68-103 counseling points

Toprol XL

see conseling points for nebivolol. exception- take with or immediately following food. common indication heart failure

lopressor

see counseling points for nebivolol. exception take with or immediately following food

Zebeta/Ziac

see counseling points for nebivolol and HCTZ. exception- additional common indication: Heart Failure

Inderal

see counseling points for nebivolol. exception can be used for migraine prophylaxis. contraindicated in bronchial asthma

Coreg

See counseling points for nebivolol. Exceptions -

Additional common indication: Heart failure.

Counseling point: Take with food.

Note: Dosing conversion is not 1:1 for CR:IR.

Contraindication: Bronchial asthma.

Normodyne

See counseling points for nebivolol. Exceptions - A drug of choice for hypertension in pregnancy.

Procardia

Common Indications: Hypertension

Warnings/Precautions: Hypotension risk

Side Effects: Generally well-tolerated. Can cause peripheral edema, gingival hyperplasia, headache, flushing, palpitations, reflex tachycardia.

Note: ER formulation is a drug of choice in pregnancy.

amlodipine

Common Indications: Hypertension

Warnings/Precautions: Hypotension risk

Side Effects: Generally well-tolerated. Can cause peripheral edema, gingival hyperplasia, headache, flushing, palpitations, reflex tachycardia.

Note: Safest calcium channel blocker (CCB) to use to lower BP in HFrEF if a CCB must be used.

Lotrel

See counseling points for amlodipine and benazepril.

Azor/Tribenzor

See counseling points for amlodipine, olmesartan, and HCTZ.

Exforge/ Exforge HCT

See counseling points for amlodipine, valsartan, and HCTZ

Cardizem

Common Indications: Arrhythmias, hypertension

Contraindications: Heart failure with reduced ejection fraction (HFrEF), severe hypotension (SBP < 90 mmHg), 2nd/3rd degree heart block

Warnings/Precautions: Heart failure symptoms may worsen, hypotension

Side Effects: Edema, constipation (more with verapamil), gingival hyperplasia

Verpamil

See counseling points for diltiazem.

Intuniv

Common Indications: Hypertension, ADHD

Warnings/Precautions: Do not discontinue abruptly (rebound hypertension).

Side Effects: Dry mouth, somnolence, fatigue, dizziness, constipation, decreased HR, hypotension

Coumadin/Jantoven

Common Indications: Stroke prevention in atrial fibrillation, VTE prophylaxis/treatment

BBW: Major/fatal bleeding

Contraindications: Pregnancy

Warnings/Precautions: Tissue necrosis/gangrene, CYP2C9*2 or *3 alleles and/or polymorphism of VKORC1 gene (increased risk of bleeding)

Side Effects: Bruising/bleeding, skin necrosis, purple toe syndrome

Drug Interactions: Warfarin is a CYP2C9 substrate - lots of drug interactions! CYP2C9 inducers decrease INR (Ex. phenytoin, phenobarbital, carbamazepine). CYP2C9 inhibitors increase INR (Ex. amiodarone, fluconazole, metronidazole)

Counseling points: Eat a consistent amount of vitamin K. Check with MD or pharmacist before starting OTCs or supplements because many interact with warfarin. Take this medication at the same time each day. Frequent INR checks needed.

Aspirin

Common Indications: Secondary stroke prevention, stable ischemic heart disease

Contraindications: NSAID or salicylate allergy, children and teenagers (risk of Reye's syndrome)

Warnings/Precautions: Bleeding

Side Effects: Dyspepsia, heartburn, bleeding

Drug Interactions: Monitor with other drugs that increase bleeding risk (NSAIDs, antiplatelets, etc)

ticagrelor

Common Indications: Acute coronary syndrome

BBW: Significant bleeding

Contraindications: Active serious bleeding

Warnings/Precautions: Bleeding risk

Side Effects: Bleeding, dyspnea

Drug Interactions: Monitor with other drugs that increase bleeding risk (NSAIDs, antiplatelets, etc)

dabigatran etexilate

Common Indications: Stroke prevention in atrial fibrillation, VTE treatment

BBW: Patients getting neuraxial anesthesia or spinal puncture (risk of hematoma and paralysis)

Contraindications: Active bleeding, mechanical prosthetic heart valves

Side Effects: Dyspepsia, gastritis-like symptoms, bleeding (especially GI)

Drug Interactions: Monitor with other drugs that increase bleeding risk (NSAIDs, antiplatelets, etc)

Counseling points: Must keep in original container. Capsules must be swallowed whole.

rivaroxaban

Common Indications: Stroke prevention in atrial fibrillation, VTE prophylaxis/treatment

BBW: Patients getting neuraxial anesthesia or spinal puncture (risk of hematoma and paralysis)

Contraindications: Active bleeding

Side Effects: Generally well-tolerated. Bleeding risk.

Drug Interactions: Monitor with other drugs that increase bleeding risk (NSAIDs, antiplatelets, etc)

Counseling points: Doses >/=15 mg must be taken with food. Discontinue 24 hours before elective surgery.

apixaban

Common Indications: Stroke prevention in atrial fibrillation, VTE treatment, DVT prophylaxis after knee/hip replacement

BBW: Patients getting neuraxial anesthesia or spinal puncture (risk of hematoma and paralysis)

Contraindications: Active bleeding

Side Effects: Generally well-tolerated. Bleeding risk.

Drug Interactions: Monitor with other drugs that increase bleeding risk (NSAIDs, antiplatelets, etc)

Counseling points: Discontinue 24 hours before elective surgery with low bleed risk, or 48 hours before surgery with moderate-high bleed risk.

clopidogrel

Common Indications: Secondary stroke prevention, stable ischemic heart disease

BBW: CYP2C19 poor metabolizers have had higher rate of cardiovascular events because clopidogrel must be converted to an active metabolite by CYP2C19.

Contraindications: Active serious bleeding

Warnings/Precautions: Bleeding risk.

Side Effects: Generally well-tolerated. Bleeding risk.

Drug Interactions: Monitor with other drugs that increase bleeding risk (NSAIDs, antiplatelets, etc). Do not use with omeprazole or esomeprazole (CYP2C19 inhibitors - decrease efficacy of clopidogrel).

enoxaparin

Common Indications: VTE prophylaxis/treatment

BBW: Patients getting neuraxial anesthesia or spinal puncture (risk of hematoma and paralysis)

Contraindications: History of HIT, active major bleed

Side Effects: Bleeding, anemia, injection site reactions (bruising, pain), thrombocytopenia

Drug Interactions: Caution with other drugs that increase bleeding risk (NSAIDs, antiplatelets, etc)

Notes: Comes as a prefilled syringe for subcutaneous injection. Do not expel air bubble from the syringe before injection.

hydralazine

Common Indications: Hypertension, heart failure

Warnings/Precautions: Can cause drug-induced lupus erythematosus (DILE)

Side Effects: Peripheral edema, headache, flushing, palpitations, reflex tachycardia

Notes: Can be used to lower BP in heart failure in patients who cannot tolerate ACE inhibitors or ARBs

isosorbide mononitrate

Common Indications: Angina

Contraindications: Do not use with PDE5 inhibitors

Warnings/Precautions: Hypotension, headache, tachyphylaxis

Side Effects: Headache, flushing, syncope

Drug Interactions: Do not use with PDE5 inhibitors.

Notes: IR formulation is dosed BID 7 hours apart to allow for a nitrate-free interval (decrease risk of developing a tolerance)

nitroglycerin SL

Common Indications: Angina

Contraindications: Do not use with PDE5 inhibitors

Warnings/Precautions: Hypotension, headache, tachyphylaxis

Side Effects: Headache, flushing, syncope

Drug Interactions: Do not use within 24 hours of sildenafil or 48 hours of tadalafil (PDE5 inhibitors).

Counseling points: Store tablets in the original amber vial and store at room temperature. Place under the tongue and let the tablet dissolve. Call 911 if pain continues after the first dose; you can take 2 additional doses at 5 minute intervals - do not exceed 3 tablets in 15 minutes.

ranolazine

Common Indications: Angina

Contraindications: Do not use with strong CYP3A4 inhibitors or inducers

Warnings/Precautions: Can cause QT prolongation

Side Effects: Dizziness, headache

Notes: Not used for acute treatment of chest pain

ondansetron

Common Indications: Nausea/vomiting

Contraindications: Do not use with apomorphine

Warnings/Precautions: Increase in QT interval, serotonin syndrome (when used with other serotonergic medications)

Side Effects: Headache, constipation

donepezil

Common Indications: Alzheimer's disease

Warnings/Precautions: Cardiac effects, bradycardia, QT prolongation

Side Effects: Nausea, diarrhea

Drug Interactions: Anticholinergic medications can decrease efficacy of donepezil. Use caution with other medications that lower heart rate.

Notes: Taking at bedtime helps to decrease nausea

rivastigmine

Common Indications: Alzheimer's disease

Dosage forms: Tablet, patch

Warnings/Precautions: Cardiac effects, bradycardia, QT prolongation

Side Effects: Nausea, diarrhea

Drug Interactions: Anticholinergic medications can decrease efficacy of donepezil. Use caution with other medications that lower heart rate.

Notes: Patch is changed daily (rotate sites - do not repeat a site for 14 days). Apply to upper or lower back, upper arm, or chest.

butalbital + acetaminophen + caffeine (BAC)

Common Indications: Tension headaches

BBW: Can cause hepatotoxicity

Side Effects: Nausea, vomiting, abdominal pain, dizziness, fatigue

Drug Interactions: Watch for other sources of acetaminophen (e.g. cough/cold medicine) to prevent additive toxicity.

Counseling points: Can take with food to reduce GI upset

eletriptan

Common Indications: Migraine

Contraindications: Uncontrolled hypertension, cerebrovascular disease, use of another triptan within 24 hours

Warnings/Precautions: Can increase blood pressure, serotonin syndrome (when used with other serotonergic medications)

Side Effects: Tingling, numbness, "triptan sensations" (pressure in the chest or neck)

Counseling points: Take at first sign of migraine. Can repeat the dose once after 2 hours if needed

rizatriptan

See counseling points for eletriptan. Exceptions -

Dosage forms: Tablet and ODT

Contraindications: Current use of MAOIs (or within 2 weeks of stopping MAOIs)

sumatriptan

See counseling points for eletriptan. Exceptions -

Dosage forms: Tablet, nasal spray, subcutaneous injection

Contraindications: Current use of MAOIs (or within 2 weeks of stopping MAOIs)

solifenacin

Common Indications: Urinary incontinence

Contraindications: Uncontrolled narrow angle glaucoma

Warnings/Precautions: Agitation, confusion, drowsiness, dizziness, blurred vision

Side Effects: Dizziness, drowsiness, dry mouth, constipation

scopalamine

Common Indications: Motion sickness

Contraindications: Closed-angle glaucoma, hypersensitivity to belladonna

Side Effects: Dry mouth, CNS effects (drowsiness, dizziness, etc), increased intraocular pressure. If patient accidentally touches their eyes after touching the medicated patch - may experience stinging of the eyes and pupil dilation.

Counseling points: Avoid alcohol while wearing the patch. Before an MRI - remove the patch. Do not drive while wearing the patch (sedation risk). Apply 4 hours before needed. Replace the patch every 3 days if needed.

meclizine

Common Indications: Vertigo, motion sickness

Warnings/Precautions: CNS depression, increased intraocular pressure

Side Effects: Sedation, dry mouth, blurry vision

Counseling points: Take 1 hour before travel, can repeat daily if needed