Side Effects and Warnings Flashcards
Lipitor
Atorvastatin
CI: pregnancy, breastfeeding, liver disease
Warnings: muscle damage (increased CPK), use in elderly > 65 years), may increase A1c and FBG (but benefits outweigh the risk)
SE: myalgia/myopathy
hepatotoxicity/nephrotoxicity
Do NOT use with gemfibrozil
Which Statins should you take in the evening?
Lovastatin (Altoprev)
Simvastatin (Zocor)
FLuvastatin
Which statin should you take with a meal?
Lovastatin (Altoprev)
Take in the evening with a meal!
Pravacol
Pravastatin
CI: pregnancy, breastfeeding, liver disease
Warnings: muscle damage (increased CPK), use in elderly > 65 years), may increase A1c and FBG (but benefits outweigh the risk)
SE: myalgia/myopathy
hepatotoxicity/nephrotoxicity
Do NOT use with Gemfibrozil
Which statins should you AVOID with CYP3A4 inhibitors?
Lovastatin (Altoprev)
Simvastatin (Zocor)
What are the CYP3A4 inhibitors that should be avoided?
G PACMAN
Grapefruit
Protease Inhibitors
Amiodarone
Cyclosporine, Cobicistat
Macrolides (not Azithro)
Azoles
Non-DHP CCBs
Zetia
Ezetimibe
CI: pregnancy breastfeeding
Warning: avoid in hepatic impairment
SE: myalgias, diarrhea
Give Zetia 2 hours before bile acid sequestrant
DO NOT use with gemfibrozil (Lopid)
A patient is on Pravachol, Zetia, and Lopid for HLD and high TG. What is wrong with this regimen? What do you recommend?
Lopid (gemfibrozil) should NOT be used with statins or Zetia!!!!!!
Praluent
Alirocumab SC
SE: injection site rxns, URTI, increased LFTs
store in fridge, can be at room temp for up to 30 days
Repatha
Evolocumab
SE; injection site rxns, URTI, back pain
store in fridge, can be at room temp for up to 30 days
Welchol
Colesevelam
Bile acid sequestrant
CI: bowel obstruction, TG > 500, history of TG induced pancreatisis
SE: constipation, ab pain, cramping, bloating, gas, INCREASED TG
***not recommended when TG are >/= 300
**SAFE in pregnancy (:
DECREASED absorption of fat soluble vitamins KADE
Cholestyramine
Bile Acid Sequestrant
CI: biliary obstruction
SE: constipation, ab pain, cramping, bloating, gas, increased TG
**not recommended when TG are >/= 300
**use good oral hygeine!!! Enamel erosion or teeth discoloration!!!
DECREASED absorption of fat soluble vitamins KADE
Which drugs should be taken 4 hours PRIOR to colesevelam (Welchol)?
Levothyroxine
Cyclosporine
Glimepiride (Amaryl)
Glipizide (Glucotrol)
Glyburide (Glynase)
Olmesartan (Benicar)
Phenytoin
Oral contraceptions with Ethyl estradiol and Norethindrone
Antara
Fenofibrate
CI: severe liver disease or renal disease (CrCl < 30), gallbladder disease
Warning: myopathy, increased risk when coadministered with statin!!!!
SE: increased LFT, hypothyroidism, increased CPK
*** can increase LDL when TG are high :(
Tricor
Fenofibrate
CI: severe liver disease or renal disease (CrCl < 30), gallbladder disease
Warning: myopathy, increased risk when coadministered with statin!!!!
SE: increased LFT, hypothyroidism, increased CPK
*** can increase LDL when TG are high :(
Trilipix
Fenofibrate
CI: severe liver disease or renal disease (CrCl < 30), gallbladder disease
Warning: myopathy, increased risk when coadministered with statin!!!!
SE: increased LFT, hypothyroidism, increased CPK
*** can increase LDL when TG are high :(
Lopid
Gemfibrozil
CI: severe liver disease or renal disease (CrCl < 30), gallbladder disease
Warning: myopathy, increased risk when coadministered with statin!!!!
SE: increased LFT, hypothyroidism, increased CPK
*** can increase LDL when TG are high :(
***DO NOT USE WITH STATINS or ZETIA due to increased risk of myopathy and rhabdomyolysis
What lopid and warfarin are given in the same patient what can happen?
Wafarin efffects increase causing an INCREASED bleeding risk and INR
Niacin
CI: active liver disease, PUD, or arterial bleeding
Warning: rhabdomyolysis, hepatotoxicity
INCREASED BG and uric acid and LFTs
SE: FLUSHING, pruritis, vomiting, diarrhea, hyperglycemia, hyperuricemia (GOUT)
Niacor vs Niaspan vs Slo-Niacin
Niacor - IR formulation most flushing and itching
Niaspan - ER formulation
less hepatotoxicity AND less flushing ===== THE BEST CHOICE*****
Slow-Niacin - CR formulation
less flushing but more hepatotoxicity!!!
Vascepa
Icosapent ethyl
Warning: hypersensitivity to fish or shellfish
SE: eructation (burping), dyspepsia, arthralgias
**can increase LDL and BLEEDING RISK!
Lovaza
Omega-3 acid ethyl esters
Warning: hypersensitivity to fish or shellfish
SE: eructatin (burping), dyspepsia, taste perversions
***can increase LDL and BLEEDING RISK
Which dyslipidemia drugs should you avoid in pregnancy?
STATINS + Zetia
Which dyslipidemia drugs are SC and can be stored at room temp for up to 30 days?
Repatha
Praluent
Which dyslipidemia drugs affect the absorption of fat soluble vitamins KADE?
Bile acid sequestrants
Chlorthalidone
CI: hypersensivity to sulfonamide
SE: hypo - K, Mg, Na
hyper - Ca, UA, LDL, TG, BG, Lithium
Photosensitivity
Impotence (ED)
DO NOT USE CrCl < 30
INCREASE Lithium levels
Hydrochlorothaizide
CI: sulfa allergy
SE: hypo - K, Mg, Na
hyper - Ca, UA, LDL, TG, BG, Lithium
Photosensitivity
Impotence (ED)
DO NOT USE CrCl < 30
INCREASE Lithium levels and dofetilide to increase QTc
Norvasc
Amlodipine
Warning: Hypotension
SE: peripheral edema, HA, flushing, palpitations, gingical hyperplasia
*substrate CYP3A4
Nicardipine IV
CI: advanced aortic stenosis
Warning: chronic HTN or BP in non-pregnant adults
DOC in pregnancy!!!!!
*CYP3A4 substrate
Adalat CC
Nifedipine
Warning: hypotension
SE: peripheral edema, HA, flushing, palpitations, gingival hyperplasia, reflex tachycardia
**used to prevent peripheral vasoconstriction in Raynaud’s
*CYP3A4 substrate
Clevidipine
CI: allergies to soy or eggs
SE: hypotension, reflex tachy, infections!!!!! increases TG
**contains 2 kcal/mL of lipid emulsion
**time of use good for 12 hours after puncture!
Tiazac
Diltiazem
CI: hypotension (SBP <90), heart block
Warning: Heart failure!!!!!! bradycardia
SE: edema, gingival hyperplasia, constipation (less than Calan)
**CYP3A4 inhibitors and pgp substrates === lower dose of sim and lova
Calan
Verapamil
CI: hypotension (SBP <90), heart block
Warning: Heart failure!!!!!! bradycardia
SE: edema, gingival hyperplasia, constipation (MORE than Tiazac)
**CYP3A4 inhibitors and pgp substrates === lower doses of sim and lova
Lotensin
Benazepril
BW: Pregnancy - death in developing fetus
CI: angioedema, within 26 hours of Entresto
Warning: angioedema, hyperkalemia, hypotension, renal impairment (increased SCr) bilateral renal artery stenosis
SE: cough (blockage od bradykinin), hyperkalemia, increased SCr, hypotension
Vasotec
Enalapril
BW: Pregnancy - death in developing fetus
CI: angioedema, within 26 hours of Entresto
Warning: angioedema, hyperkalemia, hypotension, renal impairment (increased SCr) bilateral renal artery stenosis
SE: cough (blockage od bradykinin), hyperkalemia, increased SCr, hypotension
Prinivil
Lisinopril
BW: Pregnancy - death in developing fetus
CI: angioedema, within 26 hours of Entresto
Warning: angioedema, hyperkalemia, hypotension, renal impairment (increased SCr) bilateral renal artery stenosis
SE: cough (blockage od bradykinin), hyperkalemia, increased SCr, hypotension
Accupril
Quinapril
BW: Pregnancy - death in developing fetus
CI: angioedema, within 26 hours of Entresto
Warning: angioedema, hyperkalemia, hypotension, renal impairment (increased SCr) bilateral renal artery stenosis
SE: cough (blockage od bradykinin), hyperkalemia, increased SCr, hypotension
Altace
Ramipril
BW: Pregnancy - death in developing fetus
CI: angioedema, within 26 hours of Entresto
Warning: angioedema, hyperkalemia, hypotension, renal impairment (increased SCr) bilateral renal artery stenosis
SE: cough (blockage od bradykinin), hyperkalemia, increased SCr, hypotension
ACE and ARB drug interactions
Increase Lithium concentration!!!!!
*** do not use RAAS inhibitors together
Avapro
Irbesartan
like ACE inhibitors but
- less angioedema
- less cough
- NO WASHOUT PERIOD with entresto
Cozaar
Losartan
like ACE inhibitors but
- less angioedema
- less cough
- NO WASHOUT PERIOD with entresto
Benicar
Olmesartan
Warning: spruce like enteropathy (diarrhea with weight loss)
like ACE inhibitors but
- less angioedema
- less cough
- NO WASHOUT PERIOD with entresto
Diovan
Valsartan
like ACE inhibitors but
- less angioedema
- less cough
- NO WASHOUT PERIOD with entresto
Aldactone
BW: hyperkalemia (K >/= 5.5)
CI: Addisons disease and severe renal impairment
SE: hyperkameia, increased SCr, dizziness, gynecomastia, breast tenderness, impotence (blocks androgens)
Increase Lithium concentration!!!!!
Eplerenone
BW: hyperkalemia (K >/= 5.5)
CI: strong CYP3A4 inhibitors (Azoles, Clarithromycin, Ritonavir)
SE: hyperkalemia, increase SCr, dizziness, hypertriglycerides
Increase Lithium concentration
Triamterne
Hyperkalemia
Increased Scr
Dizziness
INCREASE Lithium concentration (all diuretics!!!!)
Beta 1 selective blockers
“AMEBBA”
Atenolol (Tenormin)
Bisoprolol
Esmolol (Brevibloc)
Metoprolol tartrate (Lopressor)
Metoprolol succinate (Toprol)
Nebivolol (Bystolic
BW: do NOT dc abruptly
CI: heart block
Warning: can worsen diabetes and mask symptoms of hypoglycemia, Raynaud’s syndrome and other peripheral vascular diseases
**preferred in COPD and asthma due to less beta-2 blockage (:
SE: bradycardia, fatigue, hypotension, dizzines, depression, impotence, cold extremities
Beta-1 and 2 blockers
Propranolol (Inderal)
Nadolol (Corgard)
BW: do NOT dc abruptly
CI: heart block
Warning: can worsen diabetes and mask symptoms of hypoglycemia, Raynaud’s syndrome and other peripheral vascular diseases
SE: bradycardia, fatigue, hypotension, dizzines, depression, impotence, cold extremities
Coreg
Carvedilol
BW: do not abruptly discontinue
CI: severe hepatic impairment, heart block
Warning: can worsen diabetes and mask symptoms of hypoglycemia, Raynaud’s syndrome and other peripheral vascular diseases
***take ALL forms with FOOD!!!!!!!!! Carnivor EAT WITH FOOD
SE: Edema, weight gain bradycardia, fatigue, hypotension, dizzines, depression, impotence, cold extremities
Labetalol
DOC in pregnancy
CI: heart block
Warning: can worsen diabetes and mask symptoms of hypoglycemia, Raynaud’s syndrome and other peripheral vascular diseases
BW: do not abruptly discontinue
SE: dizziness, fatigue, bradycardia
Catapres
Clonidine
Warning: do not abruptly dc
SE: dry mouth, somnolence, fatigue, constipation, hypotension, bradycardia, impotence
patch: pruritus, erythema, rash
**weekly patch that you muse remove before MRI
Methyldopa
CI: concurrent use with MAOi
Warning: hemolytic anemia (postive Coombs test)
SE: DILE, edema or weight gain
Hydralazine
Direct vasodilatory
Warning: DILE
SE: peripheral edema, HA, flushing, palpitations, reflex tachycardia
