Cardiac Glycosides: Digoxin

• Therapeutic Uses

  • 2nd-line agent for heart failure (HF) and dysrhythmias

• Complications

  • Dysrhythmias and cardiotoxicity

    • Bradycardia

    • Hypokalemia at high risk

  • Gastrointestinal

    • Anorexia, nausea and vomiting (NV), abdominal pain

  • Central Nervous System (CNS)

    • Fatigue, weakness, vision changes

• Contraindications/Precautions

  • Caution in pregnancy/breastfeeding

  • Contraindications: ventricular dysrhythmias and heart block

  • Caution in hypokalemia, advanced HF, and impaired renal function

• Interactions

  • Diuretics leading to hypokalemia

  • ACE inhibitors and ARBs can cause hyperkalemia

  • Sympathomimetics (e.g., Dopamine)

  • Verapamil

Class IB Antidysrhythmics: Lidocaine

• Therapeutic Uses

  • Short-term use only for ventricular dysrhythmias

• Complications

  • CNS

    • Drowsiness, altered mental status (AMS), paresthesia, seizures

  • Respiratory arrest

• Contraindications/Precautions

  • Risk vs. reward during pregnancy/breastfeeding

  • Caution in liver/kidney injuries, AV blocks, sick sinus (SB), heart failure (HF)

• Interactions

  • Cimetidine

  • β-blockers

  • Phenytoin

HMG-CoA Reductase Inhibitors: Atorvastatin

• Therapeutic Uses

  • Primary hypercholesterolemia, prevention of coronary events, prevention of myocardial infarction (MI) and stroke

• Complications

  • Hepatotoxicity

  • Myopathy

• Contraindications/Precautions

  • Avoid in pregnancy/breastfeeding

  • Contraindicated in liver disease

  • Caution in history of liver disease and kidney impairment

• Interactions

  • Fibrates

  • P450 inhibitors

  • Erythromycin, ketoconazole, amiodarone, grapefruit juice

Organic Nitrates: Nitroglycerin (NTG)

• Therapeutic Uses

  • Acute angina, prevention of chronic stable angina

• Complications

  • Headaches (HA)

  • Orthostatic hypotension

  • Reflex tachycardia

  • Tolerance

• Contraindications/Precautions

  • Caution in pregnancy/breastfeeding

  • Contraindicated in hypersensitivity, anemia, glaucoma, traumatic brain injury (TBI)

  • Caution with antihypertensives, hyperthyroidism, kidney/liver disease

• Interactions

  • Alcohol (EtOH), antihypertensives

  • Phosphodiesterase type 5 inhibitors (PDES5)

Opioid Agonists: Morphine

• Therapeutic Uses

  • Relief of moderate to severe pain, sedation

• Complications

  • Respiratory depression

  • Constipation

  • Orthostatic hypotension

  • Urinary retention

  • Cough suppression

  • Sedation

  • Nausea and vomiting (NV)

  • Opioid toxicity triad: coma, respiratory depression, pinpoint pupils

• Contraindications/Precautions

  • Caution in pregnancy

  • Risk in premature infants

  • Caution in respiratory conditions, GI conditions with constipation, hepatic/renal disease

• Interactions

  • CNS depressants

  • Anticholinergic agents

  • Antihypertensives

Class IV Antidysrhythmics: Verapamil

• Therapeutic Uses

  • Ventricular rate control in atrial fibrillation (AF) and atrial flutter (A-Flutter), supraventricular tachycardia (SVT), hypertension (HTN), angina

• Complications

  • Bradycardia

  • Hypotension

  • Heart failure (HF)

  • AV block

  • Constipation

  • Peripheral edema

• Contraindications/Precautions

  • Safety not established in pregnancy/breastfeeding

  • Contraindicated in severe HF, severe hypotension

  • Caution in liver/kidney disease, HF, hypotension, taking β-blockers or digoxin

• Interactions

  • β-blockers

  • Carbamazepine, digoxin

  • Grapefruit juice

Class III Antidysrhythmics: Amiodarone

• Therapeutic Uses

  • Ventricular fibrillation (VF), ventricular tachycardia (VT), atrial fibrillation (AF)

• Complications

  • Pulmonary toxicity

  • Sinus bradycardia

  • AV block

  • Liver/thyroid dysfunction

  • GI disturbances

  • Photosensitivity

  • Phlebitis (IV administration)

• Contraindications/Precautions

  • Not safe in pregnancy/breastfeeding

  • Contraindicated in AV block and sinus bradycardia (SB)

  • Caution in liver/thyroid/respiratory disease, HF, fluid/electrolyte imbalance

• Interactions

  • Quinidine, procainamide, digoxin, diltiazem, warfarin

  • St. John’s wort, rifampin, cholestyramine

  • Diuretics, antidysrhythmics

  • β-blockers

  • Grapefruit juice.