Prototype Drug KEY NOTES only (week 6)

furosemide

Indications: HTN, HF, Edema

Adverse Effects: dizziness, vertigo, orthostatic hypotension (when pt stands up they get lightheaded and dizzy) , hypokalemia, rash, urticaria, anorexia, hyperglycemia, hyperuricemia, urinary bladder spasm, ototoxicity, dehydration

hydrochlorothiazide

Indications: HTN, HF, Edema

Adverse Effects: dizziness, vertigo, hypotension, hypokalemia, anorexia, dry mouth, diarrhea, polynuria, nocturia, muscle spasms

spironolactone

Indications: Primary Hyperaldosteronism, HTN, HF, Edema, Cirrhosis, Nephrotic Syndrome

Adverse Effects: dizziness, headache, drowsiness, rash, cramping, diarrhea, hyperkalemia, hirsutism, gynecomastia, deepening of the voice, irregular menses

Interactions: decreased effect with salicylates; increased risk of hypotension w/ other antihypertensive agents; increased risk of hyperkalemia when other RAAS blockers used

LONG DURATION (48-72 hours)

mannitol

Indications: Increased ICP, cerebral edema, increased IOP

Adverse Effects: Dizziness, headache, hypotension, rash, nausea, anorexia, dry mouth, thirst, diuresis, fluid and electrolyte imbalances, injection site reactions

acetazolamide

Indications: Glaucoma, HF, drug-induced edema; prevention or treatment of acute mountain sickness

Adverse effects: weakness, fatigue, rash, anorexia, nausea, urinary frequency, renal calculi, myelosuppression, weight loss, metabolic acidosis, hypersensitivity reactions, liver impairment, hypokalemia, hyponatremia, paresthesias, tinnitus

Interactions: increased risk of salicylate toxicity; excretion of other meds may be increased or decreased

lisinopril

Indications: HTN, HF, post MI; chronic kidney disease (off-label)

Adverse Effects: allergic reactions, angioedema, neutropenia, hypotension, dizziness, syncope, flushing, rash, pruritus, gastric irritation, proteinuria, cough, acute kidney impairment, hyperkalemia, liver impairment

Interactions: decreased anti-HTN effect w/ NSAIDs; additive anti HTN effect w/ diuretics or other anti-HTN agents; increased risk of hyperkalemia with potassium sparing diuretics; increased risk of lithium toxicity w/lithium; Should not be combined w/ other ACEIs or ARBs

captopril

?

losartan

Indications: HTN

Adverse Effects: Allergies, angioedema, hypotension, dizziness, h/a, diarrhea, abdominal pain, s/s or URI, cough, back pain, fever, muscle weakness

Interactions: increased effect w/ other anti-HTN agents; increased risk of hyperkalemia with potassium sparing diuretics; increased risk of lithium toxicity w/ lithium; decreased effects w/ NSAIDs

diltiazem (PD) , verapamil , nifedipine

Indications: HTN and angina

Adverse Effects: dizziness, light headedness, h/a, peripheral edema, bradycardia, atrioventricular block, flushing, nausea, hypotension

Interactions: increased risk of CCB toxicity w/ grapefruit juice

phentolamine

Indications: see previous slide (92)

Adverse Effects: acute and prolonged hypotensive episodes, MI, tachycardia, arrhythmia, nausea, flushing

Interactions: ephedrine and epinephrine may have decreased HTN and vasoconstrictive effects if taking with phentolamine; increased hypotension w/ alcohol

doxazosin

Therapeutic Class: antihypertensive

Indications: treatment of HTN; BPH

Adverse Effects: hypotension; h/a; fatigue; dizziness; postural dizziness; vertigo; tachycardia; edema; nausea; dyspepsia; diarrhea; retrograde ejaculation

Interactions: increased hypotension w/ vasodilators: nitrates, CCB, ACEI

clonidine

Indications: HTN; management of ADHD

Adverse Effects: bradycardia, hypotension, drowsiness, sedation, dry mouth, rebound HTN if abruptly discontinued

Interactions: concurrent use of prazosin, MAOIs, TCAs can counteract clonidine effect; additive CNS depression w/ other CNS depressants

propranolol

Therapeutic Class: antihypertensive; antianginal

Indications: HTN; angina; MI; SVT

Mode of action: juxtaglomerular apparatus

Adverse Effects: allergies; bradycardia; heart failure; cardiac arrhythmias; CVA; pulm edema; gastric pain; flatulence; impotence; decreased exercise intolerance; bronchospasm; hypotension; fatigue

Interactions: BB and CCB-increased negative inotropic effect; decreased effect of BB w/ NSAIDs

hydralazine

Indications: HTN and HF

Adverse Effects: HA, reflex tachycardia, palpitations, flushing, n/v/d, lupus-like syndrome

Interactions: Additive effect with other antihypertensives

midodrine

.

digoxin

Indications: HF, Afib

Adverse Effects: h/a, weakness, drowsiness, visual disturbances, arrhythmias, GI upset

Digoxin Toxicity S/S: Gi upset, bradycardia, dysrhythmias, h/a, blurred vision, confusion, halos

Narrow therapeutic Index: 0.5-2.0 ng/mL

Long half-life- (>36 hours)= once a day or every other day dosing

TEACHING- how to check their own pulse, periodic blood work,

sacubitril/valsartan

Therapeutic Class: Heart Failure

Indications: Class II-IV HF and Reduced EF

Adverse Effects:hypersensitivity,

angioedema, hypotension,

hyperkalemia, cough, dizziness,

and renal impairment

Interactions: ACEIs (must be d/c for at least 36 hours

prior to starting;

Potassium sparing diuretics increase risk of

hyperkalemia;

Concurrent use with nephrotoxic agents increase risk

of kidney impairment

milrinone

Pharm Class: Phosphodiesterase Inhibitors

Therapeutic Class: drug for HF

Indications: HF treatment ***unresponsive to other therapies

Adverse Effects: arrhythmias, hypotension,

nausea, vomiting,

thrombocytopenia, pericarditis, pleuritis, fever,

chest pain

-MAKE SURE THEY ARE NOT ON ANY ERECTILE DYSFUNCTIO DRUGS-

midodrine

Therapeutic Class: drug for hypotension

Indications: orthostatic hypotension

Adverse Effects: piloerection, chills, rash; HTN and bradycardia; dizziness; vision changes; vertigo; h/a;

problems w/urination

Interactions: increased toxicity or drug effect w/

cardiac glycosides, BB, alphaadrenergic agents, and

corticosteroids