NR 565 Midterm
12 Essential Considerations for Safe Pain Management - ANS -1. Opioids are not first-line therapy
2. Establish goals for pain and function
3. Discuss risks and benefits
4. Use IR opioids when starting
5. Use the lowest effective dose
6. Prescribe short durations for acute pain
7. Evaluate benefits and harms frequently
8. Use strategies to mitigate risk
9. Review PDMP data
10. Use urine drug testing
11. Avoid concurrent opioid and benzo prescribing
12. Offer treatment of opioid use disorder
\ACEI and ARB BBW - ANS -Category C during 1st trimester, D during 2nd and 3rd
Cause fetal kidney malformation and fetal hypotension
\ACEI and ARB Contraindications - ANS -Mod to severe kidney disease-monitor GFR
Renal artery stenosis
ARF
\ACEI and ARB Side Effects - ANS -Dry cough-up tp 10% with ACEI
Hyperkalemia
Angioedema-rare but life threatening
\ACEI and ARBs MoA - ANS -Inhibition of angiotensin-converting enzyme decreases formation of angiotensin II resulting
in prevention of vasoconstriction and aldosterone-mediated volume expansion
Drug of choice in DM and CKD d/t renal protection
\Aldosterone Receptor Antagonists/Mineralcorticoid Receptor Antagonists (MRAs) - ANS -Spironolactone (Aldactone),
eplerenone (Inspra)
, Block effects of aldosterone , enhance action of thiazides and loops, counterract K+ loss
\Aldosterone Receptor Antagonists/Mineralcorticoid Receptor Antagonists (MRAs) Contraindications - ANS -Anuria, ARF,
renal impairment, hyperkalemia, Addison's disease, concurrent use with eplerenone
\Aldosterone Receptor Antagonists/Mineralcorticoid Receptor Antagonists (MRAs) Side Effects - ANS -Hyperkalemia,
arrhythmias, amennorrhea, gynecomastia, deepening voice, increased hair, muscle cramps, agranulocytosis
\Aldosterone Receptor Antagonists/Mineralcorticoid Receptor Antagonists (MRAs) Special Considerations - ANS -Hepatic
dysfunction
DM d/t increase risk of hyperkalemia
\Alendronate - ANS -Biphosphonate, used as first-line treatment for osteoporosis
Inhibits osteoclasts, reducing bone resorption and turnover
\Amiodarone Contraindications - ANS -Cardiogenic shock, severe sick sinus syndrome, bradycardia, 2nd/3rd degree heart
block, hypersensitivity to iodine
\Amiodarone MoA - ANS -Decreases SA node impulse firing
Blocks sodium, potassium, and calcium channels
Has BB-like properties leading to vasodilation
Treats many tachyarrhythmias like aflutter, afib, vtach, vfib, svt
\Amiodarone Side Effects - ANS -Dizziness, fatigue, corneal microdeposits, bradycardia, hypotension, anorexia,
constipation, N/V, tremor
\Amiodarone Special Considerations - ANS -Heart failure, thyroid d/o, corneal regractive laser surgery, advanced age
\Angiotensin Receptor Neprilysin Inhibitors (ARNIs) - ANS -Play critical role in reducing risk of CV deaths and
hospitalizations-increased diruesis, vasodilation
Sacubitril/valsartan (Entresto)
Often given in place of an ACEI or ARB-NOT together
\Antiplatelet Med Contraindications - ANS -Patients with active bleeding
Use lowest effective dose and notify providers before starting PPI
\Antiplatelet Med Monitoring - ANS -Baseline-CBC, consider genetic testing with clopidoogrel
Ongoing-Non required, monitor for signs of thrombotic events like TIA, CVA, MI
\Antiplatelet Meds - ANS -Prevent blockage of coronary artery stents and reduce thrombotic events
\Atherosclerotic Cardiovascular Disease Risk Score (ASCVD) - ANS -
12 Essential Considerations for Safe Pain Management - ANS -1. Opioids are not first-line therapy
2. Establish goals for pain and function
3. Discuss risks and benefits
4. Use IR opioids when starting
5. Use the lowest effective dose
6. Prescribe short durations for acute pain
7. Evaluate benefits and harms frequently
8. Use strategies to mitigate risk
9. Review PDMP data
10. Use urine drug testing
11. Avoid concurrent opioid and benzo prescribing
12. Offer treatment of opioid use disorder
\ACEI and ARB BBW - ANS -Category C during 1st trimester, D during 2nd and 3rd
Cause fetal kidney malformation and fetal hypotension
\ACEI and ARB Contraindications - ANS -Mod to severe kidney disease-monitor GFR
Renal artery stenosis
ARF
\ACEI and ARB Side Effects - ANS -Dry cough-up tp 10% with ACEI
Hyperkalemia
Angioedema-rare but life threatening
\ACEI and ARBs MoA - ANS -Inhibition of angiotensin-converting enzyme decreases formation of angiotensin II resulting
in prevention of vasoconstriction and aldosterone-mediated volume expansion
Drug of choice in DM and CKD d/t renal protection
\Aldosterone Receptor Antagonists/Mineralcorticoid Receptor Antagonists (MRAs) - ANS -Spironolactone (Aldactone),
eplerenone (Inspra)
, Block effects of aldosterone , enhance action of thiazides and loops, counterract K+ loss
\Aldosterone Receptor Antagonists/Mineralcorticoid Receptor Antagonists (MRAs) Contraindications - ANS -Anuria, ARF,
renal impairment, hyperkalemia, Addison's disease, concurrent use with eplerenone
\Aldosterone Receptor Antagonists/Mineralcorticoid Receptor Antagonists (MRAs) Side Effects - ANS -Hyperkalemia,
arrhythmias, amennorrhea, gynecomastia, deepening voice, increased hair, muscle cramps, agranulocytosis
\Aldosterone Receptor Antagonists/Mineralcorticoid Receptor Antagonists (MRAs) Special Considerations - ANS -Hepatic
dysfunction
DM d/t increase risk of hyperkalemia
\Alendronate - ANS -Biphosphonate, used as first-line treatment for osteoporosis
Inhibits osteoclasts, reducing bone resorption and turnover
\Amiodarone Contraindications - ANS -Cardiogenic shock, severe sick sinus syndrome, bradycardia, 2nd/3rd degree heart
block, hypersensitivity to iodine
\Amiodarone MoA - ANS -Decreases SA node impulse firing
Blocks sodium, potassium, and calcium channels
Has BB-like properties leading to vasodilation
Treats many tachyarrhythmias like aflutter, afib, vtach, vfib, svt
\Amiodarone Side Effects - ANS -Dizziness, fatigue, corneal microdeposits, bradycardia, hypotension, anorexia,
constipation, N/V, tremor
\Amiodarone Special Considerations - ANS -Heart failure, thyroid d/o, corneal regractive laser surgery, advanced age
\Angiotensin Receptor Neprilysin Inhibitors (ARNIs) - ANS -Play critical role in reducing risk of CV deaths and
hospitalizations-increased diruesis, vasodilation
Sacubitril/valsartan (Entresto)
Often given in place of an ACEI or ARB-NOT together
\Antiplatelet Med Contraindications - ANS -Patients with active bleeding
Use lowest effective dose and notify providers before starting PPI
\Antiplatelet Med Monitoring - ANS -Baseline-CBC, consider genetic testing with clopidoogrel
Ongoing-Non required, monitor for signs of thrombotic events like TIA, CVA, MI
\Antiplatelet Meds - ANS -Prevent blockage of coronary artery stents and reduce thrombotic events
\Atherosclerotic Cardiovascular Disease Risk Score (ASCVD) - ANS -
