phmy P1 1st lab - nonsterile compounding drug list #2

Indications, Contraindications

Ace inhibitors / ace inhibitors and thiazide diuretic combo

hypertension, heart failure

History of angioedema, not w/in 36 hours of entresto

BBW / warnings

Ace inhibitors / ace inhibitors and thiazide diuretic combo

fetal harm and death → avoid if pregnant

angioedema, hyperkalemia, hypotension, renal impairment, avoid if bilateral renal artery stenosis

counseling points / side effects

Ace inhibitors / ace inhibitors and thiazide diuretic combo

avoid salt substitutes containing potassium (K+)

dry cough, hyperkalemia, inc in SCr, hypotension, dizziness

indications / drug interactions

Alpha 1 blockers; antihypertensive

BPH

Caution w/ PDE5 inhibiors (hypotension) or taking tadalafil for BPH

warnings / side effects

Alpha 1 Blockers; antihypertensive

orthostatic hypotension, intraoperative floppy iris syndrome (IFIS) during cataract surgery, priapism

dizzy, fatigue, HA, abnormal ejaculation, Fluid retention

Notes / counseling

Alpha 1 Blockers; antihypertensive

not recommended for high blood pressure alone; may be used in men with HTN and BPH

first dose effect of dizziness. Cardura XL can leave a shell in stool

Indications / contraindications / drug interactions

Angiotensin receptor neprilysin inhibitor (ARNI)

Heart failure

Do not use w/in 36 hours of ace inhibitors; history of angioedema

Dont use w/ ARB or ACE inhibitors, inc use of lithium toxicity

BBW / Warning

Angiotensin receptor neprilysin inhibitor (ARNI)

Fetal Harm and death → avoid in pregnancy

Angioedema, hypotension, hyperkalemia, renal impairment, bilateral renal artery stenosis (avoid use)

Side effects / notes

Angiotensin receptor neprilysin inhibitor (ARNI)

well tolerated; dry cough, hyperkalemia, inc in SCr, dizzy

decrease mortality in HFrEF

Indications / Notes

Alpha II agonist; antihypertensive

hypertension

patch - skin rash, pruritus, erythema → apply weekly to clean, dry, hairless area on upper outer arm or upper chest; remove before MRI

side effects

Alpha II agonist; antihypertensive

dry mouth, constipation, dizzy, fatigue, somnolence, dec HR, hypotension, impotence, behavioral changes

Warnings

Alpha II agonist; antihypertensive

do not d/c abruptly (rebound hypertension). must taper over 2-4 days

indications / contra

Cordarone (amiodarone)

arrhythmias

iodine hypersensitivity, 2nd/3rd degree heart block, cardiogenic shock

BBW / Warnings

Cordarone (amiodarone)

pulmonary toxicity, hepatotoxicity

hyper or hypothyroidism, optic neuropathy, photosensitivity (blue/grey skin discoloration), neurotoxicity, peripheral neuropathy, severe skin reactions (SJS/TEN)

Side effects / counseling

Cordarone (amiodarone)

hypotension, bradycardia, corneal microdeposits, photosensitivity, dizzy, drug induced lupus erythematosus (DILE)

Avoid grapefruit, amiodarone contains iodine; avoid in pregnancy (teratogenic and in breast milk)

drug interactions

Cordarone (amiodarone)

Amiodarone is an inhibitor of CYP450 2C9, 2D6, 3A4, and P-gp → lots of drug interactions

increases conc of digoxin, warfarin, simva/lovastatin

do not use with sofosbuvir → inc bradycardia

indications / contra

Betapace, Sorine (Sotalol)

arrhythmias

2nd/3rd degree heart block, cardiogenic shock

BBW / side effects

Betapace, Sorine (Sotalol)

adjsut dosing interval based on CrCl to dec risk of proarrhythmia, QT prologation, initiate in hospital

bradycardia, palpitations, dizzy, fatigue, HF

indications / contra

Tambocor (flecainide acetate)

arrhythmias

structural heart disease (heart failure, myocardial infarction), 2nd/3rd degree heart block, cardiogenic shock

BBW / warnings / side effects

Tambocor (flecainide acetate)

proarrhythmic effects (esp in atrial fibrillation)

avoid in severe hepatic impairment

visual disturbances, dizzy, dyspnea

indications / contra / notes

Lanoxin (digoxin)

arrhythmias, heart failure

ventricular fibrillation

narrow therapuetic index

warnings / drug interactions / side effects

Lanoxin (digoxin)

2nd/3rd degree heart block w/ a pacemaker

digoxin conc inc when used w/ amiodarone, dilitiazem, verapamil (use caution w/ other heart rate lowering meds)

N/V, loss of appetite, bradycardia, visual disturbances (green/yellow halos), delirium

indications / contra / warnings

fibric acid dervivatives

dyslipidemia

severe liver disease including primary biliary cirrhosis, gallbladder disease, severe renal disease (CrCl </= 30)

myopathy (inc risk in use w/ statin)

Side effects

fibric acid deriviatve

increase LFT’s but also dyspepsia (w/ Lopid only)

Drug interactions / notes

TriCor, Trilipix, Antara (fenofibrate)

increase effects of sulfonylureas and warfarin

fibrates dec TG (however can inc LDL when TG are high)

Drug interactions

Lopid (gemfibrozil)

dont use w/ ezetimibe or statins (inc risk of myopathy and rhabdomyolysis)

indications / drug interactions

Niaspan (niacin)

dyslipidemia

take 4-6 hours after BAS. monitor w/ other hepatotoxic drugs

warnings / side effects

Niaspan (niacin)

rhabdomyolysis, hepatotoxicity, inc in BG, inc in uric acid

flushing, pruritus, vomiting, diarrhea, inc in BG, hyperuricemia (gout)

counseling / notes

Niaspan (niacin)

to reduce flushing take aspirin 325mg or ibuprofen 200mg 1 hour before dose. tk at hs after low fat snack (avoid spicy food, alcohol, and hot beverages)

dec LDL and TG, inc HDL

indications / contra / drug interactions

HMG-CoA reductase inhibitors

dyslipidemia

no pregnant, breastfeeding, or liver disease

dont use w/ gemfibrozil

Warnings

HMG-CoA reductase inhibitors

muscle damage, myopathy, rhabdomyolysis (higher risk if >/= 65 yr old, higher dose, or used w/ niacin, fibrates, or CYP3A4 inhibitors)

in diabetes - inc A1C and FBG (benefit of statin outweighs risk)

side effects / counseling / notes

HMG-CoA reductase inhibitor

well tolerated; myalgia / myopathy

avoid grapefruit

dec LDL and TG, inc HDL

exception - Mevacor (lovastatin)

tk w/ evening meal (unless ER then at hs)

exception Pravachol (pravastatin) and Crestor (rosuvastatin)

less side effects than other statins

exception Zocor (simvastatin)

tk in evening

indications / drug interactions

Zetia (ezetimibe)

dyslipidemia

give ezetimibe 2 hours before or 4 hours after BAS

Warnings / side effects / notes

Zetia (ezetimibe)

myopathy, rhabdomyolysis (inc w/ statin)

myalgia

decrease LDL and TG

indications / contra / drug interactions

Bile Acid Sequestrant

dyslipidemia

bowel obstruction

tk levothyroxine 4 hours before. can dec absorption of fat soluble vitamins (ADEK), folate, and iron

side effects / notes

Bile Acid Sequestrant

constipation, abdominal pain, cramping, bloating, gas, inc TG

dec LDL, inc HDL and TG

indications / contra / drug interactions

ARB or ARB combo w/ thiazide diuretic

hypertension

dont use if history of angioedema

dont use with ACE inhibitors or ARNI

BBW / warnings

ARB or ARB combo w/ thiazide diuretic

fetal harm and death (avoid if pregnant)

angioedema, hyperkalemia, hypotension, renal impairment, bilateral renal artery stenosis (avoid use)

Side effects / notes

ARB or ARB combo w/ thiazide diuretic

generally well-tolerated; dry cough, hyperkalemia, inc SCr, hypotension/dizzy, (less than ace inhibitors)

no washout period required for ARNI

indications / contra / drug interactions

Beta Blocker, Beta 1 selective

hypertension

2nd/3rd degree AV block, severe bradycardia

insulin and sulfonylureas (inc hypoglycemic effects and mask hypoglycemia s/s). use caution w/ other meds that lower HR

BBW / warnings

Beta Blocker, Beta 1 selective

dont d/c abruptly, taper over 2 weeks

caution in pt w/ diabetes or bronchospastic diseases (asthma, COPD) - Beta 1 selective preferred

Side effects

Beta Blocker, Beta 1 selective and Beta Blocker, nonselective; Alpha-1 Blocker

bradycardia, fatigue, hypotension, dizzy, depression, impotence

exception - Toprol xl (metoprolol succinate)

tk w/ food

also for heart failure

exception - Lopressor (metoprolol tartrate)

tk w/ food

exception - Zebeta (bisoprolol) and Ziac (bisoprolol/HCTZ)

also for heart failure

Exception - Inderal, Innopran (propranolol)

also used for migraine prophylaxis

contra - bronchial asthma

Exceptions

Beta Blocker, nonselective; Alpha-1 Blocker

also for Heart Failure

Tk w/ food

dosing conversion is not 1:1 for CR: IR

contra: bronchial asthma

Exception - Labetalol

drug for hypertension during pregnancy