Pharm Class Indications, Actions, Effects, Contraindications

Thiazide Diuretics

Indications:

• 1st line treatment for mild to moderate HTN, most prescribed diuretic

• edema due to HF with normal kidney function

• Not used for emergent/immediate diuresis or ARF

Adverse Effects: Gi upset, fluid/electrolyte imbalances, hypotension, hyperglycemia

Contradictions: Sulfonamide allergy, hypovolemia, severe renal disease

Loop Diuretics

Indications:

• Drug of choice for acute heart failure, beneficial when CO and renal flow is diminished

• Acute pulmonary edma

• HTN

Adverse Effects: Electrolyte imbalance due to loss of K+ and Na+, orthostatic hypotension, potential for dysrhythmias due to low K+, Decreased K+ can lead to dig toxicity

Contraindications: electrolyte depletion, severe renal failure, hepatic encephalopathy

Cautions: pregnancy/lactation, SLE, diabetes, gout

Potassium-Sparing Diuretics

Indications: Weaker than Thiazides and Loops

• Mild HTN, usually in combo with other antihypertensives

• HF

• Edema

Adverse Effects: hyperkalemia, GI discomfort and renal failure if given with an ACE inhibitor. Hormonal changes such as decreased libido, hirsutism, gynecomastia, breast tenderness, deepening of the voice, an irregular menses d/t blocking of androgen production and alteration of testosterone-estrogen ratio

S/S of hyperkalemia: nausea, diarrhea, abdominal cramping, numbness and tingling of the hands and feet, leg cramps, tachycardia, tented T wave

Carbonic Anhydrase Inhibitors

Indications:

• Used as adjuncts with other diuretics when more intense diuresis is needed

• Glaucoma- used to treat increased IOP

• Acute mountain sickness

• Metabolic alkalosis

• Anticonvulsant

Contradictions: thiazide & sulfonamide allergies

Adverse Effects: fatigue, N/D, dizziness, dehydration, blood dyscrasias, pancytopenia, flaccid paralysis, anemia, and metabolic acidosis

Osmotic Diuretics

Indications:

• Oliguric phase of renal failure

• Increased intracranial pressure

• Intraocular pressure r/t glaucoma

Adverse Effects: GI discomfort, increased pulse, acidosis, CHF and circulatory overload

Contraindications: renal disease, anuria, pulmonary congestion, intracranial bleeding, dehydration

Administration:

• Check vial/syringe for crystals

• Warm slowly to dissolve crystals; if they don’t dissolve DON’T use

• Monitor vital signs and I/O

Angiotensin Converting Enzyme Inhibitors

Indications:

• Drug of choice for HF

• HTN

Adverse Effects: Can cause persistent dry nonproductive cough d/t accumulation of bradykinin (proinflammatory substance), hyperkalemia, angioedema (rare)

Angiotensin II Receptor Blockers (ARBS)

Indications:

• HTN — alone or in combo

• HF

• After MI

Adverse Effects: similar to ACE inhibitors but these medications may be better tolerated and they can be used with mild hepatic and renal impairment. LESS dry cough

“-sartan” ending

Calcium Channel Blockers (CCB)

Indications:

• HTN — combo therapy

• Angina

• Tachyarrhythmias

Adverse Effects: may cause or exacerbate HF

*HELPFUL in Black Population*

• Sometimes called the trifecta drugs (helpful in treating HTN as well as angina and rate/rhythm)

• Verapamil, Nifedipine, and Diltiazem = Very Nice Drugs

!! Depresses myocardia contractility !!

Nonselective Beta-Adrenergic Blockers

Indications:

• HTN

• HF

• Angina

• Rate control

Actions: DECREASE cardiac workload

Contraindications: bradycardia, heart block, shock, Acute HF, acute asthma, pregnancy, lactation

CAUTION: diabetes and hypoglycemia; COPD and chronic asthma

“-lol” ending

Nonselective Alpha-Adrenergic Blockers

Indication:

• prevention of control of hypertensive episodes w/ pheochromocytoma

• prevention and treatment of dermal necrosis and sloughing associated with IV extravasation of noreprinephrine and dopamine

Contraindications: CAD or MI

CAUTION: pregnancy or lactation

Use is limited since there has been a development of new, safer drugs

Alpha 1 Adrenergic Blockers

Indication:

• HTN

• BPH

• Additionally beneficial for dyslipidemia & renal perfusion

CAUTION: HF and renal failure d/t fall in BP; lactation

Safe for patients with diabetes and respiratory problems

“-osin” ending

Alpha 2- Adrenergic Agonists (Centrally acting)

Indication: HTN

Adverse Effects: drowsiness, dizziness, dry mouth, bradycardia, peripheral edema from sodium and water retention

CAUTION: clients who had stroke, MI, asthma, COPD, DM, MDD, CKD, pregnancy, lactation, affected skin in scleroderma and SLE

Contraindications: bleeding disorders, clients taking anticoagulants

Do NOT discontinue abruptly due to rebound hypertensive crisis

Direct Acting Vasodilators

Indication: HTN

Adverse Effects: Palpitations, edema, GI bleeding and lupus-like side effects

• Numerous side effects including reflex tachycardia (why they aren’t 1st in line)

• can cause excessive hair growth

CAUTION: PVD, CAD, HF, tachycardia

Contraindications: cerebral insufficiency, pregnancy

****Work well in Black population****

Cardiac Glycosides

Indication:

• Heart Failure

• Afib, Aflutter, and paroxysmal atrial tachycardia

Contraindications: V tach, V Fib, acute MI, renal insufficiency

CAUTION: pregnancy; lactation

Angiotensin Receptor Neprilysin Inhibitors

Indication: Reduces risk of CV death and hospitalization of HF in adult patients with CHF; treatment of pediatric patients with symptomatic HF due to decreased LV function

Action:

• Inhibits neprilysin

• Blocks the angiotensin II receptors

Adverse Effects: Hypersensitivity, angioedema, hypotension, hyperkalemia, cough, dizziness, and renal impairment

CAUTION: PVD, CAD, HF, tachycardia

Contraindications: Prior angioedema w/ACEI; concurrent use of ACEI; concurrent use of Aliskiren (renin inhibitor) w/ known renal disease; pregnancy; breast feeding

Phosphodiesterase Inhibitors

Indication: Severe heart failure

Adverse Effects: hypokalemia, hypotension, ventricular dysrhythmias Significant interactions and serious toxicity limits use; used for those that don’t respond to other agents

Administration:

• Used for short therapy for heart failure (2-3 days)

• Now also being sent home in Stage 4 HF

• BRIEF half life

• Correct hypokalemia prior to administration to decrease risk of dysrhythmias

Alpha Adrenergic Agonist

Indication: Hypotension related to orthostasis or autonomic failure

Action: React with sympathetic adrenergic receptor

• Increased BP

• Increased central blood volume

• Increased strength of cardiac muscle contraction

CAUTION- severe heart disease; acute renal disease; thyrotoxicosis; pregnancy; lactation

Contradictions: supine HTN; pheochromocytoma