NRNP6566
KeyConcept
sWeek1t
o5
We
ek1
De
scr
ibet
hec
ytoc
hromeP4
50s
yst
em.
Des
cri
beh
owi
ndu
cer
san
din
hib
itor
saf
fec
tth
ecy
toc
hrome
s
yst
ema
ndh
owt
hata
ffe
ctst
heh
alf
-l
if
eofme
dic
ati
ons
.
Cy
toch
romep 450s y
ste
mi sas er
iesofenzymesusedtome t
abol
izemedi
cat
ions.
Dr
ugsthatcau
s eCYP450me ta
boli
cd ru
gintera
cti
onsarer
eferr
edtoasei
theri
nhi
bit
orsori
ndu
cer
s.
Ind
uce r
sincre
aseCYP4 5
0e nzymea ct
iv
itybyi
ncrea
sin
ge nzy
mes y
nthe
sis
I
nhi
bit
orsblockthemetab
olicact
ivit
yofoneormor eCYP450enzymes
De
scr
ibet
hea
ffe
ctonl
owa
ndh
igha
lbu
minl
eve
lsona
cti
ved
rugl
eve
lse
spe
cia
ll
yford
rug
sth
ata
re
h
igh
lyp
rot
ei
nbou
nd.
Al
bumi
nist
hep lasmap r
otei
nwit
htheg r
eates
tc a
pa c
ityforbindi
ngdrugs.
Bi
ndin
gt op l
asmap r
ote
insaff
ectsdrugdi
stri
buti
oni ntoti
ssues
,b e
causeonl
ydrugtha
tis
notb ou
n disava
il
abl
etop e
n e
trat
etiss
ue s
,b i
ndtor ecep
tor
s,ande xe
rtac
ti
vi
ty.Asfr
ee
drugleavesthebl
oodstr
eam,moreb ounddrugisr e
leasedf
romb indi
ngsi
tes
.
Hi
ghl
ypr
ote
inb ounddrugs,l
owalbuminlev
els(w/ma l
n utr
it
ion,orchr
onicil
ln
ess)maylea
dto
t
oxi
ci
tyb
eca
uset
her
ear
efe
wert
hant
hen
orma
lsi
te
sfort
hed
rugt
obi
nd
De
scr
ibewa
yst
ole
sse
nth
ehe
pat
icf
ir
stp
asse
ffe
ct:
met
abol
i
smd
uri
ngf
ir
stp
asst
hrou
ght
hel
i
ver
Al
te
rna
tiv
erou
tes(
sup
pos
it
ory
,in
tra
ven
ous
,in
tra
mus
cul
ar,
inh
ala
tion
ala
eros
ol,
tra
nsd
erma
l,a
nd
s
ubl
i
ngu
al)a
voi
dth
efi
rst
-pa
sse
ffe
cta
ll
owd
rug
stob
eab
sor
bedd
ire
ctl
yin
tot
hes
yst
emi
c
c
ir
cul
ati
on
Bea
bletocal
cul
atecr
eati
ni
necl
eara
nceu
singt
heCock
graf
tGa
ulte
qui
ati
on:
Male =([
140-
age]×wei
ghti
nkg)
/(s
eru
mc r
eat
ini
ne×72
)
Femal
e =CrCl(mal
e)×0.
85
Des
crib
ewh a
tdetermi
nesth
efrequ
encyofd r
ugadmini
st
rat
ion:
Drughal
f-l
i
fe,pl
asmaconce
ntr
ati
o n
Befamil
iarwit
htheBeerscr
it
eri
aandhowt ousei
t:
Poten
tia
ll
yInappr
opr
iat
eMe di
cat
ionUseinOl
derAdult
s
tocall
att
ent
iontomedic
a t
ion
sthata
recommon l
ypr
obl
ema
tic
,an
dth
uss
hou
ldb
eav
oid
ed
i
nmos
tol
dera
dul
ts
De
scr
ibef
act
orst
hataf
fec
tab
sorpt
ion,d
ist
ri
but
ion
,me t
aboli
smandexc
ret
ion:
Ab
sor
pti
onlowbl
oodst
ate(
s h
ockorarr
est
);c
ontactt
imewit
hGItr
actt
oof
ast(
dia
rrh
ea=c
an’
t
a
bsor
b);
del
aye
dst
oma
che
mpt
yi
ng(
lar
geme
al=d
ela
yeda
bsor
pti
on)
;dr
ug-
dru
gord
rug
-food
i
nte
rac
ti
ons
Met
abol
i
s m gen
eti
cs,a
ge,or
ganfu
n c
ti
on
Di
st
ri
but
ion l
owa l
bumi
nle
v e
ls,
bodycompos
it
ion
,ca
rdi
acd
ecomp(
HF)
,an
dag
e
, E
xcr
eti
on a
ffe
cte
dbya
bnor
mal
kid
neyorl
i
verf
unc
ti
on;
age
,dr
ugi
nte
rac
ti
ons
8
.De
fin
ena
rrowt
her
ape
uti
cin
dexHowwou
ldy
oumon
itorap
ati
entwi
than
arr
owt
her
ape
uti
cin
dex
?
, Th
erape
uti
cin
dex:doser
angewher
eef
fic
acyofmedi
sopti
miz
e dwh
il
esi
deeff
ect
smini
miz
ed
Nar
rowthe
rapeu
tici
ndex(
NTI)d
rugsa
redefi
neda
sthos
edrugswher
esmal
ldi
ff
ere
nce
sindos
e
orb
loodc
onc
ent
rat
ionma
yle
adt
odos
ean
dbl
oodc
onc
ent
rat
ionde
pen
den
t,s
eri
ous
t
her
ape
uti
cfa
il
ure
sora
dve
rsed
rugr
eac
ti
ons
.
Bl
oodtes
tst
omon i
torbl
oodc oncen
tra
tion
sa n
dd oseadj
ustment
sa ccor
ding
ly
De
scr
ibehowagi
ngaff
ectabsor
pti
on,dis
tri
buti
on,metab
olis
m, a
nde x
cret
ion
Decr
eas
edorg
anfuncti
on,poorl
ytol
erat
ed r
ugsthatre
quir
eme t
aboli
sm,lowerr
ate
sofe
xcr
eti
on
d
ecr
eas
eins
mal
l
-bowe
lsu
rfa
cea
rea
,sl
owe
dga
str
ice
mpt
yi
ng,
anda
nin
cre
asei
nga
str
icp
H,
c
han
gesi
ndr
uga
bsor
pti
on
Wi
tha
ge,
bod
yfa
tge
ner
all
yin
cre
ase
san
dtot
alb
odywa
terd
ecr
eas
es.
Inc
rea
sedf
ati
ncr
eas
est
he
v
olu
meofd
ist
ri
but
ionf
orh
igh
lyl
i
pop
hil
i
cdr
ugs
(eg
,di
azepam,chl
ordi
azep
oxide)andmayinc
reaseth
e i
rel
imi
nat
ionhal
f-
li
ves
.
Se
rumalb
uminde c
reas
esanda l
pha1-aci
dgly
coprot
eini
ncrea
ses
Phen
ytoinandwarf
ari
naree x
amplesofdr
u g
swithahigh
err
iskoft
oxicef
fec
tswh
ent
he
s
eru
mal
bumi
nle
vel
dec
rea
ses
h
epa
ticme
tab
oli
smofma
nyd
rug
sth
rou
ght
hec
ytoc
hromeP-
450e
nzy
mes
yst
emd
ecr
eas
eswi
th
a
ge.
Ford
rug
swi
thd
ecr
eas
edh
epa
ticme
tab
oli
smc
lea
ran
cet
ypi
cal
l
yde
cre
ase
s30t
o40
%.
Drugsmet
abol
iz
edinp
h a
se1reac
ti
onsli
kel
ypr
olonged
F
irs
t-pa
ssmeta
boli
sm(meta
bol
i
sm, t
ypi
cal
l
yhepati
c,t
hatoc
cur
sbe
for
ead
rugr
eac
hes
s
yst
emi
cci
rc
ula
tion
)de
cre
asi
ngb
yab
out1
%/y
raf
tera
ge4
0.
Th
us,
forag
ive
nor
aldos
e,ol
dera
dul
tsma
yha
veh
igh
erc
ir
cul
ati
ngd
rug
c
onc
ent
rat
ion
s.
De
cre
ase
dre
nal
eli
min
ati
on
We
ek2a
nd3
I
den
tif
yan
dde
scr
ibe1
2le
adE
KGst
hatd
emon
str
ate
:
s
t n
d r
d
1,
2,a
nd3 d
egr
eeAVb
loc
ks
s
t
1d
egr
eeHBc
ard
scon
sul
t
n
d
2 d
egr
eeHB t
ype1&2
Ty
pe1:
Echo(r
/os
tru
ctu
ral
dx)
,Th
yroi
dle
vel
s,me
ds,
lyt
est
oid
ent
if
yan
dtr
eatc
aus
e
Ty
pe2
:PPM,
con
tin
uou
ste
lewi
tht
ran
scu
tan
eou
spa
cin
gifn
eed
ed,
det
ermi
nec
aus
e;
I
Vat
rop
inei
fpo
orp
erf
usi
ons
/sq3
-5mwi
thma
x3mgi
fs/
spoorp
erf
usi
on;
I
fnor
esp
ons
etoa
trop
ined
opa
,ep
i,i
sop
rot
ere
nol
r
d
3 d egre
e/comple
teHB:PPM;tel
ea ndtr
anscut
aneouspac
eifnede
d ;i
den
tif
yc au
se;I
V
at
ropi
nei
fs/spoorp
erf
usi
on;
Ifnores
ponsetoat
ropin
edopa,
epi
,i
s op
rot
erenol
STEMIinanylea
d(knowwhatar
eaoft
hehearti
saff
ecte
db a
s e
donleadl
oca
tion)
Atr
ial
fibr
il
l
ati
on:
, St
abl
eRa
tec
ont
rol
vsr
hyt
hmc
ont
rol
str
ate
gy(
AVn
oda
lbl
ock
ers
,
a
nti
arr
hyt
hmi
cs,
ant
ic
oag
ula
tion
);a
bla
tioni
fnor
esp
ons
etome
ds;
u
nst
abl
e DCC/
CV
Atr
ial
flu
tter
CV; r
atecont
rolnotasre
spon
siv
easa
fib
Vent
ri
cularfi
bri
ll
ati
on:
De f
ibr
il
la
teandCPR
VT:st
able
Stabl
e/nonsust
ained BB
Amiodar
one,s
ota
lol
,me
xil
et
inet
ore
duc
e#s
hoc
ks
Mgift
orsad
es
EPS/
abl
ati
on
n
d
Un
stabl
e CPR,e
piv
aso(2 dose)
,ami
o,li
doc
aine,
mg ,a
irwayma
nag
eme
nt
Ta
chy
card
ia:
Vaga
lmaneuv
er,
ade
nosi
ne(
6/12
mg )
,BBorCacha
nnel;
ablat
ion
;
a
nti
arr
hyt
hmi
csi
fnor
esp
ons
etoBBord
on’
twa
nta
bla
tion
Asy
stol
e:CPR
Di
st
ing
uis
hb et
weendi
hyd
rop
yri
di
nea
ndn
on-
di
hyd
rop
yri
di
nec
alc
iumc
han
nel
bloc
ker
.Kn
owwh
at
c
ond
iti
onse
achc
las
swou
ldb
eus
edt
otr
eat
.
d
ihy
drop
yri
di
nec
alc
iumc
han
nel
bloc
ker
:(e
.g.
,ni
fed
ipi
ne,
aml
odi
pi
ne)p
rima
ril
yac
tonv
asc
ula
r
s
moot
hmu
scl
es
u
seforHTN
n
on-
di
hydr
opyr
idi
neca
lci
umc
han
nel
bloc
ker
:(d
il
ti
aze
m<v
era
pami
l
)pr
ima
ril
yac
tont
heh
ear
t
useforCP,
SVT(ver
ap);
contr
oll
i
ngir
regu
larr
api
dHRan
dlower
ingBP(Dil
ti
azem)
De
scr
ibet
heme
dic
ati
onstotr
eata
tri
alf
ibr
il
l
ati
on(r
ate
,rhyt
hm,an
dembol
usp
reven
tion
).Knowth
esi
de
e
ffe
cts
,ne
ede
dmon
itor
ing
,an
din
ter
act
ionf
ore
achoft
hes
eme
dic
ati
ons
.
Ca
lcu
lat
eaCHADS2scor
eanddescr
ibetr
eatmentbasedonthescor
e:
1poi
ntf
ort
hefol
l
owingh/
o:HF,HTN, DM,st
roke/
TIA(2pt)andage>
/=7
5
0=lowri
sk,
1-2=modr i
sk,
>3=h ig
hr i
sks t
arta
ntic
oa g
Ca
lcu
lat
eaHASBL EDs coreandd escr
ibetrea
tme ntbasedont h
escore:
1poi
ntfore achoft hefol
lowing:
Hy p er
tension
Unc ontroll
ed,>160mmHgs y
stol
ic
Re na ldi
s ease(Dia
lysi
s,tr
a n
splant
,Cr> 2.
26mg /dLor>200µmol/L
)
Live rdi
s ease(Cirr
hosisorbil
ir
ubin> 2xnormalwit
hAST/ALT/AP>3xnor
mal
)
Strokeh ist
ory
Priorma j
orb l
eedingorp r
edisp
ositi
ont obleed
ing
La bileINR( Unstabl
e /
highINRs,ti
mei ntherape
uti
crange<60%)
Ag e> 65
Me d ic
ationu sagep r
edis
po s
ingtobleeding(Aspi
ri
n,cl
opi
dogrel
,NSAI
Ds)
KeyConcept
sWeek1t
o5
We
ek1
De
scr
ibet
hec
ytoc
hromeP4
50s
yst
em.
Des
cri
beh
owi
ndu
cer
san
din
hib
itor
saf
fec
tth
ecy
toc
hrome
s
yst
ema
ndh
owt
hata
ffe
ctst
heh
alf
-l
if
eofme
dic
ati
ons
.
Cy
toch
romep 450s y
ste
mi sas er
iesofenzymesusedtome t
abol
izemedi
cat
ions.
Dr
ugsthatcau
s eCYP450me ta
boli
cd ru
gintera
cti
onsarer
eferr
edtoasei
theri
nhi
bit
orsori
ndu
cer
s.
Ind
uce r
sincre
aseCYP4 5
0e nzymea ct
iv
itybyi
ncrea
sin
ge nzy
mes y
nthe
sis
I
nhi
bit
orsblockthemetab
olicact
ivit
yofoneormor eCYP450enzymes
De
scr
ibet
hea
ffe
ctonl
owa
ndh
igha
lbu
minl
eve
lsona
cti
ved
rugl
eve
lse
spe
cia
ll
yford
rug
sth
ata
re
h
igh
lyp
rot
ei
nbou
nd.
Al
bumi
nist
hep lasmap r
otei
nwit
htheg r
eates
tc a
pa c
ityforbindi
ngdrugs.
Bi
ndin
gt op l
asmap r
ote
insaff
ectsdrugdi
stri
buti
oni ntoti
ssues
,b e
causeonl
ydrugtha
tis
notb ou
n disava
il
abl
etop e
n e
trat
etiss
ue s
,b i
ndtor ecep
tor
s,ande xe
rtac
ti
vi
ty.Asfr
ee
drugleavesthebl
oodstr
eam,moreb ounddrugisr e
leasedf
romb indi
ngsi
tes
.
Hi
ghl
ypr
ote
inb ounddrugs,l
owalbuminlev
els(w/ma l
n utr
it
ion,orchr
onicil
ln
ess)maylea
dto
t
oxi
ci
tyb
eca
uset
her
ear
efe
wert
hant
hen
orma
lsi
te
sfort
hed
rugt
obi
nd
De
scr
ibewa
yst
ole
sse
nth
ehe
pat
icf
ir
stp
asse
ffe
ct:
met
abol
i
smd
uri
ngf
ir
stp
asst
hrou
ght
hel
i
ver
Al
te
rna
tiv
erou
tes(
sup
pos
it
ory
,in
tra
ven
ous
,in
tra
mus
cul
ar,
inh
ala
tion
ala
eros
ol,
tra
nsd
erma
l,a
nd
s
ubl
i
ngu
al)a
voi
dth
efi
rst
-pa
sse
ffe
cta
ll
owd
rug
stob
eab
sor
bedd
ire
ctl
yin
tot
hes
yst
emi
c
c
ir
cul
ati
on
Bea
bletocal
cul
atecr
eati
ni
necl
eara
nceu
singt
heCock
graf
tGa
ulte
qui
ati
on:
Male =([
140-
age]×wei
ghti
nkg)
/(s
eru
mc r
eat
ini
ne×72
)
Femal
e =CrCl(mal
e)×0.
85
Des
crib
ewh a
tdetermi
nesth
efrequ
encyofd r
ugadmini
st
rat
ion:
Drughal
f-l
i
fe,pl
asmaconce
ntr
ati
o n
Befamil
iarwit
htheBeerscr
it
eri
aandhowt ousei
t:
Poten
tia
ll
yInappr
opr
iat
eMe di
cat
ionUseinOl
derAdult
s
tocall
att
ent
iontomedic
a t
ion
sthata
recommon l
ypr
obl
ema
tic
,an
dth
uss
hou
ldb
eav
oid
ed
i
nmos
tol
dera
dul
ts
De
scr
ibef
act
orst
hataf
fec
tab
sorpt
ion,d
ist
ri
but
ion
,me t
aboli
smandexc
ret
ion:
Ab
sor
pti
onlowbl
oodst
ate(
s h
ockorarr
est
);c
ontactt
imewit
hGItr
actt
oof
ast(
dia
rrh
ea=c
an’
t
a
bsor
b);
del
aye
dst
oma
che
mpt
yi
ng(
lar
geme
al=d
ela
yeda
bsor
pti
on)
;dr
ug-
dru
gord
rug
-food
i
nte
rac
ti
ons
Met
abol
i
s m gen
eti
cs,a
ge,or
ganfu
n c
ti
on
Di
st
ri
but
ion l
owa l
bumi
nle
v e
ls,
bodycompos
it
ion
,ca
rdi
acd
ecomp(
HF)
,an
dag
e
, E
xcr
eti
on a
ffe
cte
dbya
bnor
mal
kid
neyorl
i
verf
unc
ti
on;
age
,dr
ugi
nte
rac
ti
ons
8
.De
fin
ena
rrowt
her
ape
uti
cin
dexHowwou
ldy
oumon
itorap
ati
entwi
than
arr
owt
her
ape
uti
cin
dex
?
, Th
erape
uti
cin
dex:doser
angewher
eef
fic
acyofmedi
sopti
miz
e dwh
il
esi
deeff
ect
smini
miz
ed
Nar
rowthe
rapeu
tici
ndex(
NTI)d
rugsa
redefi
neda
sthos
edrugswher
esmal
ldi
ff
ere
nce
sindos
e
orb
loodc
onc
ent
rat
ionma
yle
adt
odos
ean
dbl
oodc
onc
ent
rat
ionde
pen
den
t,s
eri
ous
t
her
ape
uti
cfa
il
ure
sora
dve
rsed
rugr
eac
ti
ons
.
Bl
oodtes
tst
omon i
torbl
oodc oncen
tra
tion
sa n
dd oseadj
ustment
sa ccor
ding
ly
De
scr
ibehowagi
ngaff
ectabsor
pti
on,dis
tri
buti
on,metab
olis
m, a
nde x
cret
ion
Decr
eas
edorg
anfuncti
on,poorl
ytol
erat
ed r
ugsthatre
quir
eme t
aboli
sm,lowerr
ate
sofe
xcr
eti
on
d
ecr
eas
eins
mal
l
-bowe
lsu
rfa
cea
rea
,sl
owe
dga
str
ice
mpt
yi
ng,
anda
nin
cre
asei
nga
str
icp
H,
c
han
gesi
ndr
uga
bsor
pti
on
Wi
tha
ge,
bod
yfa
tge
ner
all
yin
cre
ase
san
dtot
alb
odywa
terd
ecr
eas
es.
Inc
rea
sedf
ati
ncr
eas
est
he
v
olu
meofd
ist
ri
but
ionf
orh
igh
lyl
i
pop
hil
i
cdr
ugs
(eg
,di
azepam,chl
ordi
azep
oxide)andmayinc
reaseth
e i
rel
imi
nat
ionhal
f-
li
ves
.
Se
rumalb
uminde c
reas
esanda l
pha1-aci
dgly
coprot
eini
ncrea
ses
Phen
ytoinandwarf
ari
naree x
amplesofdr
u g
swithahigh
err
iskoft
oxicef
fec
tswh
ent
he
s
eru
mal
bumi
nle
vel
dec
rea
ses
h
epa
ticme
tab
oli
smofma
nyd
rug
sth
rou
ght
hec
ytoc
hromeP-
450e
nzy
mes
yst
emd
ecr
eas
eswi
th
a
ge.
Ford
rug
swi
thd
ecr
eas
edh
epa
ticme
tab
oli
smc
lea
ran
cet
ypi
cal
l
yde
cre
ase
s30t
o40
%.
Drugsmet
abol
iz
edinp
h a
se1reac
ti
onsli
kel
ypr
olonged
F
irs
t-pa
ssmeta
boli
sm(meta
bol
i
sm, t
ypi
cal
l
yhepati
c,t
hatoc
cur
sbe
for
ead
rugr
eac
hes
s
yst
emi
cci
rc
ula
tion
)de
cre
asi
ngb
yab
out1
%/y
raf
tera
ge4
0.
Th
us,
forag
ive
nor
aldos
e,ol
dera
dul
tsma
yha
veh
igh
erc
ir
cul
ati
ngd
rug
c
onc
ent
rat
ion
s.
De
cre
ase
dre
nal
eli
min
ati
on
We
ek2a
nd3
I
den
tif
yan
dde
scr
ibe1
2le
adE
KGst
hatd
emon
str
ate
:
s
t n
d r
d
1,
2,a
nd3 d
egr
eeAVb
loc
ks
s
t
1d
egr
eeHBc
ard
scon
sul
t
n
d
2 d
egr
eeHB t
ype1&2
Ty
pe1:
Echo(r
/os
tru
ctu
ral
dx)
,Th
yroi
dle
vel
s,me
ds,
lyt
est
oid
ent
if
yan
dtr
eatc
aus
e
Ty
pe2
:PPM,
con
tin
uou
ste
lewi
tht
ran
scu
tan
eou
spa
cin
gifn
eed
ed,
det
ermi
nec
aus
e;
I
Vat
rop
inei
fpo
orp
erf
usi
ons
/sq3
-5mwi
thma
x3mgi
fs/
spoorp
erf
usi
on;
I
fnor
esp
ons
etoa
trop
ined
opa
,ep
i,i
sop
rot
ere
nol
r
d
3 d egre
e/comple
teHB:PPM;tel
ea ndtr
anscut
aneouspac
eifnede
d ;i
den
tif
yc au
se;I
V
at
ropi
nei
fs/spoorp
erf
usi
on;
Ifnores
ponsetoat
ropin
edopa,
epi
,i
s op
rot
erenol
STEMIinanylea
d(knowwhatar
eaoft
hehearti
saff
ecte
db a
s e
donleadl
oca
tion)
Atr
ial
fibr
il
l
ati
on:
, St
abl
eRa
tec
ont
rol
vsr
hyt
hmc
ont
rol
str
ate
gy(
AVn
oda
lbl
ock
ers
,
a
nti
arr
hyt
hmi
cs,
ant
ic
oag
ula
tion
);a
bla
tioni
fnor
esp
ons
etome
ds;
u
nst
abl
e DCC/
CV
Atr
ial
flu
tter
CV; r
atecont
rolnotasre
spon
siv
easa
fib
Vent
ri
cularfi
bri
ll
ati
on:
De f
ibr
il
la
teandCPR
VT:st
able
Stabl
e/nonsust
ained BB
Amiodar
one,s
ota
lol
,me
xil
et
inet
ore
duc
e#s
hoc
ks
Mgift
orsad
es
EPS/
abl
ati
on
n
d
Un
stabl
e CPR,e
piv
aso(2 dose)
,ami
o,li
doc
aine,
mg ,a
irwayma
nag
eme
nt
Ta
chy
card
ia:
Vaga
lmaneuv
er,
ade
nosi
ne(
6/12
mg )
,BBorCacha
nnel;
ablat
ion
;
a
nti
arr
hyt
hmi
csi
fnor
esp
ons
etoBBord
on’
twa
nta
bla
tion
Asy
stol
e:CPR
Di
st
ing
uis
hb et
weendi
hyd
rop
yri
di
nea
ndn
on-
di
hyd
rop
yri
di
nec
alc
iumc
han
nel
bloc
ker
.Kn
owwh
at
c
ond
iti
onse
achc
las
swou
ldb
eus
edt
otr
eat
.
d
ihy
drop
yri
di
nec
alc
iumc
han
nel
bloc
ker
:(e
.g.
,ni
fed
ipi
ne,
aml
odi
pi
ne)p
rima
ril
yac
tonv
asc
ula
r
s
moot
hmu
scl
es
u
seforHTN
n
on-
di
hydr
opyr
idi
neca
lci
umc
han
nel
bloc
ker
:(d
il
ti
aze
m<v
era
pami
l
)pr
ima
ril
yac
tont
heh
ear
t
useforCP,
SVT(ver
ap);
contr
oll
i
ngir
regu
larr
api
dHRan
dlower
ingBP(Dil
ti
azem)
De
scr
ibet
heme
dic
ati
onstotr
eata
tri
alf
ibr
il
l
ati
on(r
ate
,rhyt
hm,an
dembol
usp
reven
tion
).Knowth
esi
de
e
ffe
cts
,ne
ede
dmon
itor
ing
,an
din
ter
act
ionf
ore
achoft
hes
eme
dic
ati
ons
.
Ca
lcu
lat
eaCHADS2scor
eanddescr
ibetr
eatmentbasedonthescor
e:
1poi
ntf
ort
hefol
l
owingh/
o:HF,HTN, DM,st
roke/
TIA(2pt)andage>
/=7
5
0=lowri
sk,
1-2=modr i
sk,
>3=h ig
hr i
sks t
arta
ntic
oa g
Ca
lcu
lat
eaHASBL EDs coreandd escr
ibetrea
tme ntbasedont h
escore:
1poi
ntfore achoft hefol
lowing:
Hy p er
tension
Unc ontroll
ed,>160mmHgs y
stol
ic
Re na ldi
s ease(Dia
lysi
s,tr
a n
splant
,Cr> 2.
26mg /dLor>200µmol/L
)
Live rdi
s ease(Cirr
hosisorbil
ir
ubin> 2xnormalwit
hAST/ALT/AP>3xnor
mal
)
Strokeh ist
ory
Priorma j
orb l
eedingorp r
edisp
ositi
ont obleed
ing
La bileINR( Unstabl
e /
highINRs,ti
mei ntherape
uti
crange<60%)
Ag e> 65
Me d ic
ationu sagep r
edis
po s
ingtobleeding(Aspi
ri
n,cl
opi
dogrel
,NSAI
Ds)
