301 AESI

Question 1

If starting K+ 5.5-6

Answer 1

recheck in 72 hours and c/w drug
If <5.5 good
If 5.5-6. reduce dose and recheck at next visit or within 2 weeks

Question 2

If starting K+ is 6.0-6.5

Answer 2

hold drug. EKG, recheck in 24 hours
If <5.5 good
If 5.5-6 and ekg good, reduce dose and recheck in 72 hours
If >6, d/c drug, recheck in 48 hours and trend until K+ down to <=5.1

Question 3

If starting K+ is >6.5

Answer 3

Hold drug, refer to acute care
If <5.5, restart and check at next regular visit
If 5.5-6.0, restart at reduced dose and recheck in 72 hours
If >6.5, permanently d/c and recheck in 48 hours. c/w monitoring until K+ <=5.1

Question 4

If starting Na 130-135 and asymptomatic

Answer 4

recheck in 72-96 hrs and discuss with MM whether to hold or continue
If >135, restart as normal
If still 130-135, discuss action with MM

Question 4

If severe hypoNa <125 w/symptoms

Answer 4

refer to ER. Consult with MM and if improvement consider above instructions, otherwise d/c drug

Question 4

If mod to severe hyponatremia <130

Answer 4

hold drug and recheck in 48 hours
If repeat >135, restart at reduced dose and consult with MM
If repeat value <135, continue to hold and recheck weekly

Question 5

Define hypotension

Answer 5

symptoms and DBP <65, or DBP 65-85 and SBP <100

Question 6

Actions if symptomatic hypotension

Answer 6

recheck BP
reduce IP first, then AHT if needed

Question 7

If severely elevated SBP <180 or DBP <110

Answer 7

recheck
increase AHT regiem first
If more needed, doxazosin 1mg recommended but up to investigator and MM

Question 8

s/s of hypercort

Answer 8

new or unexplained hyperglycemia, HTN, wt gain, abd striae, round facies

Question 9

Directions of hypercort >35

Answer 9

f/u with unscheduled 24 hr free cortisol
If 40-50, repeat in 4 weeks
If >50, reduce drug by 50% and repeat in 4 weeks

Question 10

If am serum cortisol <3

Answer 10

perform ACTH stim test within 1 week

Question 11

s/s of adrenal insufficiency?

Answer 11

weakness, weight loss, loss of appetite, hyponatremia, hypoglycemia

Question 12

Actions if cortisol <10 and >=2 of adrenal insufficency?

Answer 12

ACTH within 48 hours
If acute illness, within 5 days of + cortisol at discretion of investigator