Cardio

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α2 Agonists

clonidine: AVL: PO. IND: ADHD, HT urgency. AE: Drowsiness, rebound HTN, bradycardia. PK: Onset=30-60min. Duration=8h. DOS : ADHD : Initial=50-100ug/d. Std=3–10µg/kg/d (50–400ug/d), once/d or divided. To D/C, reduce dose 0.1mg q3–7d.


guanfacine=Intuniv: AVL: PO. IND: ADHD. DOS: Adj for renal fxn. To D/C, reduce dose 1mg q3–7d. ADHD: Initial=1mg/d. Increase dose 1mg/d/week prn. Max=4mg/d.


methyldopa: IND: 1st line for HTN in PRG. AE: Anticholinergic (dry mouth, sedation), fluid retention, , depression, orthostatic hypotension, sexual dysfxn, Na + water retention. Warning: Can cause rebound HTN if stopped abruptly.

 

Angiotensin-Converting Enzyme (ACE) Inhibitors

IND: HTN, HT crisis , HF (with BB), DM, CAD, renal disease, stroke, post ACS, angina. MOA: Blocks formation of the vasoconstrictor angiotensin II. Also prevents formation of aldosterone which leads to decreased Na and decreased fluid. EVD: Less effective and more angioedema for black pts (less renin type HTN so use thiazide or CCB). ADM: T same time of day (once/d or BID). AE: dry cough20%, increased K (avoid supplements), orthostatic hypotension/fainting, angioedema, increased Cr (>30% would be concerning), renal failure. PRG: CI. LAC: CI. DI: NSAIDs, K sparing diuretics. MON: BUN, Cr, K, BP. DOS: Requires adj for renal fxn.

benzapril=Lotensin:


captopril=Capoten: AVL: PO, SL. IND: HT urgency. PRG: CI. LAC: Safe. PK: Onset: SL=10-15min. PO=1-2h. Duration=4-6h. Food decreases F by 30%.


cilazapril=Inhibace:


enalapril=Vasotec: PRG: CI. LAC: Safe.


enalaprilat: AVL: IV. IND: HT emergency. PK: Onset=15-30min. Duration=6-12h.


fosinopril=Monopril:


lisinopril=Zestril=Prinivil: AVL: IND: HTN, post MI, MOA: EVD: ADM: T w/ or without food. AE: Chills, fever, abdominal pain, hypotension, naus, vom, diar, angioedema, joint/muscle pain. CI/Warning: PRG: LAC: DI: PK: COS: AUX: MON: DOS: Adj dose for renal fxn. Std=10-40mg once/d. OTH:


perindopril=Coversyl: Most common ACEI in practice.


quinapril=Accupril:


ramipril=Altace: EVD: HOPE trial used 10mg/d. LAC: Safe. DOS: 2.5-10mg/d (can divide BID).


trandolapril=Mavik:

 

Angiotensin II Receptor Blockers (ARBs)

IND: DM, uncomplicated HTN, CAD, HF, LVH, renal failure, and alterative if ACEI not tolerated. MOA: Blocks receptor that respond to angiotensin II (vasoconstrictor). EVD: Increased angioedema and decreased efficacy for black pts (less renin type HTN so use thiazide). AE: Rash, orthostatic hypotension/fainting, angioedema, increased K (don’t take supplements), increased Cr (stop if >30%), decreased Na, renal failure. Less cough and angioedema vs ACEI. CI: Already taking ACEI (exception in HF) . PRG: CI. DOS: Adjust for hepatic fxn.

candesartan=Atacand: DOS: 8-32mg/d (can divide BID).


eprosartan=Teveten:


irbesartan=Avapro:


losartan=Cozaar:


olmesartan=Olmetec: FDA Warning : severe D and weight loss.


valsartan=Diovan:

 

Antiarrhythmics

Class IC (Na channel blocker)

flecainide: IND: AFib. AE: N, V, D, metallic taste, agranulocytosis<1%, dysrythmias, hypotension, HF/asthma exacerbation, fatigue, HA, anxiety, dizziness. QT prolongation (known).


Class II

sotalol: Class II + III antiarrhythmic. IND: AFib (only for NSR maintenance). MOA: blocks β receptor, blocks potassium channel. AE: N, V, D, fatigue, depression, insomnia, HA, dizziness, dysrhythmia, HF/ asthma exacerbation, masks hypoglycemia. Prolongs QT (known).

Class III

amiodarone: IND: AFib. MOA: Slows HR. ADM: T w/ food. AE: Corneal microdeposits100%, N, C30%, blurred vision5%, insomnia, cough13%, pulmonary fibrosis3%, tremor15%, blue/grey skin discoloration<10%, liver toxicity, photosensitivity50%, hypo20%/hyper3%thyroidism, QT prolongation100%/Torsades0.5%. DI: Inhibits PGP. GFJ interaction. PK: t1/2=53d. Onset=1w-5months. Vd=65.8L/kg. Met by 3A4, 2C8. Inhibits 2D6, 1A2, 2C9, 3A4. MON: Thyroid and liver tests q6 months. Vitals, eye exam, and PFT yearly.


dronedarone: IND: AFib (rhythm control). EVD: Less effective vs amiodarone for NSR maintenance. AE: N, V, D, weakness, dyspnea, cough, interstitial lung disease. Warning: Avoid if HF, permanent AFib. DI: Digoxin.

 

Antiplatelets

Irreversible Cyclooxygenase Inhibitors

acetylsalicylic acid (ASA)=Aspirin: IND: Primary prevention of MI for high risk pts, secondary prevention of MIISIS 2, angina (81mg/d), during ACS. MOA: Inhibits COX-1. CI: <12yo can cuase Rye's syndrome (<19yo to be safe). PK: Inhibits platelets for 5-7d. DOS: Angina: 81mg/d. MI prevention: 81mg/d. Suspected MI: chew 162mg (2 EC tabs).


P2Y12 Inhibitors

clopidogrel=Plavix: IND: ACS, PAD, stroke, AFib. Used if intolerant to ASA. AE: D, upset stomach10%, rash6%, HA, dizziness, bleeding. CI: If previous ulcer use ASA and esomeprazole instead. DI: PPIs (pantoprazole low risk). PK: Activated by 2C19 (genetic polymorphism may decrease efficacy). DOS: Drug eluting stent: 1 year of Tx. NSTEMI: 300mg stat then 75mg/d was better for death, MI, and StrokeCURE. OTH: Very commonly seen. Hold > 5d before surgery if possible.


prasugrel=Effient: IND: Used w/ ASA for secondary prevention of MI and stroke and stent pts with high risk of thrombosis. MOA: Irreversibly inhibits ADP platelet. AE: Higher risk of bleeding vs. clopidogrel (especially if >75yo or <60kg), confusion, rash. DOS: Post PCI=10mg/d. OTH: Not commonly seen. Hold > 7d before surgery if possible.


ticagrelor=Brilinta: IND: Used w/ ASA (<150mg/d) for secondary prevention of MI and stroke. MOA: Irreversibly inhibits ADP platelets. EVD: In ACS, decreased mortality and ischemic events vs. clopidogrelPLATO. AE: HA, bleeding, dyspnea14%, decreased HR, increased uric acid, ventricular pause. DI: 3A4 + PGP. Can increase digoxin levels. PK: Doesn’t require metabolic activation like clopidogrel. COS: Expensive (not on all formularies). DOS: Post-PCI: 90mg BID. OTH: Hold > 5d before surgery if possible.

 

β Blockers (BBs)

Cardio-Selective

Acronym for the common cardio-selective drugs=BAAM. IND: Uncomplicated HTN < 60yo, HTN > 60yo with angina (not 1st line in HTN >60yo: no stroke prevention), HF (w/ ACEI), HT urgency, angina, post MICOMMIT/CCS, migraine, tremor, anxiety. EVD: Less effective in black pts. ADM: T at same time of day. AE: Orthostatic hypotension, exercise intolerance, fatigue, HA, insomnia, cold extremities, increased cholesterol, increased asthma, increased K, depression, glycemic effects (DM), impotence. Warning : Don’t stop abruptly (can lead to angina or MI in IHD). Taper to lowest dose for >1week. DI: Non-DHP CCB (both decrease HR).

acebutolol=Sectral: MOA: Has ISA (intrinsic sympathomimetic activity) which acts like NE to stimulate β receptors which increase HR and BP. EVD: May have less cold extremities but rarely used. CI: Angina.

atenolol=Tenormin: PRG: CI.


bisoprolol=Monocor:


esmolol: AVL: IV. IND: HT emergency. AE: bronchospasm, heart block, HF. PK: Onset=1-2min. Duration=10-20min.


metoprolol tartrate=Lopresor: IND: AFib (rate control). Tartrate salt in Canada not approved for HF. EVD: SR form is cheap, selective, has 24h control, and is indicated for angina, post-MI. PRG: Possibly safe. LAC: Safe. DI: 2D6. PK: t1/2=3-7h with no active metabolites.


nebivolol:


Non-Selective

nadolol=Corgard: EVD: Only BB that increases renal blood flow.


oxprenolol=Trasicor: MOA: Has ISA (intrinsic sympathomimetic activity) which acts like NE to stimulate β receptors which increase HR and BP. May see less cold extremities but rarely used. CI : Angina.


pindolol=Visken: MOA: Has ISA (intrinsic sympathomimetic activity) which acts like NE to stimulate β receptors which increase HR and BP. May see less cold extremities but rarely used. CI : Angina.


propranolol=Inderal: AVL: PO. IND: Tremor, social anxiety. DOS: Anxiety: 10mg 30min before task.


sotalol=Sotacor: AE: BB w/ more risk for: fatigue, exercise intolerance, impotence, nightmares, bronchospasms, vasoconstriction, and glycemic effects.


Non-Selective β & α1 Antagonists

carvedilol: IND: Portal HTN.


labetolol=Trandate: AVL: PO, IV. IND: HT urgency and emergency. CI : HR<60. PRG: Safe. LAC: Safe. PK: PO: F=25%. Onset=30-120min. IV: Onset=5-10min. Duration=3-6h.


felodipine=Plendil=Renedil: AVL: PO. IND: HT urgency. PK: XL: Peak=2-5h. Duration=24h.


 

Bile Acid Sequesterants aka Resins

IND: Hyperlipidemia instead or w/ statins. MOA: Binds bile in intestine forcing body to use cholesterol to make more bile. LDL receptors increase. EVD: CHD death NNT=59. Decreases LDL 10-30%, increases HDL 3-10%, increases TG 10-25%. ADM: T 4h before or 1h after meds. AE: N, C, flatulence, bloating, liver toxicity. DI: Binds to many medications.

cholestyramine=Questran: EVD: 1984 Trial showed 24g/d had NNT 59 for CHD death or Non Fatal MI. ADM: T before food. DOS: Start=4g/d. Max=30g/d (divided BID-QID).


colestipol=Colestid: DOS: Start=5g/d. Max=24g/d (divided BID-QID).


colesevelam=Lodalis: ADM: T w/ food. DOS: 1.875 g (3 tabs/1 pkg) BID or 3.75g/d.

 

Calcium Channel Blockers (CCBs)

Dihydropyridine (DHP)

IND: HTN, HT urgency, angina. MOA: Peripheral vasodilation by blocking Ca channels that constrict blood vessels. EVD: Use XR formulation to decrease reflex tachycardia (decreased stroke/MI). Increased sensitivity for elderly and black pts. Less evidence for cardio protection vs diuretics, BBs, and ACEIs. Increased edema and decreased effect on the heart vs. non-DHPs. AE: C, flushing, dizziness, reflex tachycardia, ankle edema, gingival hyperplasia5% (> for males: promote dental hygiene), palpitations, HF. CI : HF. DI: 3A4 (ex. GFJ or fluconazole) increased hypotension. Avoid NSAIDs. AUX: Do not chew/crush XR/XL tabs.

amlodipine=Norvasc: AVL: PO. IND: HT urgency. ADM: Only CCB that can be crushed. PK: Peak=6h. Duration=24h. DOS: 5-10mg/d.


felodipine=Plendil=Renedil: AVL: PO. IND: HT urgency. PK: XL: Peak=2-5h. Duration=24h.

nifedipine=Adalat: IND: HT urgency. EVD: Don’t use IR formulation: Was 1st line but increased evidence of stroke and MI due to uncontrolled BP drop and reflex tachycardia. AE: Shell of tab may be stool. PRG: Safe. LAC: Safe. PK: Peak=2h. Duration=24h.


Non-DHP

IND: AFib (rate control). MOA: Blocks AV node which decreases heart contractility and HR. AE: Bradycardia, edema, constipation, heart block. CI/Warning: Abrupt withdrawal may cause chest pain. CI in HF (decreased EF). DI: 3A4, BBs (slower HR).

diltiazem=Cardizem: EVD: Equal BP efficacy to BBs and diuretics. PRG: Possibly safe. LAC: Safe.


verapamil (VPM)=Isoptin: AE: worst CCB for C PRG: Safe. LAC: Safe.

 

Cardiac Glycosides

digoxin=Toloxin/Lanoxin: IND: AFib, HF. Often used for sedentary pts and as add on to BB or CCB. MOA: Blocks Na/K ATPase pump. + inotrope (heart pump harder). – chronotrope (decreased HR). EVD: Reduced hospitalization in HF. AE: N, V, D, anorexia, abdominal pain, dizziness, fatigue, weakness, confusion, photophobia, halos, bradycardia, heart block, dysrhythmia. CI: HR<60. PRG: Safe. LAC: Safe. DI: Amiodarone, quinidine, and verapamil (reduce digoxin dose 50%). PK: t1/2=30-40h. Steady state=1week. Large Vd but not affected by obesity (use ideal BW). 70% renal elimination. MON: Trough level done just before next dose. Min 6h after dose. Blood targets: 1-2.5nM in AFib, 0.5-0.8nM in HF. DOS: 0.0625–0.25mg/d.

 

Cholesterol Absorption Inhibitors

ezetimibe=Ezetrol: AVL: PO (tab10mg). IND: Hyperlipidemia. MOA: Inhibits cholesterol absorption at brush border. EVD: Decreases LDL 14-25%, increases HDL 1%, decreases TG 7-9%. SHARP trial looked at simvastatin + ezetimibe. ADM: T w/ or without food. AE: D, increased LFTs, muscle/joint pain, cough, fatigue. DOS: 10mg/d OTH: Often used w/ statin.

 

Direct Oral Anticoagulants (DOACs)

Formerly know as New Oral Anticoagulants (NOACs).

apixaban=Eliquis: AVL: PO tabs2.5, 5mg. IND: VTE (prophylaxis + Tx), thromboprophylaxis after hip and knee surgery, AFib. MOA: Reversibly binds active site of factor Xa which slows thrombin generation and reduces fibrin formation. EVD: Only NOAC for CrCl=15-30 but limited evidence w/ CrCl<25. Decreased bleeding vs warfarinARISTOTLE. ADM: T w/ or without food. AE: Bleeding (especially w/ antiplatelet), major bleed2%. CI: Indwelling epidural catheters or recent spinal puncture (hematoma risk). PRG: CI. LAC: CI. DI: 3A4 and PGP inducers/inhibitors. PK: t1/2=12h. F~50%. PB=87-93%. Vd=21L. 27% renal elimination. Met by 3A4/5 (major), 1A2, 2C8, 2C9, 2C19, 2J2 (minor). Doesn’t induce or inhibit CYPs or PGP. MW=459.5g/mol. COS: $337.082017 for 90d supply (180 tabs) of 5mg. MON: CrCl yearly. No anticoagulation monitoring. DOS: AFib: 5mg BID. Adj if CrCl<50. VTE Tx: 10mg BID x 7d then 5mg BID. VTE prophylaxis (>6 months after VTE): 2.5mg BID. Post Hip/Knee surgery: 2.5mg BID. Start 12-24h after surgery and continue for 14d (knee) or 35d (hip).


dabigatran=Pradaxa: IND: VTE prophylaxis, AFib. MOA: Inhibits IIa. EVD: Dialyzable (apixaban may be too). Warning/CI: Moisture sensitive (keep in original bottle). CI: CrCl<30, liver failure. DI: Separate antacids by 2h. PK: t1/2=12-17h. 80% renal elimination. Low PB. COS: $346.822017 for 90d supply (180 tabs) of 150mg. DOS: Std=150mg BID. If CrCl 30-49 or >80yo 110mg BID.


edoxaban=Lixiana: AVL: PO tabs15, 30, 60mg. IND: AFib, prevention & Tx of VTE. MOA: Inhibits factor Xa in coagulation cascade which reduces thrombin generation which prolongs clotting time. ADM: T w/ or without food. AE: bleeding, anemia. CI: CrCl<30mL/min, dialysis. COS: $300.522017 for 90d supply of 60mg (60 tabs). DOS: AFib: 60mg once/d. Tx/prevention of VTE: 60mg once/d after 5-10d of heparin. Usually for>3 months. Consider 30mg/d if CrCl=30-50mL/min or Pt<60kg. OTH: 4th DOAC to be released.


rivaroxaban=Xarelto: AVL: PO (tabs2.5, 10, 15, 20mg ). IND: VTE Tx + prophylaxis, AFib. 2.5mg tab used BID w/ once/d 81mg ASA to prevent stroke and MI. MOA: Inhibits factor Xa in coagulation cascade which reduces thrombin generation which prolongs clotting time. EVD: Less intracranial hemorrhage vs. warfarinROCKET-AF. AE: bleeding, rash and fainting. CI: CrCl<30. PK: t1/2=5-9hrs. 36% renal elimination. Food increases F. Met by 3A4. High PB. COS: $300.522017 for 90d supply of 20mg (90 tabs). DOS: Once/d. OTH: Tabs can be crushed. Dose should be followed with food. Can give via NG tube - crush and suspend in 50mL of water. Flush tube w/ water after administering. Avoid NG admin into distal part of the stomach because this can decrease F.

 

Direct Renin Inhibitors

aliskiren=Rasilez: IND: 2nd line for HTN. MOA: Prevents renin from converting angiotensin I to angiotensin II (similar to ACEI + ARB). EVD: Add on therapy with little evidence. AE: D, dry cough, increased K. PRG: CI.

 

Direct Thrombin Inhibitors

argatroban: IND: HIT. PK: t1/2= 45min. COS: Expensive. DOS: Adjust for hepatic fxn. Continuous infusion based on wt and aPTT. OTH: Doesn't form anti-Plt antibodies. Prolongs INR. Doesn’t cross react w/ Heparin antibodies.

 

Fibric Acid Derivatives (Fibrates)

IND: Hyperlipidemia (mostly for TGs). MOA: Activates PPAR-alpha, a transcription factor and regulator of lipid metabolism. EVD: Decreases LDL 5-20%, increases HDL 10-35%, decreases TG 20-50%. AE: N, abdominal pain, cholelithiasis, liver toxicity, muscle pain/rhabdo. PRG: CI. LAC: CI. DOS: Adj for renal fxn.

benzafibrate=Bezalip: DOS: 400mg/d.


fenofibrate microcoated=Lipidil Supra: DOS: 200mg/d.


fenofibrate nanocrystals=Lipidil EZ:


gemfibrozil=Lopid: DI: Repaglinide. Statins (increased risk of rhabdo). DOS: 600mg BID.

 

GP IIb/IIIa inhibitors (GPI inhibitors)

IND: Before stenting procedures. MOA: Blocks fibrinogen-mediated cross linking of platelets. EVD: Most trials show benefit when used w/ anticoagulant. Abciximab showed increased mortality (don't use). CI: Active bleed, stroke, major surgery.

eptifibatide:


tirofiban:

 

Heparins

heparin=Unfractionated Heparin (UFH): AVL: IV, SubQ. IND: DVT/VTE, PE, ACS. MOA: Binds ATIII in coagulation cycle. EVD: Preferred anticoagulant in renal impairment. AE: Bleeding, osteoporosis, HIT (flu like symptoms), hair loss, skin necrosis, increased K, hypersensitivity rxn. PK: t1/2~1h. MON: aPTT (q6h after LD and min once/d after). CBC q48h and K q2d. DOS: Dosed in units not mg. OTH: MW 3000-30,000Da. Comes from pork/beef. Antidote=protamine sulfate.
Low Molecular Weight Heparins (LMWHs)

IND: VTE (prophylaxis + Tx), ACS. EVD: Less hyperkalemia and osteoporosis vs Heparin. In renal failure heparin is preffered.
ADM: Can be given at home. AE: Bleeding, HIT (less), local pain/irritation. PK: Less PB than Heparin (more predictable). MON: baseline cbc, Scr, INR. CBC q2d. Anti-Xa levels done in severe cases. DOS: Once/d or BID. Can’t interchange dosing with heparin. OTH: ~1/3 size of heparin. Protamine reverses IIa effect but not Xa (Partial antidote).

dalteparin=Fragmin: DOS: Units/kg.


enoxaparin=Lovenox: AVL: SubQ. IND: STEMI. DOS: mg/kg.
nadroparin=Fraxiparine: DOS: Units/kg.
tinzaparin=Innohep: DOS: Units/kg.


fondaparinux=Arixtra

Same pentasaccharide sequence as UFH and LMWH but is not considered a heparin (see Indirect Factor Xa Inhibitors)

 

HMG-CoA Reductase Inhitors aka Statins

MOA: Inhibits HMGcoa reductase which leads to increased LDL receptors in liver. Also stabilizes plaques (useful for secondary prevention after MI). EVD: NNT CV event =60/33 for primary/secondary prevention. Doubling dose reduces LDL 6%. AE: Muscle pain10%, myositis1% (CK>ULN), rhabdomyolysis0.1% (dose dependent where CK>10xULN which can lead to kidney failure – watch for dark urine), liver toxicity (ALT/AST >3xULN)1%, indigestion, HA, impotence, T2DM9% RRI. For every T2DM case, 10 CV events are avoided. PRG: CI. LAC: CI. PK: Cell uptake by OATP transporters except fluvastatin. DOS: Can be fixed or based on LDL target (<2mM or 50% reduction). OTH: Inhibits CoQ10 (important for muscle fxn). Primary prevention adherence rate is only 30%.

atorvastatin=Lipitor: AVL: PO tab10, 20, 40, 80mg. EVD: Decreases total cholesterol 29-45%, decreases LDL 39-60%, increases HDL 5-9%, decreases triglycerides 19-37%. ADM: T w/ or without food. AE: D11%, joint pain10%, nasopharyngitis13%, N, stomach upset, increased BG, muscle pain, jaudince. CI: Liver disease. DI: 3A4 inhibitors ex. clarhithromycin (risk of rhabdo). PK: Metablolized by 3A4. DOS: Once/d. No dose adj for kidney fxn. Primary prevention: 10mg/dASCOTT LLA. Secondary prevention:10mg/dALLIANCE. 80mg/dMIRACL/PROVE-IT/TNT(compared vs 10mg)/IDEAL. Pts >75yo: usual max=20mg/d.


fluvastatin=Lescol: EVD: Decreases total cholesterol 20%, decreases LDL 25-34%, increases HDL 7%, decreases triglycerides 10-23%. PK: Metablolized by 2C9. DOS: Secondary prevention: 40mg BIDLIPS. OTH: Not commonly seen.


lovastatin=Mevacor: EVD: Decreases total cholesterol 18-34%, decreases LDL 20-40%, increases HDL 5-15%, decreases triglycerides 10-20%. DI: 3A4 inhibitors (ex. gemfibrozil). PK: Metabolized by 3A4. DOS: Primary prevention: 20-40mg/dAFCAPS/TexCAPS.


pravastatin=Prevachol: EVD: Decreases total cholesterol 17-27%, decreases LDL 20-40%, increases HDL 5-15%, decreases triglycerides 10-20%. PK: Less CYP metabolism vs other statins. DOS: Primary Prevention: 10-20mg/dMEGA 40mg/dWOSCOPS/ALLHAT. Secondary prevention: 40mg/dCARE/LIPID.


rosuvastatin=Crestor: EVD: Decreases total cholesterol 33-46%, decreases LDL 45-63%, increases HDL 13%, decreases triglycerides 28-35%. PK: Less CYP metabolism vs other statins. DOS: Primary prevention: 20mg/dJUPITER.


simvastatin=Zocor: EVD: Decreases total cholesterol 21-33%, decreases LDL 20-40%, increases HDL 5-15%, decreases triglycerides 10-20%. DI: 3A4 inhibitors (ex. gemfibrozil). PK: Metabolized by 3A4. DOS: Secondary Prevention: 20-40mg/d4S. 40mg/dHPS. 80mg/d associated w/ increased muscle problemsSEARCH.

 

Hyperpolarization-Activated Cyclic Nucleotide-Gated (HCN) Channel Blockers

ivabradine: IND: HF w/ EF <35%, angina. MOA: Reduces HR by blocking funny channel in SA node. ADM: T w/ food (F increases 30% w/ food). AE: Enhanced brightness14.5%, bradycardia, HA, dizziness. DI: 3A4 inhibitors. PK: t1/2=6h. F~40%. COS: ~$100 for 3 months. DOS: Not studied CrCl<15mL/min. No dose adj >15mL/min. Std=5mg/d (once/d or 2.5mg BID). Max=7.5mg/d. Adj to target HR=50-60bpm. OTH: Not commonly seen.

 

Indirect Factor Xa Inhibitors

fondaparinux: AVL: SubQ. IND: VTE (Tx + prophylaxis), post surgery, ACS. MOA: Potentiates ATIII ~300x which selectively inhibits Xa. AE: Increased bleeding, osteoporosis. CI: CrCl <30mL/min. PK: t1/2=20hrs. PB=0. MON: Xa assay if necessary. DOS: Once/d. OTH: No risk of HIT. Not reversed by protamine like Heparin.

 

Loop Diuretics

furosemide=Lasix: IND: Edema, HF, HTN w/ kidney failure. ADM: T in the am (makes you pee). AE: orthostatic hypotension, increased urination, decreased: Ca, Na, K. Can affect BG levels. PK: t1/2=6h (Lasix).

 

Nitrates

nitroglycerine (NTG): AVL: Patch NitroDur=Minitran=Transderm-Nitro, SL spray Nitroligual, SL tabs Nitrostat , IV. IND: Angina, ACS. SL spray can be used prophylactically before exercise. IV used for HT emergency. MOA: Dilates blood vessels in the heart. ADM: Stop activity and sit down if experiencing angina. Patch: T off patch hs and place new one in am (less tolerance to the drug and low risk of angina while sleeping). Rotate site to avoid irritation. Apply to dry skin anywhere except below knee, on skin folds, injured site (chest preferred). Applied like a Band-Aid without touching sticky surface. Don’t cut or reuse. SL spray: prime but don't shake. AE: HA, facial flushing, syncope, dizziness, fainting, hypotension, tachycardia. CI: severe aortic stenosis. DI: Viagra, Cialis etc. PK: Patch: Onset=30-60min. Duration=variable. SL spray: Onset<2min. Duration=up to 30min. SL tabs: Onset<2min. Duration=up to 30min. IV: Onset=2-5min. Duration=5-10min. DOS: SL spray: 1 spray (0.4mg) q5 min Rx2. Call 911 if no resolution after 2nd spray. OTH: Doesn’t prevent or reverse MI. SL tabs rarely seen because of short expiry.

 

Potassium-Sparing Diuretic

spironolactone: IND: HTN, HF. EVD: Decreased mortality if added on after ACEi + BB for systolic HFRALES. AE: increased K, breast enlargement.

 

Thiazide/Thiazide-Like Diuretics

ADM: T in am (makes you pee).

hydrochlorothiazide (HCTZ)=Hydrodiuril: EVD: Preferred thiazide for HTN. First among equals vs ACEI + CCB. Less effective if Cr<30 (use loop). Effective in elderly and black pts. AE: N, V, rash, orthostatic hypotension, photosensitivity, impotence1%, muscle cramps, weakness, decreased K, decreased Na, increased Ca, decreased Mg, increased cholesterol, increased uric acid (gout1%), increased BG.
LAC: Safe.


chlorthalidone=Hygroton: AVL: PO tab50,100mg. PK: t1/2=40-80h.


indapamide=Lozide:

 

Thrombolytics

alteplase (TPA): IND: STEMI. EVD: Vs TNK, TPA is less expensive, more non-cerebral bleeding, worse 30d mortality for pts treated >4h after symptoms. DOS: Max=100mg in 90min.

tenecteplase (TNK): AVL: IV. IND: STEMI. EVD: Vs TPA, TNK is easier, more $, has less non-cerebral bleeding, improved 30d mortality if pts treated >4h after symptom onset. CI: Past intracranial bleed, head trauma/surgery within 3 months. DOS: Ideally given within 30min of entering hospital.

 

Vasodilators

hydralazine=Aprezoline: AVL: PO, IV. IND: HT urgency and emergency, HF (in black pts). AE: Reflex tachycardia, lupus like syndrome. PK: PO: Onset=20-30min. Duration=8h. F=50%. IV: Onset=10-20min. Duration=12h.

 

Vitamin K Antagonists

warfarin=Coumadin: IND: VTE/PE, AFib, valve replacement. MOA: Inhibits vitamin K dependent clotting factors: 2, 7, 9, 10 and proteins C+S. ADM: T at same time of day. INR testing usually in am so hs dosing is more convenient for dose adj. AE: N, D, cramping, bleeding, purple toe syndrome, skin necrosis. PRG: CI. DI: Cholestyramine (inhibits F), septra, metronidazole (inhibit met), rifampin, carbamazepine (induces met), celebrex/NSAIDs, garlic (antiplatelet), American ginseng (decreases INR), cranberry (increased INR). PK: S enantiomer more active. F~100%. R met by 1A2. S met by 2C9. MON: INR q2d, then q7d, q14d, q28d, max=12 weeks. DOS: INR dose adj: [INR<2=increase weekly dose 5-15%]. [INR:2-3=no dose change]. [INR: 3.1-3.5=decrease weekly dose 5-15%]. [INR:3.6-4=hold 0-1 doses and decrease weekly dose 10-15%]. [INR>4=hold 0-2 doses and decrease weekly dose 10-15%] OTH: Keep consistent vitamin K diet/supplement. Limit alcohol. Avoid contact sports. Overlap with heparin/LMWH/fondaparinux at >5d and INR>2 for 24h.

 

AVL: IND: MOA: EVD: ADM: AE: CI/Warning: PRG: LAC: DI: PK: COS: AUX: MON: DOS: OTH:
AVL: IND: MOA: EVD: ADM: AE: CI/Warning: PRG: LAC: DI: PK: COS: AUX: MON: DOS: OTH:


AVL: IND: MOA: EVD: ADM: AE: CI/Warning: PRG: LAC: DI: PK: COS: AUX: MON: DOS: OTH:


AVL: IND: MOA: EVD: ADM: AE: CI/Warning: PRG: LAC: DI: PK: COS: AUX: MON: DOS: OTH:


AVL: IND: MOA: EVD: ADM: AE: CI/Warning: PRG: LAC: DI: PK: COS: AUX: MON: DOS: OTH:


AVL: IND: MOA: EVD: ADM: AE: CI/Warning: PRG: LAC: DI: PK: COS: AUX: MON: DOS: OTH: