Warning and Conceling

Fetal Toxicity - Discontinue if pregnant, can cause injury or death to fetus

Angiotensin-Converting Enzyme Inhibitor (ACE-I)

May cause dry cough, May rarely cause life-threatening swelling of tongue/face (angioedema)

Angiotensin-Converting Enzyme Inhibitor (ACE-I)

Fetal Toxicity - Discontinue if pregnant, can cause injury or death to fetus

Renal impairment; patients need monitoring

Angiotensin II Receptor Antagonist (ARB)

May cause dizziness, tiredness, weakness, diarrhea, back pain + stuffy nose

Angiotensin II Receptor Antagonist (ARB)

May cause peripheral edema, reflex tachycardia, hypotension, headaches, dizziness, palpitations, constipation, and flushing. May cause rebound hypertension or angina exacerbation with abrupt discontinuation

Dihydropyridine Calcium Channel Blocker

May cause peripheral edema, bradycardia, hypotension, headaches, dizziness, palpitations, constipation (verapamil) and flushing

Non-Dihydropyridine Calcium Channel Blocker

abrupt discontinuation of therapy can exacerbate angina or acute coronary insufficiency develops

Beta Blocker

May cause bradyarrhythmias, bronchospasm, fatigue, memory impairment, sexual dysfunction, and can cause or mask hypoglycemia. Recommended to gradually taper down dosing to avoid acute tachycardia, hypertension, and/or ischemia in those with underlying cardiovascular disease caused when withdrawn abruptly.

Beta Blocker

May cause sexual dysfunction, orthostatic hypotension (less risk with tamsulosin), dizziness, and drowsiness. Take at bedtime. May cause intraoperative floppy iris syndrome in patients undergoing cataract surgery. First dose syncope can occur within 3 hours of first dose or after dose is increased. Can cause priapism

Alpha 1-blocker

May cause hypotension, bradyarrhythmias, bronchospasm, fatigue/sleep disorders, and can cause or mask hypoglycemia. Recommended to gradually taper down dosing to avoid acute tachycardia, hypertension, and/or ischemia in those with underlying cardiovascular disease caused when withdrawn abruptly

Alpha 1-blocker/Beta-Blocker

Epidural clonidine not recommended for obstetrical, postpartum, or perioperative pain management due to risk of hemodynamic instability unacceptable in these patients. In rare cases potential benefits may outweigh possible risks

Central alpha-2 agonist

May cause dizziness, sedation, dry eyes, dry mouth, and other anticholinergic effects. Do not abruptly discontinue medication as can cause rebound hypertension and reflex tachycardia; gradually taper. 

Central alpha-2 agonist

May cause hypotension, reflex tachycardia, headaches, mood changes, fluid retention, anorexia, dermatitis, and lupus-like reactions

Direct Arterial Vasodilator

Fluid/electrolyte loss due to profound diuresis; supervision required together with adjusting dose to pt's needs (Bumetanide + Furosemide)

Loop Diuretics

take earlier in the day to avoid getting up to pee at night as will increase frequency urination. May lead to acute kidney injury due to fluid loss, hypovolemia, hyperglycemia, cause reversible hearing loss (dose-dependent), and/or potentially hypersensitivity reaction (sulfonamide allergy and cross-sensitivities). Consider additional monitoring/avoiding in patients with a history of gout

May cause dehydration

• furosemide 40 mg = bumetanide 1 mg = torsemide 10-20 mg

Loop Diuretics

Fetal toxicity (______ ACEi or ARB combo; see ACEi and ARB)

Thiazide Diuretics

Take earlier in the day to avoid getting up to pee at night as will increase frequency urination. May lead to acute kidney injury due to fluid loss, photosensitivity, cause reversible acute ocular effects, and/or potentially hypersensitivity reaction (sulfonamide allergy and cross-sensitivities). Consider additional monitoring/avoiding in patients with a history of gout since may cause hyperuricemia

Thiazide Diuretics

Hyperkalemia (serum potassium levels ≥5.5 mEq/L) can occur; more likely to occur in patients with renal impairment and diabetes

Potassium Sparing Diuretic

Take earlier in the day to avoid getting up to pee at night as will increase frequency urination. May lead to acute kidney injury due to fluid loss, photosensitivity, cause reversible acute ocular effects, and/or potentially hypersensitivity reaction (sulfonamide allergy and cross-sensitivities)

Potassium Sparing Diuretic

Fetal toxicity - concern for feminization of male fetus

Mineralocorticoid (Aldosterone) Antagonist

May cause hyperkalemia, gynecomastia (spironolactone), sexual dysfunction, and lead to addison's disease

Mineralocorticoid (Aldosterone) Antagonist

nasal stiffness, gastric ulceration (with high doses), depression (with high doses), sexual side effects, edema

Peripheral Sympathetic Inhibitor

Increase K; decrease renal function (increase SCr)

Direct Renin Inhibitor