drug list 3 - counseling points

Indications/warnings

Procardia (nifedipine) - DCCB

Norvasc (amlodipine) - DCCB

hypertension

hypotension risk

Side effects

Procardia (nifedipine) - DCCB

Norvasc (amlodipine) - DCCB

well tolerated; peripheral edema, gingival hyperplasia, HA, flushing, palpitations, reflex tachycardia

Notes

Procardia (nifedipine) - DCCB

ER formulation for pregnant

Notes

Norvasc (amlodipine) - DCCB

Safest CCB to use to lower BP in HFrEF if CCB necessary

Indications / Contra

Cardizem, Tiazac (dilitazem) - NDCCB

Calan (Verapamil) - NDCCB

arrhythmias, hypertension

HF w/ reduced ejection fraction (HFrEF), severe hypotension (SBP < 90mmHG), 2nd/3rd degree heart block

Warnings / side effects

Cardizem, Tiazac (dilitazem) - NDCCB

Calan (Verapamil) - NDCCB

HF symptoms may worse, hypotension

Edema, constipation (inc w/ verapamil), gingival hyperplasia

indications / warnings / side effects

Intuniv (guanfacine) - alpha 2 adrenergic agonist

Hypertension, ADHD

dont d/c abruptly (rebound HBP)

dry mouth, somnolence, fatigue, dizzy, constipation, dec HR, hypotension

Indications / Contra / Side effects

Coumadin, Jantoven (Warfarin) - Vitamin K antagonist; anticoagulant

strove prevention in atrial fibrillation, VTE prophylaxis/treatment

pregnant (hazardous)

bruising/bleeding, skin necrosis, purple toe syndrom

BBW / warnings

Coumadin, Jantoven (Warfarin) - Vitamin K antagonist; anticoagulant

major/fatal bleeding

tissue necrosis/gangrene, CYP2C9*2 /*3 alleles or polymorphism of VKORC1 gene (inc risk of bleeding)

Drug interactions / counseling

Coumadin, Jantoven (Warfarin) - Vitamin K antagonist; anticoagulant

warfarin is CYP2C9 substrate - lots of interactions

CYP2C9 inducers dec INR (phenobarbital, carbamazepine), CYP2C9 inc INR (amiodarone, fluconazole, metronidazole)

Indications / Contra

Ecotrin (aspirin) - antiplatelet, salicylate, NSAID

2ndary stroke prevention, stable ischemic heart disease

NSAID or salicylate allergy, below 18 (risk of reyes syndrome)

Side effects / warning / drug interactions

Ecotrin (aspirin) - antiplatelet, salicylate, NSAID

dyspepsia, heartburn, bleeding

bleeding

monitor w/ other drugs that inc bleeding risk (NSAIDs, antiplatelets)

Indications / contra

Brilinta (ticagrelor) - P2Y12 antagonist; antiplatelet

acute coronary syndrome

active serious bleeding

BBW / side effects / drug interactions

Brilinta (ticagrelor) - P2Y12 antagonist; antiplatelet

significant bleeding risk

bleeding, dyspnea

monitor w. other drugs that inc bleeding risk

indications / contra

Pradaxa (dabigatran etexilate) - Direct Thrombin Inhibitor, DOAC

stroke prevention in atrial fibrillation, VTE treatment

active bleeding, mechanical prosthetic heart valves

BBW / drug interactions

Pradaxa (dabigatran etexilate) - Direct Thrombin Inhibitor, DOAC

neurazial anesthesia or spinal puncture (risk of hematoma & paralysis)

monitor w/ drugs that inc bleeding risk

Side effects / counseling

Pradaxa (dabigatran etexilate) - Direct Thrombin Inhibitor, DOAC

Dyspepsia, gastritis like symptoms, bleeding (esp. GI)

keep in OG container, swallow Capsules whole

BBW / side effects

Xarelto (rivaroxaban) - Factor Xa inhibitor, DOAC

Eliquis (apixaban) - Factor Xa inhibitor, DOAC

neurazial anesthesia or spinal puncture (risk of hematoma & paralysis)

well tolerated; bleeding risk

Contra / drug interactions

Xarelto (rivaroxaban) - Factor Xa inhibitor, DOAC

Eliquis (apixaban) - Factor Xa inhibitor, DOAC

active bleeding

bleeding risk drugs

indications / counseling

Xarelto (rivaroxaban) - Factor Xa inhibitor, DOAC

stroke prevention in atrial fibrillation, VTE prophylaxis/treatment

doses > 15mg tk w/ food; d/c 24 hr before elective surgery

indications /Counseling

Eliquis (apixaban) - Factor Xa inhibitor, DOAC

stroke prevention in atrial fibrillation, VTE prophylaxis/treatment, DVT prophylaxis after knee/hip replacement

d/c 24 hr before elective surgery w/ low bleed risk or 48 hr before w/ med-high bleed risk

indications / contra

Plavix (clopidogrel) - P2Y12 antagonist, antiplatelet

2ndary stroke prevention, stable ischemic heart disease

active serious bleeding

BBW / warning

Plavix (clopidogrel) - P2Y12 antagonist, antiplatelet

CYP2C19 poor metabolizers inc risk cv events bc drug → active metabolite by CYP2C19.

bleeding risk

Side effects / drug interactions

Plavix (clopidogrel) - P2Y12 antagonist, antiplatelet

well tolerated; bleeding risk

drugs inc bleeding risk; no omeprazole or esomeprazole (CYP2C19 inhibitors dec effect)

indications / contra

Lovenox (enoxaparin) - LWMH

VTE prophylaxis/treatment

history of HIT, active major bleed

BBW / drug interactions

Lovenox (enoxaparin) - LWMH

neuraxial anesthesia or spinal puncture (risk of hematoma and paralysis)

drugs with inc bleeding risk

side effects / notes

Lovenox (enoxaparin) - LWMH

bleeding, anemia, injection site brusing/pain, thrombocytopenia

prefilled syringe for subq inj; dont expel air bubbles b4 inj

Indications / warnings

Apresoline (hydralazine) - vasodilator, antiHBP

Hypertension, HF

drug induced lupus erthematosus (DILE)

side effects / notes

Apresoline (hydralazine) - vasodilator, antiHBP

peipheral edmea, HA, flushing, palpitations, reflex tachycardia

used to dec BP in HF pt who cant take ACE/ARB’s

Indications / contra

Imdur (isosorbide mononitrate) - Nitroglycerin antianginal, vasodilator

Nitrostat (nitroglycerin SL) - Nitroglycerin antianginal, vasodilator

angina

NOT w/ PDE5 inhibitors (w/in 24 hr sildenafil or 48 hr tadalafil )

warning / side effect

Imdur (isosorbide mononitrate) - Nitroglycerin antianginal, vasodilator

Nitrostat (nitroglycerin SL) - Nitroglycerin antianginal, vasodilator

hypotension, HA, tachyphylaxis

HA, flushing, syncope

notes

Imdur (isosorbide mononitrate) - Nitroglycerin antianginal, vasodilator

IR - dosed BID 7 hr apart to allow for a nitrate-free interval (dec risk of tolerance)

Counseling

Nitrostat (nitroglycerin SL) - Nitroglycerin antianginal, vasodilator

OG container at room temp; SL let dissolve, call 911 if pain cont after 1st dose; max 3 doses in 15 mins (5 min apart)

Indications / contra

Ranexa (ranolazine) - antianginal, CV agent

angina

Strong CYP3A4 inhibitor or inducer

Warning / Side effect / Notes

Ranexa (ranolazine) - antianginal, CV agent

QT prolongation

dizzy, HA

not for acute treatment of angina