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Common cardiac medications HTN and heart failure medications ACE inhibitors Block the conversion of angiotensin 1 to angiotensin 2 and prevent sodium water retention Examples: Enalapril, Perindopril, Ramipril, Lisinopril Indications: HTN, Nephroprotective in DM, CHF, CAD, post-MI Side effects: Dry cough, Hyperkalemia, Hypotension, Angioedema Contraindications: Renal artery stenosis, Low GFR (caution) Additional notes: It is the drug of choice in a patient with DM and HTN Monitor creatinine I week after starting ACEI; stop it if elevated > 30%. ARB (anaiotensin receptor blockers) Block the angiotensin receptor and prevent sodium water retention. Examples: Valsartan, Candesartan, Irbesartan Side effect: same as ACEI, but does not cause a dry cough Indications and contraindications are the same as ACE! Additional notes: Same indications and contraindications as ACE! If ACEI causes cough so, switch to ARB Losartan is the drug of choice in a patient with HTN and gout Direct renin inhibitors (DRI) The block renin directly Example: Aliskiren Indications: HTN Side effects: Same as ACEI, Rhabdomyolysis, Seizures Page 1388 | INTERNAL1-17AFEEF-MERGED-1.pdf |
Beta-blockers Classified as selective or non-selective Block receptors to decrease heart rate, contractility, and oxygen demands in the heart muscle Examples: o Selective PI: Bisoprolol, Atenolol, Metoprolol o Non-selective: Propranolol, Labetalol, Carvedilol Side effects: Hypotension, fatigue, light-headedness, depression, bradycardia, hyperkalemia, bronchospasm, cold extremities, impotence, exacerbation of Raynaud's phenomenon, and claudication Indications: HTN, CAD, acute Ml, post-MI, CHF (start low and go slow), A. Fib, SVT, and hyperthyroidism Contraindications: Sinus bradycardia, 2nd or 3rd-degree heart block, hypotension, WPW. Caution in asthma, claudication, Raynaud's phenomenon, and decompensated CHF Calcium channel blockers Action: Non-dihydropyridines: block calcium channels in smooth and myocardial muscles, cause decreased Heart rate, contractifity, and oxygen demands in the heart, also act as a vasodilator Dihydropyridines: Block smooth muscle calcium channels causing peripheral vasodilation Examples: Dihydropyridines: (peripherally acting): amlodipine, nifedipine, felodipine Non-dihydropyridines: (centrally acting): diltiazem, verapamil Indications: Dihydropyridines: HTN, Raynaud's phenomena Non-dihydropyridines: HTN, CAD, SVT, diastolic dysfunction Side effects: Dihydropyridines: Hypotension, edema, flushing, headache, fight-headedness Non-dihydropyridines: Hypotension, bradycardia, lower limb edema Page 1389 | INTERNAL1-17AFEEF-MERGED-1.pdf |
Contraindications: Dihydropyridines: Severe aortic stenosis and liver failure Non-dihydropyridines: Sinus bradycardia, 2nd or 3rd-degree heart block, hypotension, WPW, CHF also, it is contraindicated to use with Beta-blockers Thiazide diuretics Action: Reduce Sodium reabsorption in the distal convoluted tubule Examples: hydrochlorothiazide, chlorthalidone, meto(azone Indications: HTN Side effects: Hypotension, Hypokalemia, Polyuria, Hyper-GLUC (hyperglycemia, hyperfipidemia, hyperuricemia, and hypercalcemia) Contraindications: Sulfa allergy, pregnancy Loop diuretics Action: Blocks Sodium/Potassium pump in the loop of Henle Examples: furosemide, Bumetanide, Torsemide Indications: Edema, congestive heart failure Side effects: Hypokalemia, Hypovolemia, alkalosis, hyperuricemia, gout, dehydration, ototoxicity, and hypocalcemia Contraindications: Hypokalemia, Hypovolemia Potassium-sparina diuretics Action: Antagonize aldosterone receptors Examples: spironolactone, eplerenone, Amiloride, Triamterene Indications: HTN, HF, Hypokalemia Side effects: Hyperkalemia, Gynecomastia Eplerenone does not cause gynecomastia Contraindications: pregnancy, renal failure, hyperkalemia Page 1390 | INTERNAL1-17AFEEF-MERGED-1.pdf |
Digitalis (Diqoxin) Action: Inhibit the sodium/potassium pump, increase intracellular Sodium and calcium concentration, and increase myocardial contractility. It also slows AV node conduction Indications: Congestive heart failure, atrial fibrillation Side effects: Hyperkalemia, Arrhythmias, yellow vision, Nausea, and Vomiting Contraindications: 2nd or 3rd degree AV block, Hypokalemia, WPW Antiplatelet medications Salicylates Action: Antiplatelet (irreversible), preventing Thromboxane A2-mediated platelet aggregation Examples: Aspirin-Indications: CAD, PAD. CVA, Ml, Side effects: bleeding, Gl ulcers, Gl upset Contraindications: active bleeding or peptic ulcer disease Clopidogrel Action: Antiplatelet affect the ADP-dependent activation of glycoprotein llb/llla complex Indications: CAD, PAD, CVA, Ml, Side effects: bleeding, Gl upset Nitrates Action: relax vascular smooth muscles Examples: nitroglycerine Indications: CAD, Ml, HFSide effects: headache, hypotension Contraindications: Concurrent use of Viagra, angle-closureglaucoma, increased Intracranial pressure Page 1391 | INTERNAL1-17AFEEF-MERGED-1.pdf |
Statins Action: HMG-Co A reductase inhibitors-reduce cholesterol synthesis Examples: Atorvastatin, Simvastatin, rosuvastatin Indications: Dyslipidemia, decreased mortality in CAD, Ml Side effects: abdominal pain, myalgia, rhabdomyolysis Contraindications: liver failure, Muscle disease Amiodarone Action: class Ill antiarrhythmic drug, block potassium channel to prolong cardiac repolarization Indications: AF, ventricular arrhythmias Side effects: hypothyroidism, hyperthyroidism, bradycardia, Gl upset, hepatitis, pulmonary infiltrate, salt-gray skin, Adrenaline Action: sympathomimetic amine with both alpha and beta-adrenergic stimulating properties Indications: anaphylaxis cardiac arrest Dose: anaphylaxis (0. 5 ml 1: 1000 1M), arrest (10 ml. 1: 10,000) Side effects: tachycardia, palpitations, headache GI medications Antacids Action: neutralize gastric acid Examples: aluminum hydroxide, magnesium carbonate Indications: GERD, dyspepsia Side effects: decreased absorption of digitalis, ferrous preparations, diarrhea or constipation 1-12 blockers Action: block histamine 2 receptors in the stomach and decrease acid secretion Examples: famotidine, ranitidine, cimetidine Indications: GERD, dyspepsia, peptic ulcer Side effects: headache, dizziness, decreased absorption of digitalis, ferrous preparations, diarrhea or constipation page 1392 | INTERNAL1-17AFEEF-MERGED-1.pdf |
Proton pump inhibitors (PPI's) Action: bind irreversibly to the proton/hydrogen pump in the stomach, reduce hydrogen secretion, and decrease acidity Examples: omeprazole, lansoprazole, pantoprazole Indications: GERD, peptic ulcer Side effects: decreased absorption of digitalis, ferrous preparations, diarrhea or constipation, inhibit cytochrome P450 enzyme except for pantoprazole, nausea, vomiting, diarrhea, headache diziness Laxatives Bulk-forming laxatives: Action: increase fecal mass Examples: wheat bran Indications: constipation secondary to inadequate dietary intake, patient with colostomy, ileostomy, hemorrhoids, anal fissure Side effects: flatulence and abdominal distension Stimulant laxatives: Action: stimulate intestinal motility Indications: constipation Side effects: abdominal cramps, diarrhea, Hypokalemia Fecal softeners: Action: soften and lubricate feces Examples: Arachis oil, liquid paraffin Indications: constipation with fecal impaction Side effects: local irritation of the anus Osmotic laxatives: Action: Increase the amount of fluid in the large bowel Examples: lactulose, phosphate magnesium salt Indications: constipation, bowel preparation for radiologic investigations Side effects: abdominal distension, flatulence, Hypokalemia Page 1393 | INTERNAL1-17AFEEF-MERGED-1.pdf |
Aminosalicylate: Action: unknown, but it seems to be a local anti-inflammatory Examples: sulfasalazine, mesalazine, balsalaide olsalazine Indications: inflammatory bowel disease, rheumatoid arthritis(sulfasalazine) Side effects: Gl upset, hypersensitivity, anemia, renal dysfunction Cholestyramlne: Action: form an insoluble complex with bile acid and prevent its absorption, and promotes the reduction in serumcholesterol Indications: relieve diarrhea in a patient with ileal resectionor ileal disease Side effects: can interfere with some drug absorpfion Analgesics Paracetamol Action: inhibit CNS production of prostaglandins Indications: mild to moderate pain Side effects: few side effects, hepatotoxic in large doses Contraindications: caution with hepatic disease Opioids Action: agonize G-protein-coupled receptor in the neuronal cell membrane Examples: codeine, dihydrocodeine, morphine, oxycodone, fentanyl, pethidine, tramadol Indications: moderate to severe pain Side effects: nausea, vomiting, constipation, respiratory depression Page 1394 | INTERNAL1-17AFEEF-MERGED-1.pdf |
Non-Steroidal anti-inflammatory druas (NSAIDs) Action: inhibit Cyclooxygenase receptor (COX), selectively on COX2 or nonselectively, anti-inflammatory and pain-relieving effect Examples: diclofenac sodium, Indomethacin, ibuprofen, celecoxib, etoricoxib, Indications: arthitis, moderate pain relief Side effects: renal impairment, non-selective can cause peptic ulcer disease, Stevens-Johnson syndrome Contraindications: peptic ulcer disease, asthma patient (caution) Corticosteroids They augment and, in some cases, replace the natural glucocorticoid and mineralocorticoid activity of endogenous steroids. Glucocorticoid side-effects Endocrine: impaired glucose regulation, increased appetite/weight gain, hirsutism, hyperlipidemia Cushing's syndrome: moon face, buffalo hump, striae Musculoskeletal: osteoporosis, proximal myopathy, avascular necrosis of the femoral head Immunosuppression: increased susceptibility to severe infection, reactivation of tuberculosis Psychiatric: insomnia, mania, depression, psychosis Gastrointestinal: peptic ulceration, acute pancreatitis Hematological: increased total WBC count, but monocytes and eosinophils decreased, increased Platelet count. Ophthalmic: glaucoma, cataracts Suppression of growth in children Intracranial hypertension Mineralocorticoid side-effects fluid retention hypertension Page 1395 | INTERNAL1-17AFEEF-MERGED-1.pdf |
Cyclosporine It is an immunosuppressant medication from a natural source Medical uses: to prevent Graft-versus-host disease in BM transplantation Prevent rejection of kidney, heart, and liver transplants Severe Rheumatoid Arthritis and Psoriasis, Severe Atopic dermatitis, alopecia Acute severe ulcerative colitis not responding to treatment with steroids. Treatment of eye conditions: o Dry eyes caused by Sj枚gren's syndrome o Uveitis with noninfective cause Side effects: Nervous symptoms: Tremor, Headache, Numbness, and tingling Gl symptoms: Nausea, Vomiting, Diarrhea, Abdominal discomfort, Indigestion, and Gl upset Renal damage, Hyperkalemia, Hypertension Infection Hirsutism Gum hyperplasia Hypertriglyceridemia Leg cramps Di盲ness, Flushing Page 1396 | INTERNAL1-17AFEEF-MERGED-1.pdf |