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atorvastatin (Statin)
- Therapeutic class: antihyperlipidemia
- Pharmacologic class: HMG-CoA reductase inhibitor.
- Preg. Cat: X
- MOA: inhibits action of HMG-CoA reductase, which results in less cholesterol biosynthesis. Liver responds by making more LDL receptors-increases removal of LDL from blood. Takes up to 2 weeks for a therapeutic effect.
- Indication: Hypercholesterolemia-Decrease risk of MI/Stroke
- Contraindications: Hepatic disease, persistent elevation of serum transaminases, prior sensitivity to drug.
- Adverse effects: common-headache, GI complaints, diarrhea, constipation. Hepatic function monitored during first few months. Serious adverse effect-Rhabdomyolysis.
- Interactions: risk of rhabdomyolysis increases with antibiotic use such as erythromycin(increases levels of statin by 40%) some cyclosporine and niacin supplements.
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Questran (Cholestyramine) Bile Acid Sequestrants
- Therapeutic class: Antihyperlipidemic
- Pharm Class: Bile acid sequestrant
- Preg. Cat: C
- MOA: Binds bile acids in the intestine which are high in cholesterol-this is excreted in the stool. Liver responds by increasing LDL receptors. May take up to 30 days to reach maximum effect. Sometimes combined with statins.
- Indication: Hypercholesterolemia-Decrease risk of MI/stroke.
- Contraindications: biliary obstruction, or sensitivity to drug.
- Adverse effects: constipation, bloating, gas, nausea/vommiting. Serious-GI obstruction.
- Interactions: Binds to other drugs which will interfere with their absorption. May also increase effects of anticoagulents. Serum calcium, sodium, and potassium levels may decrease. Check electrolyte levels.
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Gemfibrozil (lopid) Fibric acid agent (Fibrate)
- Therapeutic class: antihyperlipidemic
- Pharm Class: Fibric acid agent (fibrate)
- Preg. Cat: B
- MOA: Activate lipoprotein Lipase with increases the elimination of triglycerides from the plasma. exact MOA Unknown.
- Indications: Extremely high triglyceride levels. Not first line drug mainly for those with a genetic disorder where they have high VLDL.
- Contraindications: hepatic impairment, severe renal dysfuntion, gallbladder disease, hypersensitivity to drug.
- Adverse effects: May increase liver enzyme values, CPK and serum glucose levels. may decrease hemoglobin(Hgb), hematocrit(Hct) and WBC, Gallstone.
- Interactions: in combination with statins increases risk of rhabdo, use with oral anticoagulants causes potentiation. may also icnrease antidiabetic agents.
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ezetimibe (Zetia) Cholesterol absorption inhibitors
- Therapeutic class: antihypercholesterolemia
- Pharm Class: Cholesterol absorption inhibitor
- Preg. Cat: C
- MOA: Blocks intestinal lumen cells from absorping cholesterol in the Jejunum of small intestine. Up to 50%, but body responds by creating more cholesterol so usually given with a statin.
- Indications: Hypercholesterolemia
- Contraindications: should not be given with a sequestrant block absorption.
- Adverse effects: arthralgia, malaise, URI, elevated hepatic enzyme, rhabdomyolysis, dysrythmias, hypersensitivity.
- Interactions:
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Lisinopril (prinivil,zestril) (ACE inhibitor)
- Therapeutic class: HF/HTN
- Pharm Class: ACE inhibitor
- Preg Cat: C first trimester, D second and third trimester
- MOA: Inhibits Angiotensin converting enzyme which stops RAAS. Decreases BP by letting kidneys excrete sodium/water preserves potassium.
- Indications: Antihypertensive/HF/ protection of renal failure for diabetes.
- Contraindications: Hyperkalemia,angioedema caused by ACE inhibitor therapy. Should not be used during pregnancy.
- BLACK BOX WARNING: Fetal injury and death may occur. discontinue during preg.
- Adverse effects: Cough, headache dizziness, orthostatic hypotension, rash. Serious: Cx pain, angioedema.
- Interactions: NSAIDS/ indomethacin may decrease antihypertensivity of ACE inhibitor. Monitor closely if they're on a diuretic as well, fall risk. Electrolyte levels for hyperkalemia.
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Digoxin (lanoxin)
- Therapeutic class: HF
- Pharm Class: cardiac glycoside
- Preg. Cat: A
- MOA: Positive Inotropic, and some negative dromotropic. Inhibits Na+, -K+ATPase, critical enzyme responsible for pumping sodium ions out of the myocardial cell in exchange for potassium ions. as sodium increases, Ca+ is released from storage causing a more forceful contraction.
- Indications: HTN/HF
- Contraindications: Heart blocks, ventricular dysrhythmias, renal impairment should receive low dose along with geriatrics, also use with caution in patients with MI, Cor pulmonale, or hypothyroidism.
- Adverse effects: can cause dysrythmias, particularly in patients with hypokalemia or renal disease. visual disturbances.
- Interactions: concurrent use of digozin with some diuretics can cause hypokalemia which leads to risk of dysrythmias. Use with ACE inhibitor, spironolactone or potassium supplement can lead to hyperkalemia reducing therapeutic effect. Concurrent use with positive inotropic drugs leads to additive effect. concurrent use with beta blockers leads to additive of bradycardia. Close monitoring required for digoxin levels. Ginsing can cause dysrythmias in addition.
- Therapeutic level 0.8ng/mll-2.0ng/ml. Level above 1.8ng/ml is considered Toxic.
- ANTIDOTE: given for toxicity called Digibind.
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furosemide (lasix) Loop
- Therapeutic class: HTN/HF
- Pharm Class: diuretic
- Preg. Cat: C
- MOA: inhibition of sodium and water reabsorption from the loop of Henle and distal renal tubules; potassium, magnesium and calcium also may be excreted
- Indications: CHF, edema, HTN, HF,
- Contraindications: hypokalemia, pneumonia
- Adverse effects: electrolyte imbalances, orthostatic hypotension. Serious: severe hypotension, dehydration, hypokalemia, hyponatremia, ototoxicity (loop Diuretics).
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Spironolactone (Potassium sparring diuretic)
- Therapeutic class: HTN, CHF/HF
- Pharm Class: aldosterone antagonist
- Preg class: C
- MOA: Inhibits Aldosterone, sodium and water excreted potassium is sparred. Prevents cardiac remodeling. decreases mortality unknown.
- Indications: HTN, CHF, Edema, pulmonary edema.
- Contraindications: Hyperkalemia
- Adverse effects:
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HCTZ-Thiazide-Distal convoluted tubule Less effective then loop
- Therapeutic class: HTN/HF/
- Pharm Class: Thiazide diuretic
- Preg Cat: B
- MOA: act on the distal convoluted tubule (just beyond the loop of Henle) to promote sodium, chloride and water excretion
- INdications: CHF, Edema, HTN, HF
- contraindications: Hyperkalemia-leads to dysrythmias.
- Adverse effects: May precipitate a gout, loss of potassium and othostatic hypotension most common.
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Angiotensin Receptor Blockers (ARB) (sartans)
- Therapeutic class: HTN/HF
- Pharm class: ARB
- Preg Cat: C firs trimester, D for second and third trimester.
- MOA: Block angiotensin II from the angiotensin 1 (AT1) receptorsCause vasodilation and decrease peripheral resistance
- Indications: HTN, HF w/COPD.
- Contraindications: angioedema, acute renal failure
- Adverse effects: fetal toxicity, neonatal mortality, headache, dizziness, orthostatic hypotension rash, diarrhea.
- Interactions: non specific reserved for those that cannot tolerate ACE inhibitor.
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Metoprolol (Beta-adrenergic blocker)/ (Atenolol (tenormin) Most widely prescribed).
Propranolol is NON-selective-effects lungs as much as heart.
- Therapeutic class: HTN/ HF
- Pharm Class: Beta-adrenergic blocker
- Preg Cat: C
- MOA: selective Beta 1 blocker at higher dose may block Beta 2 which effects bronchial. reducing SNS.
- Indications: HTN/ HF
- Contraindications: 2nd and 3rd degree heart block. Asthma/ COPD/ cardiogenic shock, bradycardia must be greater than 60bpm.
- Adverse effects: severe hypotension, sexual dysfunction, fatigue, insomnia, dizziness, headache.
- Interactions: Concurrent use with digozin may result in bradycardia. Oral contraceptives may cause increase effects of metoprolol. May enhance the hypoglycemic effects of insulin.
- Antidote: atropine can reverse severe bradycardia.
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Nitroglycerin (Vasodilator)
- Therapeutic Class: Antianginal drug
- Pharm Class: Organic nitrate-vasodilator
- Preg Cat: C
- MOA: Works at vascular smooth muscle to form nitric oxide which triggers a cascade resulting in the release of calcium ions. Works at vascular smooth muscle to form nitric oxide which triggers a cascade resulting in the release of calcium ions
- Indications: HTN/ Angina Pectoris
- contraindications: BP less then 100 systolic. ED drugs, used for those that can't tolerate ACE inhibitors
- Adverse effects: Face Flushing, headache, rash, syncope, postural hypotension.
- interactions: Viagra (ED drugs) Unsafe drop in BP.
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Calcium Channel Blockers
Diltiazem (cardizem)
- Therapeutic class: Antianginal
- Pharm Class: Calcium channel blocker
- Preg Cat: C
- MOA: Inhibits the transport of calcium into the cells, it will relax both coronary and peripheral blood vessels, bringing more oxygen to the heart muscle and decreases the workload of the heart
- Indications: treat dysrhythmias, hypertension and stable and vasospastic angina
- Contraindications: Heart block, severe hypotension, use with caution for those with renal impairment or hepatic impairment.
- adverse effects: dizziness, headache, edema of ankles and feet, abrupt withdrawal may precipitate an acute anginal episode.
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Nicotinic acid
- Therapeutic class: Antihyperlipidemia
- Pharm Class: Niaspan or Niacin- B complex vitamin
- Preg cat. C
- MOA: Mainly used to lower VLDL-high dose of 2-3g a day needed compared to a supplement dose of 25mg.
- Indications: High VLDL levels-rarely used-as monotherapy.
- Contraindications: dysrythmias-A-fib.
- Adverse effects: flushing, nausea, puritus, headache, bloating, diarrhea. exacerbates goat. uric acid build up.
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Alpha-adrenergic antagonists
- Therapeutic class: Antihypertension
- Pharm Class: Prazosin, minipress
- Preg. Cat.
- MOA: alpha blockade-relaxes smooth muscle systemically.
- Indications: HTN and prostatic hypertrophy.
- Contraindications: hypotension
- Adverse effects: Orthostatic hypotension, dizziness, dry mouth, nausea, bradycardia.
- Interactions: Other antihypertensives.
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Nitroprusside (Nitropress)
- Therapeutic class-Antihypertensive
- Preg cat:X
- MOA: Dilates smooth muscle-slowly lower BP 20-30mm/hg/hr. monitor BP constantly, cyanide toxicity and stroke.
- Indications: HTN-BP diastolic greater than 120mm/hg. Hypertensive crisis (230/130)
- Contraindications: hypovolemia, internal bleeding.
- Adverse effects: severe hypotension, cyanide toxicity.
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