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Pharmacy Practice V > Beta Blockers, Ranolazine, Digoxin, and Ivabradine > Flashcards

Beta Blockers, Ranolazine, Digoxin, and Ivabradine Flashcards

1
Q

What are the Contraindications for ALL Beta Blockers?

A
  1. Decompensated HF
  2. Cardiogenic Shock
  3. Severe Bradycardia
  4. AV Block
  5. Sick Sinus Syndrome
  6. Asthma/Bronchospastic Disease
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2
Q

Can you initiate a NEW beta blocker in decompensated HF?

A

NO

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3
Q

Can you use a beta blocker in asthma/bronchospatic diseases?

A

Yes, it they are NOT nonselective, aka the cardioselective ones

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4
Q

How does DM affect beta blockers?

A

They mask hypoglycemia, patients will not be sweating in a hypoglycemic situation

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5
Q

What is the titration and taper rule of beta blockers?

A

Titrate and Taper every 1-2 weeks

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6
Q

Can you use Nondihydropyridine CCBs with BB?

A

NO = additive bradycardia

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7
Q

Can you used Clonidine with BB?

A

NO = enhanced AV blocking, SA node dysfunction, and rebound HTN

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8
Q

Can you used NSAIDs with BB?

A

EH = cause decreased effect on BP

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9
Q

What are the common A/Es of BB?

A
  1. Dizzy
  2. Drowsy
  3. Fatigue
  4. Bradycardia
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10
Q

What are the beta blockers?

A
  1. Bisoprolol
  2. Atenolol
  3. Metoprolol
  4. Nebivolol
  5. Propranolol
  6. Carvedilol
  7. Labetalol
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11
Q

What is the indication for Propranolol?

A

FDA: Stable Angina, HTN, Migraine HA, portal HTN

Off Label: thyroid storm

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12
Q

What is the specific class of BB for Propranolol?

A

Non-Selective
Lipophilic

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13
Q

What is the concern with Propranolol?

A

CI: asthma
Counseling: take on an empty stomach

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14
Q

What is the indication for Atenolol?

A

FDA: HTN and Angina

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15
Q

What is the specific class of BB for Atenolol?

A

Relatively Cardioselective
NOT Lipophilic

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16
Q

What is the indication for Metoprolol Tartrate?

A

FDA: HTN, Post MI, AFib, and Angina

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17
Q

What is the specific class of BB for Metoprolol Tartrate?

A

Relative Cardioselective
Lipophilic

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18
Q

What is the concern with Metoprolol Tartrate?

A

Take with food to increase absorption

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19
Q

What is the indication for Metoprolol Succinate?

A

FDA: HTN, Angina, HFrEF, Post MI

20
Q

What is the specific class of BB for Metoprolol Succinate?

A

Relatively Cardioselective
Lipophilic

21
Q

What are the concerns with Metoprolol Succinate?

A

Take without regard to food
Tablet is scored and may divide in half BUT do NOT crush or chew

22
Q

What is the indication for Bisoprolol?

A

FDA: HTN
Off: HFrEF

23
Q

What is the specific class of BB for Bisoprolol?

A

Relatively Cardioselective
Lipophilic

24
Q

What is the indication for Nebivolol?

25
Q

What is the specific class of BB for Nebivolol?

A

Relatively Cardioselective

26
Q

What is the indication for Carvedilol?

A

FDA: HTN, HFrEF

27
Q

What is the specific class of BB for Carvedilol?

A

Nonselective Beta + Alpha Blocker

28
Q

What are the concerns with Carvedilol?

A

AE = hypotension/syncope
Take with food to decrease absorption and limit orthostatic BP changes
Capsules can be opened and sprinkled in applesauce

29
Q

What is the indication of Ranolazine?

A

Chronic Angina

30
Q

What is CI’d with Ranolazine?

A

Strong 3A4 inhibitors/inducers and Liver Cirrhosis

31
Q

What are the AEs of Ranolazine?

A
  1. Dizzy
  2. HA
  3. Constipation
  4. QTc Prolongation
32
Q

What do you counsel with Ranolazine?

A
  1. Avoid Grapefruit
  2. Do NOT crush/chew
33
Q

What is the indication for Digoxin?

A

FDA: HFrEF, AFib

34
Q

What are the lipophilic BBs?

A

Metoprolol, Bisoprolol, Carvedilol, and Propranolol

35
Q

What are the hydrophilic BBs?

A

Atenolol and Labetalol

36
Q

What are the AEs of Digoxin?

A
  1. Dizzy
  2. GI Upset
  3. Bradycardia
37
Q

When is Digoxin preferred and not preferred for treatment?

A

Useful in patient sixth HFrEF and AF

CI: Ventricular Fibrillation

38
Q

What weight do you use when calculating CrCl for Digoxin?

39
Q

What is considered Digoxin Toxicity? What are the S/S?

A

AV Node Suppression
Anorexa, N/V, VISUAL CHANGES GREEN YELLOW HALO, Arrhythmias

40
Q

What increases the risk of Digoxin Toxicity?

A

Low Potassium/Low Magnesium and High Calcium

41
Q

What are DDIs to be of concern when using Digoxin?

A
  1. Diuretics
  2. BAS
  3. Amiodarone
  4. Verpamil
  5. Diltazem
42
Q

What is the indication for Ivabradine?

A

HFrEF with EF <35% and HR >70 bpm already on max GDMT/BB or CI’d

43
Q

What are the AEs and Warnings for Ivabradine?

A

Warning: increase risk of Afib
A/E: Brightness or Halo

44
Q

What are the CIs for use of Ivabradine?

A
  1. Acute decompensated CHF
  2. Sinus bradycardia
  3. SA Node disorders
  4. Low BP <90/50
45
Q

What are the patient counseling points of Ivabradine?

A

Take with food to increase bioavailability
AVOID grapefruit

Pharmacy Practice V (19 decks)

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