Renin inhibitor, aliskiren *All have boxed warnings for fetal toxicity*
37
What are some indicators on a patient exam that would imply one is pregnant?
HCG+ test would indicate the patient is pregnant
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What are the drugs of Choice in pregnancy when required to treat high blood pressure?
labetalol, nifedipine ER, methyldopa,
39
chronic hypertension:
hypertension that develops before pregnancy
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gestational hypertension:
hypertension that develops during pregnancy
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Preeclampsia:
occurs after week 20 of the pregnancy and is evident by elevated blood pressure and proteinuria in the majority of cases.
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When should pregnant patients receive drug treatment for chronic hypertension? What should the BP be maintained at?
If SBP > or = 160 mmHg OR DBP > or equal to 105 mmHg BP should be maintained between 120-160 mmHg systolic AND 80-110 mmHg diastolic
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For Treating Chronic Hypertension what is the Goal BP to be maintained?
Maintained SBP 120-160 mmHg AND DBP 80-105
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Thiazide Type Diuretics Indications: MOA: Contraindications: Warnings: Side Effects: Monitoring: Pearls/Notes: Drug-Drug/Food interactions:
MOA: drugs inhibit Na and water reabsorption in the distal convoluted tubules of the nephrons. So there is increased excretion of Na/Cl/H2O/K Contraindications: Hypersensitivity to sulfonamide-derived drugs, **Sulfonamide-derived drugs** Warnings: Side effects: decrease K/Mg/Na (hypokalemic/hypomagnemic) increased retention of Uric acid/ Blood glucose/ TG/LDL/HCO3/Ca **do increase uric acid so be cautious in patients with gout** **thiazide type diuretics retain Calcium, so good for bones**, Loop diuretics primary used for HF excrete calcium, so bad for bones and can cause osteoporosis. photosensitivity/impotence (inability to keep an erection) Monitoring: electrolytes/renal function/ Note/Pearls: Take early in the day to avoid nocturia ** Not effective if CrCl < 30mL/min** Drug-Drug Interactions: we want to look for additive effects in electrolyte losses. in combination with NSAIDs can be problematic, Drugs that can cause sodium and water retention (NSAIDs) can decrease the effectiveness of antihypertensive medications. Can decrease lithium renal clearance and increase risk of lithium toxicity. Do NOT use in combination if possible.
46
There is one Thiazide-type diuretic that is available IV, which one?
chlorothiazide (Diuril)
47
Dihydropyridine Calcium Channel Blockers (DHP CCBs) Indications: Dosing: MOA: Contraindications: Warnings: Side effects: Monitoring: Note/Pearls: Drug-Drug Interactions:
Indications: hypertension/chronic stable angina/Prinzmetal's angina MOA: work more at peripheral vascular smooth muscle than myocardial cells, inhibiting Ca ions from entering. This causes peripheral arterial vasodilation and coronary artery vasodilation. Contraindications: Warnings: Side effects: reflex tachycardia, headache, flushing, peripheral edema, palpitations, gingival hyperplasia (overgrowth of gums) Monitoring: Note/Pearls: Drug-Drug Interactions:
48
Which Calium Channel Blocker comes as a lipid emulsion preparation? How many calories does this provide to patient if given? What is the maximum time of use after vial has been punctured and why?
Clevidipine (Cleviprex) -provides 2kcal/mL, and is a milky white in color -it is more prone to bacterial overgrowth since it is an emulsion, strict aseptic technique required and once vial is punctured is only good for 12 hours.
49
Which Calcium Channel Blocker is the safest to use if one is needed in HFrEF?
amlodipine (Norvasc)
50
Which Calcium Channel Blocker is the drug of choice in Pregnancy?
Nifedipine ER (Adalat CC, Procardia XL)
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Which Calcium Channel Blocker has a Warning not to use for Chronic Hypertension or acute BP reduction in non-pregnant adults due to profound hypotension that has results in MI & death?
Nifedipine IR (Procardia)
52
Which Calcium Channel Blocker has the Contraindication for patients that have an allergy to soybeans/soy products/or eggs?
Clevidipine (Cleviprex) is an emulsion, so remember can increase TGs
53
Which Calcium Channel Blockers are available IV?
Nicardipine IV (Cardene IV) & Clevidipine (Cleviprex)
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Non-Dihydropyridine Calcium Channel Blockers (non-DHP CCBs) Indications: Dosing: MOA: Contraindications: Warnings: Side effects: Monitoring: Note/Pearls: Drug-Drug Interactions:
Indications: primarily used to control HR in certain arrhythmias (atrial fibrillation) and are sometimes used for hypertension and angina. MOA: work at peripheral vascular smooth muscle but primarily are more selective for the myocardium (myocardial cells) then the DHP CCBs. They inhibit Ca ions from entering cardiac smooth muscle. However, the decrease in BP produced is due too negative inotropic (decreased force of ventricular contraction) AND negative chronotropic (decreased HR) effects. **Avoid in HFrEF** Contraindications: Warnings: Heart Failure (may worsen symptoms), bradycardia, increased LFTs Side effects: edema/constipation (more with verapamil)/gingival hyperplasia (more than the DHP CCBs) Monitoring: Note/Pearls: IV:PO conversions are NOT 1:1 Not All generic products are therapeutically equivalent to the Brand-name products. Drug-Drug/Food Interactions: Use caution with other drugs that decrease HR, including beta-blockers, digoxin, clonidine, amiodarone, and dexmedomidine (Precedex) Do NOT use with grapefruit juice
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negative inotropic:
56
negative chronotropic:
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All Calcium Channel Blockers (DHP & non-DHP, except for ________) are major substrates for ___________?
clevidipine CYP3A4
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Diltiazem and Verapamil are inhibitors of _________ So, if patients are on Simvastatin or Lovastatin, we would want to use lower doses. Another option would be to change patient to a statin that is NOT metabolized by CYP3A4 these include: __________
CYP3A4 Pitavastatin/Pravastatin/Rosuvastatin
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RAAS Inhibitors (ACE-inhibitor) Indications: Dosing: MOA: Contraindications: Warnings: Side effects: Monitoring: Note/Pearls: Drug-Drug Interactions:
Indications: hypertension Classes: ACE-inhibitors MOA: inhibit/block the ACE enzyme, preventing the conversion of Angiotensin I to Angiotensin II Contraindications: DO NOT USE in pregnancy. Do NOT Use within 36 hours of a neprilysin inhibitor Warnings: angioedema, increase K and increase SCr Side effects: cough Monitoring: Note/Pearls: Drug-Drug Interactions:
62
RAAS Inhibitors (ARBs) Angiotensin Receptor Blocker Indications: Dosing: MOA: Contraindications: Warnings: Side effects: Monitoring: Note/Pearls: Drug-Drug Interactions:
Indications: hypertension Classes: ARBs (Angiotensin Receptor Blockers) MOA: drug binds to the angiotensin II type-1 (AT1) receptor on vascular smooth muscle, blocking Angiotensin II from binding to receptor and preventing vasoconstriction. Contraindications: DO NOT USE in pregnancy Warnings: angioedema, increase K and increase SCr Side effects: less cough, less angioedema Monitoring: Note/Pearls: 1st line in CKD - cause they vasodilate efferent arteriole, decrease pressure -slow progression of kidney disease -protect the heart from remodeling effects of Angiotensin II in heart failure patients - No washout required if switching from an ARB to Entresto or vice versa Drug-Drug Interactions:
63
RAAS Inhibitors Direct Renin inhibitor Indications: Dosing: MOA: Contraindications: Warnings: Side effects: Monitoring: Note/Pearls: Drug-Drug Interactions:
Indications: hypertension MOA: directly binds to and inhibits renin, which is responsible for the conversion of angiotensinogen to Angiotensin I. With a decrease in the formation of angiotensin I then less angiotensin II formation and less vasoconstriction and aldosterone secretion. Contraindications: with ACE inhibitors or ARBs Warnings: Side effects: Monitoring: Note/Pearls: 1st line in CKD -slow progression of kidney disease -protect the heart from remodeling effects of Angiotensin II in heart failure patients Drug-Drug Interactions:
64
Angiotensin II causes what?
vasoconstriction of the efferent arterioles of the nephrons (which increases the workload in the glomeruli) and increased release of aldosterone from the adrenal cortex (which results in Na and H2O retention) * this causes increased blood pressure
65
ACE-inhibitors and ARBs have demonstrated what, in regard to patients with kidney disease and albuminuria.
slow the progression of kidney disease in patients with albuminuria
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What beneficial effects do ACE inhibitors and ARBs have on patients with Heart failure?
they protect the myocardium from the remodeling effects of Angiotensin II
67
RAAS inhibitors decrease blood pressure by _________________
blocking the effects of Angiotensin II
68
If a patient develops angioedema with any type of RAAS inhibitor then _______________
other RAAS inhibitors SHOULD BE AVOIDED -ACE inhibitors -ARBs -Renin inhibitors -ARNI (angiotensin receptor/neprilysin inhibitor)
69
RAAS inhibitors should never be used in _________
combination. Only one drug from a single drug class. -ACE inhibitors -ARBs -Renin inhibitors -ARNI (angiotensin receptor/neprilysin inhibitor)
70
What is the potentially fatal adverse effects that can occur with any RAAS inhibitor?
Angioedema
71
If switching from an ACE-inhibitor to Entresto or Entresto to an ACE inhibitor, then what is required?
36-hour wash out period is required.
72
Renin is responsible for the conversion of ______________
Angiotensinogen to Angiotensin I
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Renin is released from the ________
kidneys
74
Angiotensinogen is released from the _________
liver
75
What drug class, part of the RAAS inhibitors has a higher risk of angioedema?
Ace inhibitors have a higher risk of angioedema than ARBs African American patients are at higher risk of angioedema
76
What specific ARB has a safety issue of sprue-like enteropathy? How does this present?
olmesartan severe, chronic profuse diarrhea at any point after starting treatment with weight loss, abdominal pain
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Potassium-Sparing Diuretics---- Group 1: "traditional" in combination used for HTN to counteract K loss from thiazide diuretics. Group 2: Aldosterone antagonists indications: MOA: Contraindications: Warnings: Side effects: Monitoring: Note/Pearls: Drug-Drug Interactions: Check potassium first and monitor! Do not start if potassium is above 5 mEq/L
Indications: - often used in combination with HCTZ to counteract the mild potassium losses seen with thiazide diuretics. - the aldosterone receptor antagonists are the preferred add-on drugs in resistant hypertension, despite maximum tolerated doses of a CCB + ACE inhibitor or ARB + thiazide diuretic. - aldosterone receptor antagonists are commonly used in heart failure MOA: the aldosterone receptor antagonists compete with aldosterone at receptor sites in the distal convoluted tubule and collecting ducts of the nephron, increasing Na and H2O excretion and preserving K. Contraindications: Warnings: Side effects: Monitoring: notes/Pearls: Drug-Drug Interactions:
80
Beta-Blockers indications: MOA: Contraindications: Warnings: Side effects: Monitoring: Note/Pearls: Drug-Drug Interactions:
indications: Not 1st line for HTN. Are used 1st line for: - For Post-MI or ischemic heart disease: any beta blocker without ISA - Heart Failure: bisoprolol, carvedilol, and metoprolol succinate only MOA: Boxed Warnings: DO NOT Discontinue abruptly. Contraindications: Severe bradycardia; 2nd or 3rd degree AV block, cardiogenic shock, Warnings: Caution in patients with diabetes, can increase or decrease blood glucose levels. Can mask signs of low blood glucose. Can worsen asthma/COPD Side effects: decrease HR, decrease blood pressure, dizziness, depression, sexual dysfunction. Monitoring: Note/Pearls: Drug-Drug Interactions:
81
Which beta-blockers have (ISA) Intrinsic Sympathomimetic Activity?
Acebutolol/Penbutolol/Pindolol - so these do not decrease the HR as well as other beta-blockers, this is because they have ISA meaning they partially stimulate those receptors. - these SHOULD NOT be used in patients' post-MI or patients with ischemic heart disease
82
Which beta-blockers are non-selective?
Propranolol/Nadolol/Pindolol/Timolol/Carvedilol/Labetalol "TLC PPN"
83
Which beta-blockers are selective for Beta-1 receptor? **remember AMEBBA**
Atenolol, Metoprolol, Esmolol, Bisoprolol, Betaxolol, Acebutolol
84
Which beta-blockers have activity at alpha-1 receptor in addition to beta receptors?
carvedilol & labetalol
85
If a beta-blocker is needed in a patient with bronchospastic disease (asthma, COPD), what type of beta-blocker is preferred?
beta-1 selective
86
which beta blockers are indicated & preferred if treating chronic heart failure?
bisoprolol/carvedilol/metoprolol succinate
87
Why do we need to be cautious with using beta-blockers in patients with diabetes?
they can mask the symptoms of low blood sugar.
88
Why can't beta-blockers be discontinued abruptly?
the beta blockers prevent NE from binding to the beta receptors. If stopped without tapering, you can get a flood of incoming NE binding to many receptors, stimulating them which can be detrimental to the patient.
89
Which Beta-blocker is selective for beta-1 with nitric oxide vasodilation?
Nebivolol (Bystolic)
90
Which beta blockers if given to patients with pulmonary disorders could cause and or increase risk of a bronchospastic exacerbation?
timolol/propranolol/pindolol/nadolol *are more lipophilic
91
which beta blockers have greater ability to decrease SVR (systemic vascular resistance) and why?
carvedilol/labetalol - because they block alpha-1 receptors in the periphery
92
which beta-blocker is the drug of choice for pregnancy?
labetalol
93
Centrally-acting alpha-2 adrenergic agonists Class: Indications: Dosing: MOA: Contraindications: Warnings: Side effects: Monitoring: Note/Pearls: Drug-Drug Interactions:
Indications: not used 1st line for HTN, are used for resistant HTN Dosing: MOA: drugs decrease BP by stimulating alpha-2 adrenergic receptors in the brain and reducing sympathetic outflow of NE, which decreases SVR & HR. (preventing the outflow of noradrenaline hormones NE/Epi from the CNS) Contraindications: Warnings: DO NOT DISCONTINUE abruptly (can cause rebound hypertension), must be tapered gradually over 2-4 days Side effects: dry mouth, somnolence, fatigue, constipation, decreased HR, hypotension, impotence, Monitoring: Note/Pearls: Drug-Drug Interactions:
94
which of the centrally acting alpha-2 adrenergic agonists is preferred in pregnancy for treating HTN?
Methyldopa
95
why can't centrally acting alpha-2 adrenergic agonists be discontinued without a taper?
can cause rebound hypertension. Which is a sudden increase in blood pressure that can be accompanied with tachycardia, palpitations, flushed feeling, warm skin, headache.
96
which antihypertensive is available as a patch formulation?
clonidine (Catapres-TTS)
97
Should the Catapres-TTS patch be removed prior to an MRI?
Yes
98
which centrally acting alpha-2 adrenergic agonists are indicated for the treatment of ADHD?
Kapvay (clonidine ER) Intuniv (guanfacine ER)
99
Which centrally acting alpha-2 adrenergic agonist can cause (DILE) drug-induced lupus erythematosus?
Methyldopa
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Direct Vasodilators Indications: Dosing: MOA: Contraindications: Warnings: Side effects: Monitoring: Note/Pearls: Drug-Drug Interactions:
Indications: MOA: these drugs cause direct vasodilation of arterioles, with little effect on veins. This results in a decrease in SVR and reduction in BP. Contraindications: Warnings: Side effects: peripheral edema/headache/flushing/palpitations/reflex tachycardia Monitoring: Note/Pearls: Drug-Drug Interactions:
102
which direct vasodilator can cause (DILE) drug-induced lupus erythematosus?
Hydralazine
103
which direct vasodilator is available OTC but is used in topical products for Hair growth?
Minoxidil
104
Which direct vasodilator has a boxed warning indicating it is a potent antihypertensive- which can cause pericardial effusion and angina exacerbations?
Minoxidil
105
The direct vasodilators are usually given with what in combination? and why is this done?
beta-blocker, because the reflex tachycardia is significant + loop diuretic, because peripheral edema is so significant, it is needed to control fluid.
106
which direct vasodilator can cause hirsutism?
minoxidil
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Nonselective Alpha-1 blockers Indications: Dosing: MOA: Contraindications: Warnings: Side effects: Monitoring: Note/Pearls: Drug-Drug Interactions:
Indications: Not recommended for HTN - Used for BPH Dosing: MOA: Contraindications: Warnings: Side effects: Monitoring: Note/Pearls: Drug-Drug Interactions:
109
Hypertensive Emergency: When patient has a blood pressure of - How do we treat?
Blood Pressure > or equal to 180/120 mmHg Life Threatening Acute organ damage Use IV medications: we want to decrease blood pressure by less than or equal to 25% within the 1st hour. No more than 25% within 1st hour.
110
Hypertensive Urgency: When patient has a blood pressure of - How do we treat?
Blood Pressure > or equal to 180/120 mmHg No acute organ damage present Use Oral medications. Treat with any oral medication that has a short onset of action (15-30min) Decrease BP gradually over 24-48 hours.
111
What are the Key IV Hypertensive Medications for Hypertensive Emergency?
chlorothiazide clevidipine, nicardipine diltiazem/verapamil enalaprilat esmolol, labetalol, metoprolol tartrate propranolol nitroglycerin, nitroprusside
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Class: Indications: Dosing: MOA: Contraindications: Warnings: Side effects: Monitoring: Note/Pearls: Drug-Drug Interactions:
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Class: Indications: Dosing: MOA: Contraindications: Warnings: Side effects: Monitoring: Note/Pearls: Drug-Drug Interactions:

Notes/Facts/Brand vs Generic (23 decks)

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