Side Effects Flashcards
Amiodarone (Naxterone, Pacerone)
BW: pulmonary toxicity, Hepatotoxicity, PROARRHYTHMIC = must be hospitalized for IV loading dose
CI: iodine hypersensitivity (contains iodine)
Warning: Hyper and Hypothyroidism, optic neuropathy, photosensitivity (slate blue skin discoloration), neurotoxicity, SJS
SE: hypotension, bradycardia, corneal microdeposisits, photosensitivity, drug-induced lupus erythematosus (DILE)
MONITOR: LFTs, BP, thyroid every 3-6 months, chest xray, ECG ——– HALF LIFE 40-60 days!!!!
DOC in HF
DRUG interations: CYP inhibitor
increases warfarin action and simastatin and lovastatin
**be careful with the bradycardia with other drugs (nonDHP, beta blockers, digoxin)
Diltiazem (Cardizem, Tiazac)
CI: HFrEF, severe hypotension, heart block
Warning: hypotension, WORSENS heart failure, increases LFT
SE: edema, arrhythmias, constipation, gingival hyperplasia
CYP inhibitors - do not take with grapefruit!
Verapamil (Calan SR)
CI: HFrEF, severe hypotension, heart block
Warning: hypotension, WORSENS heart failure, increases LFT
SE: edema, arrhythmias, constipation (MORE than diltiazem), gingival hyperplasia
CYP inhibitors - do not take with grapefruit!
Digoxin (Digox, Lanoxin)
Typical dose: 0.125 - 0.25 mg
CI: Ventricular fibrillation
Warning: vesicant (avoid extravasation)
SE: dizziness, mental disturbances
NARROW THERAPEUTIC INDEX
Toxicities:
initial - n/v, loss of appetite, bradycardia
severe - blurred/double vision, greenish/yellow halos around lights, confusion, delirium
Antidote: DigiFab
not given alone for rate control
**HYPOthyroidism can increase risk of digoxin toxicity
*HYPO K, Mg, and HYPER Ca increase risk of digoxin toxicity!
P-gp substrate —- decrease dose with inhibitors!!! (Amiodarone)
Disopyramide
Proarrhythmic, Anticholinergic effects
Quinidine
Proarrhythmic, Avoid in G6PD deficiency (hemolysis)
CI: use with quinolones or ritonavir == QTc prolongation
SE: drug-induced lupus erythematosus (DILE), diarrhea, stomach cramping
Cinchonism (overdose): tinnitus, hearing loss, blurred vision, delirium
**Na intake increases Quinidine (consistent use)
***Alkaline foods increase Quinidine
Procainamide
Active metabolite = NAPA is renally cleared, decrease dose CrCl < 50
Proarrhythmic
BW: agranulocytosis, + ANA –> lupus (DILE)
SE: hypotension, rash
Flecainide
BW: Proarrhythmic especially in AF
reserve for patients with life-threatening ventricular arrhthmias
SE: dizziness, visual disturbances, dyspnea
Propafenone
reserve for patients with life-threatening ventricular arrhthmias
CI: heart failure, myocardial infarcation, sinus bradycardia, cardiogenic shock, hypotension
SE: taste disturbance (Metallic), dizziness, visual disurbances
** also has beta blocking effect
Dronedarone
BW: increased risk of death stroke and HF in patients with decompensated HFor permanent AF :(
CI: concurrent use with CYP inhibtiors and QTc prolonging medications, PREGNANCY, hepatic impairment
Warning: hepatic failure, pulmonary disease, increased SCr, hypomagnesia, hypokalemia
SE: QTc, diarrhea, bradycardia, asthenia
**DOES NOT CONTAIN IODINE —- little effect on thyroid (:
major substrate!
Sotalol
Non-selective beta blocker
CrCl < 60 —- decrease frequency
BW: ECG monitoring at initation — QTc
CI: heart block, sinus bradycardia, uncontrolled HF, asthma, cardiogenic shock
SE: bradycardia, palpitations, chest pain, dizziness, fatigue, TdP, bronchocontriction!
Ibutilide
ONLY of conversion to NSR
Proarrhythmic
SE: ventricular tachycardias, hypotension, QTc
**correct Mg and K before use
Dofetilide
BW: administered with ECG moniotring and assess CrCl for 3 days
Proarrhythmic
CI: QTc > 440 msec at baseline and some drugs
SE: ventricular tachycardias (TdP), QTc prolongation!!!!!!
DOC for HF patients
Adenosine
t1/2 - less than 10 seconds
Used for SVT ONLY
SE: transient new arrhythmias, facial flushing, chest pain, GI distress, transient decrease in blood pressure, dyspnea
CI: heart block, symptomatic bradycardia
6 mg IV push
