Medical Pearls/ Patient Counseling

Abrupt D/C may cause angina, MI, or Hypertensive emergency; need to taper over 2 wks

Improves symptoms, decreases hospitalization
no effect on mortality

*abrupt D/C may cause worsening HF

Adjust dose in pts with renal dysfunction

Effects take up to a month
Don't stop abruptly
CI'd with MAOIs
increased suicidality in kids/teens

+/- Food
avoid getting up to fast when using (OrthoStatic HTN)
Tell MD if plan to start/stop smoking

Drowsiness
CI'd w/ MAOIs (wait 2 weeks after stopping MAOI)
CI'd after an MI
caution in CV pts, Glaucoma, SZ pts

+/- Food
CI'd w/ MAOIs, and Narrow angle GLAUcoma
Caution w/ pts on Albuterol
Caution in HTN, CVD, & unrinary reTN

CI'd w/ MAOIs
Drowsiness
Tell MD if rash/hives present
Dont abruptly DC
ASA or NSAIDs may cause GI Bleed

Take w/ Food
Drowsiness
No Grapefruit juice
hypOTN, N/V,
PRIAPISM may occur

CI'd w Narrow angle GLAUCOMA
Caution w/ impaired Renal or Hep
Drowsiness/ HABIT forming

CI'd w Narrow angle GLAUCOMA
Caution w/ impaired Renal or Hep
Drowsiness/ HABIT forming

SE's usually MILD
CI'd w MAOIs
HypOnatremia
Drowsiness
up to 2 weeks to work
DONT abruptly DC
Tell MD if XS thirst, leg, foot hand swells

+/-Food
Take in EVENING
Should DC b4 anesthesia

+/- Food
May cause ACIDOSIS
Should Periodically measure Bicarb
Drowsiness
Keep HYDRATED to avoid Kidney Stones
DC gradually

Drowsiness
HABIT Forming
Avoid Grapefruit
CI'd in kids under 6 months
CI'd in open angle Glaucoma
CI'd in Renal/Hep pts

CI'd w MAOIs
Caution w HTN pts (monitor pts BP)
AEs: taste perversion, TINNitus, MYDriasis, ABNORMAL ejaculation/orgasm

CI'd w MAOIs
Drowsiness
Tachycardia, Dry mouth, N/V
Caution in HEP pts
Caution in Glaucoma
DONT DC unless told

+/_ Food
Drowsiness
Dont DC abruptly (Taper over 1 week)

Caution in Renal pts
+/-Food
AEs: Dizziness, HA, confusion, HTN
Daily doses >5mg should be given BID & increases shouldnt be made sooner than weekly

DONT DC abruptly
Drowsiness
Food or MILK to avoid GI upset
CI'd in HEP pts
Life-threatening PANCREAtitis

CI'd w MAOIs
Dont abruptly DC
Caution in HEP pts
ASA or NSAIDs increase GI Bleed

May cause FAINTING in 1st doses
Caution w Diabetes pts
Avoid XS sunlight/heat
Food or Milk to avoid GI upset

HABIT forming
Caution in Elderly, Debilitated pts
Long term AEs: Dry mouth, back pain, flu-like sx, palpitations Upper Resp, infxn

NOT effective (except Metolazone) when CrCl<30mL/min; use Loops
CI'd w/ Sulfa drugs
Have Ceiling doses (unlike Loops)

Weak anti-Hypertensives
Not used as Monotherapy
Often used w/ HTCZ to decrease hypOkalemia
CI'd in hYPERkalemia, CKD

CI'd in Pregnancy, HYPERkalemia, BILATERAL Renal Artery Stenosis
Switch to ARB if cough intolerable
Captopril has SHORTest DOA

Same CI's as ACEi
HYPERkalemia & RENAL insuff also likely w/ ACEi

Use w. Caution when CrCl<30mL/min

AVOID taking w/ FATTY food
DONT use w/ Cyclosporine

No CIs
SEs: Reflex tachycardia, HA, Flushing, PERIPHERAL Edema, GINGIVAL HYPERplasia,
HF exacerbation (EXCEPT Amlodipine and Felodipine)

CI'd in
greater than 2nd degree heart block, SYSTOLIC HF
SEs: BRADYcardia/heartblock, CONSTIPATION, PERIPHERAL Edema, GINGIVAL Hyperplasia, HF exacerbation

DONT use with PDE-5 inhibitors (CI'd) increased risk of hypOTN,

Should NOT be used as 1st line therapy

CI'd w/ Methyldopa (Liver Dz)
SEs: Sedation, ORTHOstatic HypOTN, Depression,
PERIPHERAL Edema, Dry Mouth
Patch applied WEEKly
Abrupt DC (esp w/ Bbs) may acuse MI or HTNsive emergency; TAPER over 2 weeks

CI'd in Acute MI, Aortic dissection
ORTHOstatic hypOTN,
Peripheral Edema,
Lupus-like Syndrome
used for Refractory HTN

CI'd in Complete Biliary Obstruction
Can be used in Liver Dz pts
Caution in pts w/ High TGs
Colesvelam has FEWER GI SEs and interactions

also available OTC
Flushing/itching, Orthostatic hypOTN, Myopathy, HYPERuricemia, HYPERglycemia

CI'd in Gallbladder Dz, HEP pts, severe RENAL fxn,( Adjust dose)
When adding to statin, Fenofibrate preferred

CI'd in PREGNANCY, HEP dysfxn
Most effective drugs to lower LDL
Pravastatin NOT metabolised by CYP enzymes

No CIs
Cyclosporine & fibrates may increase effects

CI'd w. Sulfa drugs
Decrease sx; Effect on mortality unknown
Similar SEs to Thiazides...except
causes HypOCALcemia

CI'd in K>5mEq/L
CI'd in CrCl <30
CI'd w. strong CYP 3A4 inhibitors
SEs: HYPERkalemia, GYNOMASTIA, breast tenderness, HIRSUTISM, menstrual changes

250mg-500mg PO q6h
Adjust dose in RENAL pts
Take 1 hour BEFORE or 2 hrs AFTER meals
SEs: Hypersensitivity rxn, N/V/D,
INTERSTITIAL NEPHRITIS
Hemolytic anemia (after prolonged use)

250mg - 500mg PO q8h or
500mg-875mg PO q12h
can be used in 3-drug tx for H. pyolri
1 hour Before or 2 hours AFTER food

AminoPCN + Beta lactamase inhibitor
Adjust dose in RENAL pts
Good AEROBIC coverage

Rapid acting insulin: 5-15mins
Peak: 30 -90mins
Duration: < 5hrs
HYPOglycemia (BG:<70mg/dL) is most COMMON SE
Should be given within 15 minutes from eating

Rapid acting insulin: 5-15mins
Peak: 30 -90mins
Duration: < 5hrs
HYPOglycemia (BG:<70mg/dL) is most COMMON SE
Should be given within 15 minutes from eating

aka NPH (Neutral Protamine Hagedorn)
Short acting insulin
Onset: 2-4hrs
Peak: 4-10hrs
DOA: 10-16hrs

Long Acting, Basal insulin
Onset: 2-4hrs
NO PEAK
DoA: 20-24hrs

Long Acting Insulin
Onset: 5 - 15mins
Dual Peaks
DoA: 10-16hrs

Long acting insulin
Onset:5-15mins
Dual peaks
DoA: 10-16hrs

Long acting insulin
70%insulin aspart protamine/ 30% aspart
Onset:5-15mins
Dual peaks
DoA: 10-16hrs

long acting insulin
70%NPH/ 30% Regular insulin
Onset30 - 60mins
Dual peaks
DoA: 10-16hrs

glucocorticoid agonist
CI'd as primary tx for acute bronchospasm
SEs: Throat irritation, Oral candidiasis, Lower Resp infxn
HFA formulation
Most Potent Corticosteroid
44-440mcg BID

glucocorticoid agonist
CI'd as primary tx for acute bronchospasm
SEs: Throat irritation, Oral candidiasis, Lower Resp infxn
Respules are the ONLY nebulized corticosteroid
200-800mcg BID

glucocorticoid agonist
CI'd as primary tx for acute bronchospasm
SEs: Throat irritation, Oral candidiasis, Lower Resp infxn
220-440mcg/day

Long acting Beta-2 Agonist
CI'd as acute bronchodilator
CI'd in Tachycardic pts
SEs: HA, HTN, dizziness, Chest pain
ONLY use in adjunct tx w. inhaled corticosteroids: may increase risk of DEATH
Diskus:50mcg/puff (max: 2 pufs/day)

Selective leukotriene antagonist
Approved as young as 1 yr olds
SE: CHURG STRAUSS syndrome (rare)
4-10mg/@ bedtime

Beta-2 receptor agonist
XS use can INCREASE risk of DEATH
Nebulizer compatible w. budesonide, cromolyn, ipatropium
INTERACTS w. noselective Bbs (decreases its efx)
CI'd in TACHYcardic pts
SEs (Dose Dependent)
Angina, A.fib, arrhythmias, Tremors
MDI: 90mcg/puff

Beta-2 receptor agonist
INTERACTS w. noselective Bbs (decreases its efx)
CI'd in tachycardic pts (Less cardiac efx)
Prime the inhaler by releasing 4 actuations prior to use
MDI: 45mcg/puff (2000puffs/canister)

Fluticasone & Salmeterol
Dosages: 100/50, 200/50, 500/50
synergistic efex w. the combo
MAX dose: 1 puff BID