Contraindications Flashcards
Abrupt withdrawal can precipitate hypertensive crisis
Centrally Acting Sympatholytics /“Central Alpha Agonists”
Clonidine (Catapres)
Methyldopa
Aldosterone Antagonists and K+ sparing diuretics contraindications
Hyperkalemi
Anuria
severe, progressive kidney disease/dysfunction
Can’t be given during pregnancy or if the patient has angioedema
ACEs and ARBs
TMP-SMX is contraindicated if (renal)
CrCl <15 ml/min
Drugs that contain sulfa
Furosemide (Lasix) Torsemide (Demadex) Bumetanide (Bumex) HCTZ (Microzide) Chlorothiazide (Diuril) TMP+SMX
Caution:
Metolazone (thiazide related)
Antibiotics + Pregnancy
Quinolones, tetracyclines, metronidazole and aminoglycosides unless severe or life threatening infection
Trimethoprim in first trimester (folate)
Sulfas at term (interferes with bile conjugation)
Nitrofurantoin at term (risk of neonatal hemolysis)
Generally, avoid any antibiotics in first trimester if possible and use shortest effective duration
Don’t use ____ with digoxin due to risk of bradycardia or AV block
Carvedilol
Contraindications to laxative use
Acute abdomen Intestinal obstruction Perforation Toxic megacolon Unexplained abdominal pain
Absolute contraindications for opioid use
Hepatic disease
Increased intracranial pressure
Avoid this central alpha agonist during pregnancy
Clonidine
methyldopa okay
Avoid _____ in fibromyalgia
Opioids
too often prescribed but not recommended
Pyridium is contraindicated if..
CrCl < 50
Beers Criteria
use Bactrim with caution→ can elevate risk of hyperkalemia in patients with decreased kidney function who are receiving ACE-I or ARBs
Caution
Rebound effect: acid hypersecretion with
abrupt discontinuation→ Consider taper therapy
PPIs
Avoid codeine and tramadol if….
<12 years old
High potency steroids
Can’t be used on face
Avoid ____ for pain control if a patient has a history of falls or fractures
SNRIs
Lactic acidosis concerns mean you shouldn’t give _____ if kidney impairment
metformin
Stop in cases of N/V, dehydration
Avoid these medications in ESRD
morphine
demerol
hydrocodone
codeine
If social history includes _______ opioids might not be the best choice
History of addictive behavior
Caring for small children at home
Teenagers in home
Digoxin
Don’t give if reduced renal clearance or hypokalemia
Firefighters don’t get
Muscle relaxants
Contains Salicylate → contraindicated with ASA allergy
Avoid use in children/teenagers who have or are recovering from viral illness→ Risk of Reye Syndrome (from ASA)
Pepto Bismol
BPH: avoid
Meds that trigger urinary retention:
Antihistamines
Avoided in patients with seizure disorder or anorexia
Bupropion (Wellbutrin)
Beta blockers
Asthma Severe bradycardia 2nd/3rd-degree AV block Uncompensated HF SBP <100, Cardiogenic shock
- *Avoid abrupt withdrawal!!**
- Can precipitate acute coronary events and severe increases in BP
Glaucoma: avoid
Meds that trigger increased IOP:
Antihistamines
Anti-diarrheal Cautions/Contraindications
Bloody or suspected infectious diarrhea High fever/toxicity Pseudomembranous colitis Acute ulcerative colitis Use caution in patients with a history of drug abuse
Caution in elderly patients with IBS
Dicyclomine (Bentyl)
CCBs contraindications
SA or AV node
Abnormalities, B-blockers, HF
HF→ not given due to edema side effects
NOT indicated for acute “rescue” treatment of bronchospasm
Inhaled anticholinergics (SAMAs/LAMAs)
Don’t give _____ to RA
long term short acting opioids! Switch to long acting with short acting PRN for breakthrough pain.
(this applies to any chronic pain situation)
Is NOT for use with opioids
Buprenorphine patch
Extreme caution with these medications in ESRD
hydromorphone
oxycodone
Don’t use loops (furosemide) with _____ because hypokalemia will increase its toxicity
Digoxin
Don’t use opioids in combination with
Benzos or gabapentinoids
Due to Overdose, respiratory depression and death
(dunno if this only applies to elderly?)
Metoclopramide CI
obstruction
perforation
GI hemorrhage
Don’t give ___ if the patient has anuria
Diuretics (loops, but I think it applies to all)
3 drugs not to combine bc all lower BP, together could cause hypotension
Furosemide
carvedilol
lisinopril
SNRI contraindicated if liver disease
Duloxetine (Cymbalta)
Too sedating for transportation drivers
Cetirizine (Zyrtec)
Levocetirizine (Xyzal)
Azelastine (Asteline)
Nasal Spray
Diphenhydramine (Benadryl)
Nitrates CI
Within 24 hours of
Sildenafil (Viagra
HCM
RV infarction
Abortifacient→ Contraindicated in pregnancy or those who may become pregnant while taking the drug
Misoprostol
