Pharmocology Cardiac Exam #1 Flashcards
Side Effects, Contraindications, and Interactions
ACE Inhibitors captopril (Capoten) Side Effects:
Severe hypotension, Dry productive cough (Rx may be discontinued), Angioedema (tx with epi), Rash and metallic taste in mouth.
ACE Inhibitors captopril (Capoten) Contraindications:
Preg(D), Angioedema, hypotension, liver disease
ACE Inhibitors captopril (Capoten) Interactions:
Potassium sparing diuretics, NSAIDS (decrease effectiveness), may in crease lithium toxicity
ARB’s (Angiotension II Receptor Blockers) losartan (Cozaar) Side Effects:
Angioedema, HA, insomnia, Severe Hypotension (expand volume with IV therapy)
ARB’s (Angiotension II Receptor Blockers) losartan (Cozaar) Contraindications:
Preg(D)
ARB’s (Angiotension II Receptor Blockers) losartan (Cozaar) Interactions:
other hypertensive Rx
Aldosterone Antagonists eplerenone (Inspra) and sprironolactone (Aldactone) Side Effects:
Hyperkalemia
Aldosterone Antagonists eplerenone (Inspra) and sprironolactone (Aldactone) Contraindications:
Serum potassium above 5.0mEq/L
Aldosterone Antagonists eplerenone (Inspra) and sprironolactone (Aldactone) Interactions:
Drugs that increase potassium, may cause Lithium toxicity
Direct Renin Inhibitors aliskiren (Tekturna) Side Effects:
Hyperkalemia, Cough or Angioedema, Diarrhea or abdominal pain (high doses)
Direct Renin Inhibitors aliskiren (Tekturna) Contraindications
Preg(D)
Calcium Channel Blockers nifedipine(Adalat, Procardia) Side Effects:
Reflex tachycardia (rx beta blocker), Lightheadedness, dizziness, facial flushing, peripheral edema of feet and legs, Hypotension, Gingival hyperplasia
Calcium Channel Blockers nifedipine(Adalat, Procardia) Contraindications:
Hx of acute MI, unstable angina, aortic stenosis, GI obstruction, children
Calcium Channel Blockers nifedipine(Adalat, Procardia) Interactions:
Beta blockers Increase risk for HF
Alpha1 Adrenergic Blockers doxazosin(Cadura) Side Effects:
Ortho Hypo, Reflex tachycardia
Alpha1 Adrenergic Blockers doxazosin(Cadura) Contraindications:
Hypotension, hx of syncope, children
Alpha1 Adrenergic Blockers doxazosin(Cadura) Interactions:
sildenafil(Viagra) increases hypotension
Beta Adrenergic Blockers atenolol(Tenorimin) and metoprolol(Lopressor) Side effects:
Bradycardia, HF, Rebound excitation-angina or MI with sudden withdrawal (taper 1-2weeks)
Beta Adrenergic Blockers atenolol(Tenorimin) and metoprolol(Lopressor) Interactions:
Beta blockers with OA’s increase risk for hypoglycemia
Beta Adrenergic Blockers atenolol(Tenorimin) and metoprolol(Lopressor) Contraindications:
Sinus bradycardia, moderate to severe HF, PVD, children under 6
Adrenergic Neuron Blockers reserpine(Serpalan) Side Effects:
Severe depression, Bradycardia, Ortho Hypo, GI problems
Adrenergic Neuron Blockers reserpine(Serpalan) Contraindications:
Preg(D), pt with depression, MAOI’s, ulcers/ulcerative colitis
Adrenergic Neuron Blockers reserpine(Serpalan) Interactions:
MAOI’s, antihypertensive drugs increase risk for hypotension
Centrally Acting Alpha2 Agonists clonidine(catapres) Side Effects:
CNS effects: Drowsiness, dizziness; dry mouth; Rebound hypertensive crisis may result if discontinued abruptly (taper dose)
Centrally Acting Alpha2 Agonists clonidine(catapres) Interactions:
CNS depressants, TCA’s
Centrally Acting Alpha2 Agonists clonidine(catapres) Contraindications:
Anticoagulant therapy
Alpha/Beta Blockers carvedilol(Coreg) Side Effects:
Dizziness, Hypotension, Bradycardia (report HR less than 60)
Alpha/Beta Blockers carvedilol(Coreg) Contraindications:
Unstable HF, Severe bradycardia, asthma or chronic resp. disorder
Alpha/Beta Blockers carvedilol(Coreg) Interactions:
Increased risk for hypoglycemia with insulin or OA’s, MAOI’s, antihypertensive drugs Increase risk for hypotension
Direct Acting Vasodialators hydralazine(Apresoline) Side Effects:
HA and palpitations; tachycardia (beta blocker can decrease); Systemic Lupus; Fluid retention, edema; abrupt withdrawal may cause hypertensive crisis and HF (Taper slowly)
Direct Acting Vasodialators hydralazine(Apresoline) Contraindications:
MI, Tachycardia
Direct Acting Vasodialators hydralazine(Apresoline) Interactions:
MAOI’s, other antihypertensives
Thiazide Diuretics hydrochlorothiazide(HydroDIURIL) Side Effects:
Fluid and Electrolyte imbalances, Hyperglycemia, Increased uric acid levels
Thiazide Diuretics hydrochlorothiazide(HydroDIURIL) Contraindications:
Greatly Decreased urine output, electrolyte imbalance
Thiazide Diuretics hydrochlorothiazide(HydroDIURIL) interactions:
lithium toxicity
Loop Diuretics furosemide (Lasix) Side Effects:
Fluid and electrolyte imbalances, Hypotension, Ototoxicity, Hyperglycemia, Increased uric acid
Loop Diuretics furosemide (Lasix) Contraindications:
Electrolyte imbalance or dehydration, Increased oliguria
Loop Diuretics furosemide (Lasix) Interactions:
Digoxin toxicity is increased with hypokalemia, NSAIDs decrease effects, Lithium toxicity may occur, Ototoxic drugs
Potassium-sparing diuretics spironolactone(Aldactone) Side Effects:
Hyperkalemia; Menstrual irregularities, abnormal hair growth, deepening of voice (in women); Gynecomastia (in men)
Potassium-sparing diuretics spironolactone(Aldactone) Contraindications:
Preg(D), Renal Failure, Hyperkalemia
Potassium-sparing diuretics spironolactone(Aldactone) Interactions:
ACE inhibitors, ARB’s, Direct renin blockers, potassium supplements, and salt subs
Cardiac Glycosides digoxinILanosin) Side Effects:
GI problems, CNS sx: HA, Visual disturbances, yellow vision, blurred vision (may be signs of early toxicity), Cardiac dysrhythmias (withold if less than 60/min) for severe toxicity: IV digoxin immune Fab (Digibind)
Cardiac Glycosides digoxinILanosin) Contraindications:
Ventricular fibrillation or tachy, digoxin toxicity
Cardiac Glycosides digoxinILanosin) interactions:
Other antidysrhythmics, diuretics
sympathomimetics dobutamine(Dobutrex) Side Effects:
Tachycardia, Cardiac dysrhythmias, possible angina pain
sympathomimetics dobutamine(Dobutrex) Contraindications:
V-Tach, dehydration, children under 2
sympathomimetics dobutamine(Dobutrex) Administrations:
IV only
sympathomimetics dobutamine(Dobutrex) Interactions:
MAOI’s, TCA’s, General anesthetics, Beta blockers
Phospodiesterase Inhibitors milrinone(Primacor) Side Effects:
Hypokalemia, Cardiac dysrthythmias, Hypotension, Anginal chest pain
Phospodiesterase Inhibitors milrinone(Primacor) Admin:
IV Only
Phospodiesterase Inhibitors milrinone(Primacor) Contraindications:
Aortic or pulmonary valve disorder, acute MI
HMG-CoA Inhibitors (Statins) simvastatin(Zocor) Side Effects:
Myopathy can progress to rhabdomyolysis, liver toxicity
HMG-CoA Inhibitors (Statins) simvastatin(Zocor) Contraindications:
Preg(X), Current liver disease, renal failure, Rhabdomyolysis, MS, children under 10
HMG-CoA Inhibitors (Statins) simvastatin(Zocor) INteractions:
other drugs that lower cholesterol, drugs that inhibit CYP3A4, Grapefruit juice, warfarin
Fibrates gemfibrozil(Lopid) Side Effects:
GI problems NVD, Gallstones, Myopathy (measure CPK), Liver toxicity
Fibrates gemfibrozil(Lopid) Contraindications:
Gall bladder disease, LIver dysfunction, renal impairment
Fibrates gemfibrozil(Lopid) Interactions
Statin antilipemics greatly increase risk for myopathy, Warfarin, statins increase risk for hypoglycemia
Nitrates nitroglycerin(Nitrostat) Side effects:
HA, Ortho Hypo, Tachy, Tolerance
Nitrates nitroglycerin(Nitrostat) Contraindications:
Hypotension, Hypovolemia, hyperthyroidism, liver disease
Nitrates nitroglycerin(Nitrostat) Interactions:
Increased hypotension with antihypertensives, betablockers and calcium blockers decrease tachy (desired effect)
Class IA Sodium Channel Blockers quinidine, procainamide side effects:
Hypotension, ventricular dysrhythmias, arterial embolism, speed shock with too rapid IV, Quinidine: cinchonism, Procainamide: SLE, Agranulocytosis (only used short term)
Class IA Sodium Channel Blockers quinidine, procainamide Contraindications:
Impaired liver function, HF, renal impairment
Class IA Sodium Channel Blockers quinidine, procainamide Interactions:
Anticholinergics, antihypertensives, grapefruit juice, warfarin
Class IB Sodium Channel Blockers lidocaine(Xylocaine) Side Effects:
CNS effects (toxicity)
Class IB Sodium Channel Blockers lidocaine(Xylocaine) Contraindications:
Supraventricular dysrhythmias, untreated bradycardia
Class IB Sodium Channel Blockers lidocaine(Xylocaine) INteractions:
Beta blockers, Phenytoin
Class IC Sodium Channel Blockers flecainide(Tambocor) Side effects:
Visual effects (blurred, difficult focusing), Worsen HF, edema, Widens QRS, prolongs QT and PR intervals
Class IC Sodium Channel Blockers flecainide(Tambocor) Contraindications:
Recent MI, Electrolyte Imbalance
Class IC Sodium Channel Blockers flecainide(Tambocor) Interactions:
Increases digoxin levels
Class II/ Beta Adrenergic Blockers propranolol(Inderal) Side Effects:
Bradycardia, Rebound excitation (angina pain or MI with sudden withdrawal; do not stop abruptly), CNS effects: Confusion, fatigue, drowsiness, hypoglycemia, Bronchospasms
Class II/ Beta Adrenergic Blockers propranolol(Inderal) Contraindications:
Pulmonary edema, PVD, asthma, severe COPD
Class II/ Beta Adrenergic Blockers propranolol(Inderal) Interactions:
Other antihypertensives, antacids, digoxin, OA may increase Hypoglycemia
Class III/ Potassium Channel Blockers amiodarone(Cordarone) Side Effects:
Pulmonary toxicity with pneumonitis, visual effects(optic neuropathy with possible blindness), cardiac effects (hypotension and bradycardia), Blue grey discoloration of the skin, HF, CNS effects (dizziness, tremor, hallucination)
Class III/ Potassium Channel Blockers amiodarone(Cordarone) Contraindications:
Preg(D), shock, bradycardia, severe hepatic disease
Class III/ Potassium Channel Blockers amiodarone(Cordarone) Interactions:
grapefruit juice
Class IV Calcium Channel Blockers verapamil(Calan) Side Effects:
Hypotension, Bradycardia, HF, peripheral edema, lightheadness, dizziness
Class IV Calcium Channel Blockers verapamil(Calan) Contraindications:
Severe hypotension, CHF
Class IV Calcium Channel Blockers verapamil(Calan) INteractions:
Beta Blockers increase bradycardia and HF, Increased lithium levels, grapefruit juice