Heparin 

-what it does

-what is it used for 

Heparin prevents clots by causing prompt antigoagulant activity

Heparin is used for strokes, pulmonary embolisms, and massive DVT

Low molecular weight heparins..

2 medication names 

What are they used for 

Enoxaparin and Dalteparin 

Low molecular weight heparins are used to treat DVT and prevent DVT post-op

Heparin complications 

normal 

life threatening 

what to monitor for 

normal- increased bleeding, heart rate, decreased BP

Life threatening- Hep induced Thrombocytopenia (HIT) 

massive bleeding

watch for bruising, bleeding through mucous membranes, black tarry stools, low platelet counts, Petechiae

Heparin antidote 

Lab to monitor 

Route of administration 

Protamine 

monitor PTT

IV route only 

Heparin contraindications 

 contraindicated in low platelet counts 

following eye, brain, spinal cord surgeries, lumbar puncture, or regional anesthesia 

PUD, severe hypertension, liver or kidney disease 

avoid NSAIDS and other anticoagulants 

Heparin nursing administration 

Obtain baseline vitals, CBC, platelet count

must check with another nurse 

monitor PTT every 4-6 hours 

sub Q (in stomach only) or IV

do not aspirate 

monitor for bleeding

electric razor, soft toothbrush

Oral anticoagulant 

used to treat

Warfarin 

used to treat venous thrombosis,

thrombus formation in A-fib 

prevention of recurrent MI, ischemic attacks, PE, DVT

Warfarin Complications 

Hemorrhage 

monitor vitals and for bleeding

tell patients signs of bleeding 

monitor PT and INR

Warfarin overdose 

antidotes 

Administer Vitamin K 

must be diluted and pushed slowly

If vitamin K doesn't work administer fresh frozen plasma or whole blood 

Warfarin contraindications

prganancy category X- fetal hemmorhage and death

no clients with low platelet counts ( thrombocytopenia) or current uncontrollable bleeding 

recent eye or spinal cord surgeries, lumbar puncture, or regional anesthesia 

Liver or alcohol disorders higher bleed risk

Warfarin interactions 

drugs

foods

drugs: heparin, aspirin, acetaminophen

all increase effects of warfarin

foods: high vitamin K foods 

ie. lettuce, spinach, cabbacge, broccoli, leafy greens, mayo

if you already have diet high in Vit.K it is fine to continue but do not suddenly increase vit. K - decrease effects f warfarin 

warfarin nursing administration

route 

key actions

route is usually always oral

obtain vitals 

monitor PT and INR (most accurate) 

baseline CBC, Platelets, HCt

full effect is not achieved for 3-5 days may be on heparin until then 

avoid alcohol and OTC medication, wear med alert bracelet

bleeding precaustions, toothbrush and razor

Warfarin antidote

administer vitamin K to increase clotting factor 

Direct thrombin inhibitors 

Main drug 

other drugs end in?

how does it work?

Dabigatron 

other drugs end in "rudin"

works by directly inhibiting thrombin thereby, preventing thrombus from being formed 

Dabigatron (rudin)

pharmacological use

prevents stroke or embolism in client who have A-fib

Argatroban

used to prevent or treat thrombosis in clients who can not take heparin due to HIT

heparin induced Thrombocytopenia 

direct thrombin inhibitor complications 

antidote 

GI bleeding, ulcer formation, nausea,vomitting 

- take with food to reduce risk 

Dabigatron has no antidote 

contraindicated in active bleeding and liver impairement 

direct thrombin inhibitor nursing actions

oral capsules 

prefered without food for absorbtion but can be take with food to reduce GI effects 

must be used within 30 days of open container 

Direct inhibitor of factor Xa

drug 

theraputic uses

Rivaroxaban 

ued in clients who have atrial fibrilation and in the prevention of DVT and PE 

Direct inhibitor of factor Xa

complications 

antidote 

interactions 

Rivaroxaban can cause bleeding, GI effects 

teach client how to minotr bleeding and what to report

no antidote

can give activated charcoal to prevent further absorption

Interact with Erythromycin, Diltiazem, Verapamil, amioderone

Direct inhibitor of factor Xa

Key nursing actions 

monitor liver function and kidney function

moitor base line function and test periodically 

monitor HGB and HCT 

use cautiously with multiple anticoagulants 

oral med with food 

Antiplatelets 

drugs (4)

Aspirin (salicyclic)

Clopidegrel

Pentoxyfylline

Cilostazol

antiplatelets 

which two can be given together

clopidogrel and aspirin

antiplatelets 

MOA

theraputic uses

route 

prevents platelets from clumping together 

inhibit platelet aggragation

Used to prevent MI aspirin 81mg/day

ischemic sroke, acute coronary syndrome 

oral route 

antiplatelets 

complications 

what to monitor for 

complications include GI effects, tinnitus- reyes syndrome 

bleeding dizziness, weakness, headache 

monitor for bruising, black tarry stools, bleeding gums, coffee ground emesis, ringing ears 

Thrombolytic medications 

main drug

drugs end in 

when to use the drug 

Alteplase 

"plase" drugs 

clot busters dissolve an active clot if used within 30 mins of formation 

Alteplase 

used for 

special precaution

used to treat acute myocardial infarction 

limit sites of venipuncture and injections 

Alteplase 

contraindications

interactions 

contraindicated in any prior hemorrhages, cerebral vascular lesions, active internal bleeding, history of head or spinal trauma past 2 months, brain tumors, liver or kidney disorder. recent GI bleeding, major surgery w/in 10 days, older clients

Interacts with NSAIDS, heparin, warfarin, thrombolytics, antiplatelets 

Alteplase 

nursing administrations

labs to check 

Use of thrombolyitics should be used within 3 hours of clot

obtain baseline vitals 

platelets, HGB, HCT, aPTT, PT, INR 

ensure adquate IV access for emergency medications and have emergency equipment available 

limit iv puncture sites 

Alteplase Antidote 

Aminocaproic Acid 

Whole Blood

-what does it do

-when is it given 

Whole blood increases the total amount of circulating blood volume 

whole blod is only given in traumatic injuries r surgicl procedures... significant blood loss

Packed Red Blood Cells (PRBCs)

what they do

when are they used 

packed rbc's increase only the rbc count

this is needed in severe symptomatic anemia

rbc's carry oxygen 

Platelet concentrate

what does it do

theraputic uses 

increases platelet count 

used for thrombocytopenia 

platelets less than 20,000

active bleedig less than 50,000

Fresh Frozen plasma 

what does it do

theraputic uses 

replaces coagulation factors 

used in excessive bleeding

massive hemorrhage 

exstensive burns 

Albumin

what does it do 

theraputic uses 

expands circulating blood volume 

theraputic uses 

burns and hypoalbuminemia

Blood product complications 

Acute Hemolytic Reactions:

what it is 

symptoms

when it occurs 

what to do 

Reaction to the wrong blood type 

very deadily will destroy all blood cells

save tubing send to lab  

Assess basline vitals 

stay during the intial 15 mis

will happen very early 

stop infusion immediately!

keep IV open with saline 

Blood product complications 

Febrile nonhemolytic reactions 

most common reaction 

 save tubing send to lab  

fever (any increase in temperature from baseline)

sudden chills 

administer acetaminophen for fever 

Blood product complications

Anaphylactic reactions 

signs and symptoms

what you do 

antidote 

Symptoms- anxiety wheezing SOB shock cardic arrest

what do you do- stop infusion

save tubing send to lab 

notify provider

keep iv open with saline 

administer epinepherine 

Blood product complications

Circulatory overload:

what it is

whos at risk- symptoms

what to do 

Excess fluid volume 

older adults are at a higher risk

and clients who have high infusion unit amounts

symptoms- coughing, SOB, crackles, hypertension, tachycardia, jugular veins 

stop infusion, administer diuretics, and oxygen

monitor I/O

Blood product complications

Sepsis

what to monitor for

symptoms 

what to do 

treatment 

monitor blood product for gas bubbles

discoloration and cloudiness

symptoms rapid onset of chills fever vomitting diarrhea shock hypotension

Obtain blood culture, send the tubing blood to lab for analysis.

Treat with antibiotics and steroids 

Blood Product nursing administrations

key points

Obtain baseline values HGB, HCT, Platelets, protien levels, albumin, PT, PTT, fibrogen, potassium, calcium 

- ensure 20-gauge or larger IV for blood cells

- full transfusion should be done within 4 hours from fridge

- always use 0.9% normal saline 

- change tubing every 2 units of blood to prevent infection

- blood must be in it's own line not with any other meds 

Massive Transfusions 

Greater or equal amounts of blood volume being replaced that are in the body. 

normally 10 units of blood 

or 5 units in 4 hours

monitor PT PTT Platelets every 5 units 

monitor potassium and calcium 

warm blood using blood warmer to prevent hypothermia

Thrombus 

blood clot

Embolism

moving blood clot

to brain or lungs 

Peptic Ulcer disease 

What is it 

The imbalance between gastric mucosal defenses and antagonistic defenses 

Acid becomes too high and breaks down mucosal defense

Peptic Ulcer disease 

Medications 

Antibiotics 

Amoxicillin

Clarithromycin

Metronidazole

Tetracycline

Peptic Ulcer disease 

how do the antibiotics work

alters and stops the disease process 

eradication of H. Pylori bacteria 

Peptic Ulcer disease 

how do you know it is H.Pylori/ how is it treated 

H.Pylori is always treated with 2-3 antibiotics for 14 days to increase the effectiveness and minimize resistance

never suddenly stop antibiotics suddenly 

H2 Receptor antagonists 

Main med

all meds end in

Rantidine 

"tidine" 

H2 Receptor antagonists

Rantidine 

how it works 

lowers acid acid concentration in the stomach

Cimetidine 

-when is it used 

-Sde Effects

hardly used anymore because it causes many adverse side effects 

side effects are decreased libido, gynecomastia, impotence

can inhibit medication metabolizing in warfarin theophylline lidocaine 

Rantidine and famotidine

have almost no side effects 

used to decrease gastric acid and ulcers

caution in elderly (can cause CNS effects)

caution in pneumonia and COPD

monitor WBC

H2 receptor antagonists 

nursing actions 

 tell client to avoid foods that promote gastric acid secretion such as caffiene decaf and caf 

tell clients to avoid NSAIDS

encourage to always call provider if any questions or problems even though meds are OTC talk to pharmacist

proton pump inhibitors

drugs end in 

prazole

proton pump inhibitors

how do they work

theraputic effects 

prazoles work by reducing acid production

ulcers, erosive esophagitis, GERD, hyper acid syndrome

proton pump inhibitors

prazoles 

headache diarrhea nausea vomitting 

osteoperosis long term use - take Vit D an calcium

contraindicacted in clients who have dysphagia or liver disease, COPD, osteoperosis 

Prazoles and azoles do not mix

Digoxin levels increase- monitor levels

proton pump inhibitors

do not crush chew or sprinkle over food

take once a day in morning prior to food

avoid NSAIDS and alcohol 

treat ulcers for 4-6 weeks

watch for bleeding 

Mucosal Protectant 

drug

what does it do 

times to administer 

sucralfate 

form protective barrier over ulcers 

can protect ulcer for 6 hours

take an hour before meals 3x a day and bedtime 

Mucosal Protectant sucralfate 

side effects 

contraindications

interactions 

nursing administration 

no systemic side effects, may cause constipation

contraindicated in kidney disease and failure 

interfere and lessen absorption of warfarin digoxin

give 2 hours apart

take 4x a day an hour before meals and bedtime

Antacids 

how does it work/ what is it used for

3 drugs 

antacids nuetralize gastric acid and inactivate pepcin to reduce pain. Does not cure just relieves pain in GERD

Aluminum hydroxide

Magnesium hydroxide

Calcium carbonate 

Antacids that cause constipation

2 drugs 

what does the calcium compound cause 

kidney stones

drug that causes diarrhea 

magnesium 

two antacids that can be combined 

when are they combined 

aluminum and magnesium 

combined when a client has trouble controlling their bowel functions 

antacids

side effects 

contraindications 

fluid retention in antacids containing sodium- keep away from hypertensive patients ad heart failure

magnesium compounds can lead to toxicity and should be avoided in renal failure 

never take antacids with alcohol or GI obstructions 

antacids 

nursing administration

shake all liquid formulations to evenly disperse medication

medication can be administered 7x daily 

1 hour after each meal

3 hours after each meal

and take before bedtime 

take all other meds an hour apart from antacids 

Prostaglandin E

drug 

when is it used/ what is it for

Misoprostol 

used for prevention of ulcers in long term NSAID use 

used to induce labor in pregnant 

Misoprostol 

side effects 

contraindications 

diarrhea, dysmennorrhea is normal

contraindicated in pregnancy

Gastrointestinal Disorders 

Antiemetics 

used for 

CINV 

cancer induced nausea and vommitting 

anti nausea

Antiemetics 

Dexamethasone

CINV 

glucocorticoid 

raises blood sugar, increases infection

long term cushings disease- moon face buffalo hump 

 Antiemetics 

Ondansetron 

post op drug for nausea 

common drug dizziness headache diarrhea 

CINV

don't give if they have long QT intervals

Antiemetics 

promethazine

must be diulted and administered through central vein 

Side effects sedation hypotension anticholergenic effect 

EPS- face spasms discontinue immediatly 

antidote- diphenhydramine or bensatropine

Antiemetics 

cannabinoids 

treat CINV increase appetite 

decrease BP increase HR

cannibas related side effects 

Anticholinergic 

drug

scopolamine 

treats motion sickness 

transdermal administration 

anticholinergic 

lorazepam

high rates of sedation

depress nerve function at multiple CNS sites 

Laxatives

4 drugs 

Psyllium

docusate 

bisacodyl

magnesium 

Laxative

psyllium 

bulk forming laxative

softens fecal mass and increases bulk 

identical to dietary fiber 

control stool for ileostomy or colostomy 

promotes defecation in older adults 

Laxative 

Docusate 

used for opioid costipation

stool softener doesnt makeyou go just makes it easier

relieves constipation

less painful bowel movements

Laxatives 

bisacodyl

will make you run!

will make you go!

used prior to surgeries or testing like colonoscopy

Laxatives 

magnesium hydroxide 

draws water in to intestine 

used for post op client prep 

rapid evacuation of bowels

gives you the runs 

can lead to magnesium toxicity avoid in kidney function

Laxatives 

contraindications

nursing administrations

contraindicated in clients with bowel obstruction

avoid ulcerative collitis and diverticulitis

teach that laxatives can lead to fluid and electrolyte imbalance

increase fluid amounts 2-3L per day

encourage exercise 

Antidiarrheals 

Diphenoxylate 

will effect CNS at high doses

Decrease intestinal motility in opiod receptors

anticholergenic effects 

provide symptomatic relief to diarrhea 

contraindicated i GI issues and blocks

avoid alcohol and depressants 

tell clients to avoid caffiene and not to drink plain water but refuel electrolytes 

prokinetic agents

Metroclopramide

good for post op nausea and vomitting 

may cause NARCS-U side effects 

increases upper GI motility 

CINV control and GERD management 

may cause sedation and EPS

contraindicated in seizures and GI Issues 

no alcohol or depressants 

IBS-D

drug

whos it for

side effects

cintraindications

nursing administrations

Alosetron

only for women for diarrhea lasting 6months with resistance to first line medications

can result in GI toxicity bowel obstruction and perforation

contraindicated on bowel issues, chrons, bowel obstructions

clients issues should resolve within 4 weeks but will reutrn a week following dicontinuation 

IBS-C

drug

action 

complications

Lubiprostone

increases fluid secretion- causes diarrhea

used for chronic constipation

may cause severe diarrhea monitor stools and loss of fluid and elctrolytes 

Sulfasalazine 

use

complications 

contraindications

used for IBS, crohns, IBD

can cause anemia monitor CBC levels

may cause nausea and vomitting

contrindicated in pregnancy

Probiotics 

various bacteria and yeast and normal flora

used to treat and prevent C.difficile and diarrhea 

may cause bloating and gas

administer 2hrs apart from antibiotics 

Insulin 

pharmacological action

complications 

promotes cellular uptake of glucose - decreases levels

moves potassium into cells

treatment of hyperkalemia, extreme stress and infection

complications are hypoglycemia- too much insulin 

cold and clammy need candy glucose 

Insulin

what is lipohypertrophy 

roatate injection sites and

keep an inch between injection site 

Insulin interactions

Nursng administration

concurrent use of diuretics and glucocorticoids can raise blood sugar levels 

beta blockers can mask the SE of hypoglycemia 

Short acting insulin clear long is cloudy

ensure glucose is near when admin insulin

role vial between hands rotate sites sub Q

Insulin expiration

-unopened insulin

-pre mixed insulin vials

-premixed insulin syringes

-vial in use 

- unopened until expiration date in fridge

-premixed vial in fridge 3 weeks

-premixed syringe 1-2 weeks fridge

-in use room temp away from light and heat 1 month

insulins that are clear in color, not administered IV, should never be mixed with another insulin 

Glargine 

Detemir

Sulfonylureas 

medication

Glipizide 

oral antidiabetic

Glipizide 

how does it work 

type of diabetes

side effects

releases insulin from the pancreas 

type 2 diabetic blood glucose control with diet and exercise

may caue hypoglycemia

give snack 15g carbs

4oz of orange or 2 oz grape juice 

8oz of milk

Glipizide 

key interactions

nursing admnistrations

take with breakfast

Use with alcohol can cause a disulfiram reaction

NSAIDS can cause added hypoglycemic effects 

beta blcokers can mask hypoglycemic signs ad inhibit insulin release 

Biguanides 

oral antidiabetic

medication

Metformin

Metformin

reduces the production of glucose in the liver by suppresing gluconeogenesis

first line medication for type 2 diabetes 

Metformin

may cause hypoglycemia

administer snack 15g or grape 2oz orange 4oz milk 8oz

Gastrointestinal effects minor and go away over time 

Life threatening lactic adidosis

stop medication- shown by hyperventilation myalgia 

Metformin

always discontinue 48 hours before testing with dyes

start med back 48 hours followng testing 

iodine concurrent use results in kidney failure

take med 2x daily with food 

Acarbose

how does it work

side effects

how to take

slows carbohydrate absorption 

side effects are GI discomfort 

Hepatotoxicity long term

get basline liver function and periodic monitoring

use with metformin adds to GI effects 

must take with the first bite of food 3x daily 

Levothyroxine 

used for

interractions

side effects 

contraindictions

Hypothyroidism

Drug increases metabolic rate 

may decrease digoixn levels 

overmedication may cause hyperthyroidism symptoms 

Chronic over treatment may cause A-fib

Contraindicated in MI, cardiovasular disease adrenal insufficiency 

Propylthiouracil (PTU) 

used for

interractions

side effects 

contraindictions

used for hyperthyroidism

creates euthyroid state

too much can cause hypothyroidism 

contraindicated in clients with bone marrow or immune suppresion and liver failure 

interacts with Digoxin and anticoagulants

Hyperthyroidism 

Symptoms 

anxiety, tachycardia, palpitations, altered appetite, Abdominal cramping, heat intolerace, fever, rapid weight loss, menstrual irregularities

Hypothyroidism 

Symptoms 

Drowsiness, depression, weight gain, edema, bradycardia, anorexia, cold intolerance, dry skin

Thyroid disorder umbrella points

-interactions 

-evaluation of effectiveness

-key nursing points 

thyroid drugs interact with Digoxin levels, and cause greater bleeding risk in anticoagulants. Drugs must be continued during pregnancy and provider must be notified to switch drug brands.

effectiveness will create euthyroid state and subside symptoms 

monitor vitals weight I/O CBC T3 T4

Instruct that medication is LIFELONG- do not discontinue

Radioactive Iodine 

what does it do

Treat hyperthyroidism and throid cancer in clients who have not responded to any other treatment options

will destroy thyroid 

Radioactive Iodine 

complications 

contraindications

complications- radiation sickness, nausea vomitting

bone marrow supression hypothyroidism 

Contraindications- Pregnancy X must test for pregnanacy before administering medication 

discontinue all other antithyroid medications 1 week prior

Radioactive Iodine 

nursing administration 

teaching points 

client must remain 6 feet from others 

do not share their utensils

limit contact to 30mins per day per person

increase fluid intake

dispose of waste per biohazard protocol

viod frequently 

keep secretions away from others 

nonradioactive Iodine 

used for

complications

interactions

used to create euthyroid state and decrease thyroid size prior to surgical removal

may cause iodism - early toxicity metallic tast rash frontal headache sore teeth and gums

Interact with iodine enriched food, stay away from seafood 

nonradioactive Iodine 

May be take in conjunction with another therapy, does not interact

dilute iodine with juice to improve taste

take same time daily 

increase fluid intake 

do not discontinue medication

Antidiuretic hormone

medications

Vasopressin 

Desmopressin (synthetic form)

Vasopressin 

what is it 

what it does 

what it is used for 

ADH hormone 

promotes reabsorption of water in kidneys 

causes vasoconstriction

used to treat diabetes insipidus (large excretion of water)

sometimes used during CPR to increase blood flow to brain and heart 

Vasopressin 

complications 

contraindications

nursing administration 

complications are too much water absorption, pounding headache change in LOC

Excessive vasoconstriction - myocardial ischemia

contraindicated in MI Coronary artery disease, renal impairments 

Monitor vitals, EKG BP BUN Creatnine I/O Electrolytes

Hydrocortisone 

how does it work

what is it used for

works my mimicking the effect of natural steriod hormones.

Used for chronic and acute replacement therapy for adrenalcortical insufficiency 

Hydrocortisone 

complications- Osetoporosis long term use, adrenal suppression taper off, PUD- monitor for bleeding, Infetion, retention of fluid and sodium. 

contraindicated in clients with active infection, monitor closely with diabetes, hypertension, heart failure, hypokalemia

Hydrocortisone 

interacts with NSAIDS, acetaminophen, alcohol

do not give with live accines will get infection

give med with food orally, taper dose off do not stop suddenly, notify provider if fever, muscle pain, weakness

what is important to remember about thrombolytic medication

what is the drug name 

Alteplase

can cause a alot of bleeding very quickly, monitor your sites of injection and limit them 

What 2 drugs are most hospital patients on as a preventative

pantoprazole- to prevent stress ulcers when in high stress environment 

Enoxaparin- prevent clots in bed ridden patients

Iron supplements 

drug 

key facts 

Ferrous Sulfate 

treat and prevent iron deficiency anemia

May cause GI effects

potant stain teeth must dilute with orange juice 

IV form may stain skin se Z-track

IV route is safer than parenteral 

may cause tarry stools that are not bleeding!

Vitamin B12

what is it called

Key points

Cyanocobalamin

necessary to convert folic acid into active form

b12 anemia may cause heart dysrhythmias 

loss of intrinsic factor canot take oral

monitor potassium, cannot just treat folic acid

B12 deficiency- beefy tounge pallor neuropathy

Magnesium acts as a?

Laxative 

Potassium

key points

conducts nerve impulses

may cause GI distress 

may give insulin for overdose

never administer bolus must push slowly 

monitor I/O

ange 3.5-5 

what goes first magnesium or potassium

Magnesium before Potassium!

Rapid Acting 

names  

-Insulin glulisine (Apidra)

Rapid acting 

OPD

short acting names

(Novolin R)

short acting 

OPD

O 0.5-1 hour

P 1-5 hours

D 6-10 hours

Intermediate insulin

names 

-NPH (Humulin N)    

Intermediate insulin

OPD

O 1-2 hours

P 6-14 hours

D 16-24hours

Long-acting 

names  

-Insulin detemir (Levemir)

Long acting

O

P

D

O 70 mins

P none
D 24hours

LAB VALUES

AST

LAB VALUES

ALT

0-35

LAB VALUES

BUN

BUN

10-20

LAB VALUES

CREATNINE

0.5-1.2

LAB VALUES

GLUCOSE

65-115

LAB VALUES

MAGNESIUM

1.7-2.7

LAB VALUES

CALCIUM

8.4-10.2

LAB VALUES

POTASSIUM

3.5-5.1

LAB VALUES

SODIUM 

135-145

LAB VALUES

DIGOXIN

0.5-2

LAB VALUES

PT

NEW NORMAL PT

10-13

(1.5 - 2X )

LAB VALUES

aPTT

aPTT NEW NORMAL

24.3- 32.8

(1.5-2.5) X

LAB VALUES

INR

NEW NORMAL INR

 1-2

2-3 

LAB VALUES

WBC

4.1-11.2

LAB VALUES

HGB

MEN / WOMEN

MEN 13-17.3

WOMEN 11.5-15.5

LAB VALUES

HCT

MEN/WOMEN

MEN 40-52

WOMEN 35-46

LAB VALUES

PLT

140-400

LAB VALUES

SERUM CHOLESTEROL

BELOW 200

LAB VALUES

LDL 

BELOW 100

LAB VALUES

HDL

ABOVE 60

LAB VALUES

TRIGLYCERIDES 

BELOW 200

LAB VALUES

VLDL

BELOW 130