Académique Documents
Professionnel Documents
Culture Documents
Indications: Pulmonary Embolism, Deep Vein Thrombosis, MI, Rheumatic Heart disease w/heart valve
damage,prosthetic heart valves,atrial fibrillation
Mechanism of Action: Inhibits Vitamin-K dependent action of clotting factors II, VII, IX, X, formed in liver
Indications: Acute anginal attacks (S.L. isosorbide dinitrate only); to prevent conditions that
may cause anginal attacks
Side Effects: CNS: Fever, GI: diarrhea, anorexia, nausea, vomiting, cramps,, mouthulcerations, sore mouth,
melena GU: enhanced uric acid excretion, hematuria, excessive menstrual bleeding Hematologic:
hemmorhage Hepatic: hepatitis, Jaundice Skin: dermititis, urticaria, necrosis, gangrene, alopecia, rash
Contraindications: * Contraindicated in patients hypersensitive to drug and in those with bleeding from the
GI, GU, or respiratory tract; aneurism, cerebrovascular hemorrhage, severe or malignant hypertension,; severe
renal or hepatic disease; subacute bacterial endocarditis, pericarditis, or pericardial effusion; or blood
dyscrasias or hemorrhagic tendencies.
* Contraindicated during pregnancy, threatened abortion, eclampsia
or preeclampsia and after surgery involving large open area, eye, brain or spinal cord; recent prostatectomy;
major regional lumbar block anesthesia, spinal puncture, or diagnostic, or therapeutic invasive procedures. *
Avoid using in patients with a history of warfarin induced necrosis; in unsupervised patients with senility,
alcoholism or psychosis; or in situations in which there are adequete laboratories for coagulation testing. *
Use cautiously in patients with diverticulitis, colitis, mild or moderate hypertension, or mild or moderate
hepatic or renal disease; with drainage tubes in any orifice; with regional or lumbar block anesthesia; with
heparin induced thrombocytopenia, and deep venous thrombosis; or in conditions that increase the risk of
hemorrhage. * use cautiously in breast feeding women
Mechanism of Action: Thought to reduce cardiac oxygen demand by decreasing preload and
afterload. Drug may increase blood flow through the collateral coronary vessels.
Side Effects: CNS: headache, dizziness, weakness CV: Orthostatic hypotension, tachycardia,
palpations, ankle edema, flushing, fainting EENT: S.L. Burning. GI: Nausea, vomiting. Skin:
Cutaneous vasodilation, rash
Contraindications: * Contraindicated in patients with hypersensitivity or idiosyncracy to
nitrates and in those with severe hypotension, angle closure glaucoma, increased intercranial
pressure, shock, or acute MI with low left ventricular filling pressure. * use cautiously in
patients with blood volume depletion (such as from diuretic therapy) or mild hypotension
Drug: Morphine
Indications: Severe pain * Moderate to severe pain requiring continuous around the clock
opiod. Single dose epidural extended pain relief after major surgery
Mechanism of Action: Unknown. Binds with opiod receptors in the CNS, altering perception
of and emotional response to pain
Side Effects: CNS: Dizziness, Euphoria, light-headedness, nightmares, sedation, somnolence,
siezures, depression, hallucinations, nervousness, physical dependence, syncope. CV
bradycardia, cardiac arrest, shock, hypertension, hypotension, tachycardia. GI: constipation,
nausea, vomiting, anorexia, biliary tract spasms, dry mouth, ileus. GU: urine retention
Hemotologic: thrombocytopenia Respiratory: apnea, respiratory arrest, respiratory depression.
Skin: diaphoresis, edema, pruitis and skin flushing. Other: decreased libido
Contraindications: Contraindicated in patients hypersensitive to drug and those with conditions
that would preclude I.V administration of opiods (acute bronchial asthma or upper airway
obstruction). * Contraindicated in patients with GI obstruction * Use with caution in elderly or
debilitated patients and in those with head injury, increased intercranial pressure, seizures,
chronic pulmonary disease, prostatic hyperplasia, severe hepatic or renal disease, acute
abdominal conditions, hypothyroidism, Addison's disease, and urethral stricture. * Use with
caution in patients with circulatory shock, biliary tract disease, CNS depression, toxic psychosis,
acute alcoholism, delirium trmens, and seizure disorders.
Plavix (clopidogrel)
ADP receptor antagonist
Antiplatelet
USE: - Patients at risk for ischemic events recent MI, CVA, PAD
- patients with acute coronary syndrome
Decrease arthrothrombotic events in CABG and other heart Patients
Lovenox (enoxaparin)
Heparin (Anti-Coagulant)
USE: -prevention & treatment of venous thrombosis & pulmonary
embolism
-treatment of atrial fibrillation w/ embolization
-diagnosis & treatment of DIC
-prevention of clotting in blood samples & heparin lock sets
-acute MI, left ventricular thrombi
Mechanism: -inactivates factor XA, inhibiting thrombus formation by
blocking the conversion of prothrombin to thrombin & fibrinogen to
fibrin
-inactivates factor XIII, thrombin-induced activation of factors V and VIII
Side: Effects: -derm (loss of hair)
-hematologic (hemorrhage, bruising, thrombocytopenia, elevated AST, ALT
levels,hyperkalemia
-hypersensitivity (chills, fever, urticaria, asthma)
-osteoporosis, suppression of renal function, white clot syndrome
Contraindications: -contraindicated w/ hypersensitivity to heparin; severe
thrombocytopenia; uncontrolled bleeding; any patient who cannot be monitored
regularly w/ blood coagulation tests; labor & immediate postpartum period
-increased bleeding w/ anticoagulants, salicylates, penicillins, cephalosporins
Integrillin (eptifibatide)
Antiplatelet drug
Glycoprotein IIb/IIIa receptor antagonist
USE: -treatment of acute coronary syndrome
-prevention of cardiac ischemic complications in patients undergoing elective,
emergency, or urgent percutaneous coronary intervention
Mechanism: inhibits platelet aggregation by binding to the glycoprotein IIb/IIIa
receptor on the platelet, which prevents the binding of fibrinogen & other
adhesive ligands to the platelet
Side: Effects: -CNS (headache, dizziness, weakness, syncope, flushing)
-derm (rash, pruritis)
-GI (nausea, GI distress, constipation, diarrhea)
-Hematologic (thrombocytopenia)
-bleeding, hypotension
Contraindications: -contraindicated w/ allergy to eptifibatide, bleeding
diathesis, hemorrhagic CVA, active abnormal bleeding or CVA within 30 days,
uncontrolled or severe hypertension, major surgery w/in 6 wks, dialysis, severe
renal impairment, low platelet count
-use cautiously in the elderly, w/ pregnancy, lactation, renal insufficiency
-use cautiously when combining w/ other drugs that affect blood clotting
Atenolol
Captopril
ACE inhibitor, Antihypertensive
Mechanism: -blocks beta-adrenergic receptors of the SNS in the heart and kidney,
decreasing CO and oxygen consumption, decreasing the release of rennin from the
kidney, and lowering BP
Side: Effects: -allergic (pharyngitis, erythematous rash, fever, sore throat, laryngospasm,
respiratory distress
-CNS (dizziness, vertigo, tinnitus, fatigue, depression, paresthesias, sleep disturbances,
hallucinations, disorientation, memory loss, slurred speech
-CV (bradycardia, CHF, cardiac arrythmias, sinoatrial or AV node block, tachycardia, PVI,
claudication, CVA, pulmonary edema, hypotension
-derm (rash, pruritis, sweating, dry skin)
EENT (eye irritation, dry eyes, conjunctivitis, blurred vision
-GI (gastric pain, flatulence, constipation, diarrhea, N/V)
-GU (impotence, decreased libido)
-joint pain, muscle cramps
-Respiratory (bronchospasm, dyspnea, cough, bronchial obstruction)
-decreased exercise tolerance, development of antinuclear antibodies
Contraindications -contraindicated with sinus bradycardia, second or third degree heart block,
cardiogenic shock, CHF, pregnancy
-use cautiously w/ renal failure, diabetes or thyrotoxicosis, lactation, respiratory disease
-increased effects w/ verapamil, anticholinergics, quinidine
Altace
(ramipril)
Antihypertensive, ACE inhibitor
Lipitor (atorvastatin)
Antihyperlipidemic, HMG-CoA reductase inhibitor
USE: -treatment of elevated total cholesterol, serum triglycerides, and LDL cholesterol in
pts w/ hypercholesterolemia
-to increase HDL-C in pts w/ primary hypercholesterolemia
-to treat boys and post-menarchal girls ages 10-17 w/ heterozygous familial
cholesteremia -prevention of CV disease
Zocor (simvastatin)
Antihyperlipidemic
HMG-CoA Reductase inhibitor
USE: -treatment of elevated total cholesterol, serum triglycerides, and LDL cholesterol in pts w/
hypercholesterolemia
- secondary prevention of CV events in hypercholesterol with CHD or @ risk for CHD
-to reduce the risk of coronary disease, mortality, and CV events
-treatment of type III hyperlipoproteinemia
-to treat boys and post-menarchal girls ages 10-17 w/ heterozygous familial cholesteremia
Mechanism: -inhibits HMG-CoA reductase, the enzyme that catalyzes the first step in cholesterol
synthesis pathway, resulting in a decrease in serum cholesterol, serum LDLs, & either an increase or
no change in serum HDLs
Side: Effects: -CNS (headache, asthenia, sleep disturbances)
-GI (flatulence, diarrhea, abdominal pain, cramps, constipation, nausea, dyspepsia, heartburn, liver
failure
-respiratory (sinusitis, pharyngitis)
--rhabdomyolysis with acute renal failure, arthralgia, myalgia
Contraindications: -contraindicated w/ allergy to simvastatin, fungal byproducts, pregnancy,
lactation
-use cautiously w/ impaired hepatic and renal function, cataracts
-increased risk for myopathy or rhabdomyolysis w/ erythromycin, rithromcin, HIV protease inhibitors,
itraconazole, ketoconazole, clarithromycin, nefazodone
Mechanism: -inhibits HMG-CoA reductase, the enzyme that catalyzes the first step in
cholesterol synthesis pathway, resulting in a decrease in serum cholesterol, serum LDLs,
and increases serum HDLs
-increases hepatic LDL recapture sites, enhances reuptake and catabolism of LDL; lowers
triglyceride levels
Side: Effects: -CNS (headache, asthenia)
-GI (flatulence, abdominal pain, cramps, constipation, nausea, dyspepsia, heartburn,
liver failure)
-respiratory (sinusitis, pharyngitis)
-rhabdomyolysis with acute renal failure, arthralgia, myalgia
Contraindications: -contraindicated with allergy to atorvastatin, fungal byproducts,
active hepatic disease, or unexplained and persistant elevations of transamine levels,
pregnancy, lactation
-use cautiously w/ impaired endocrine function
-possible severe myopathy or rhabdomyolysis w/ erythromycin, cyclosporine, niacin,
fibric acid derivatives, antifungals
Digoxin
Cardiac glycoside
Cardiotonic
USE: -CHF
-Atrial fibrillation
Mechanism: -increases intracellular calcium & allows more calcium to enter the
myocardial cell during depolarization via a Na-K pump mechanism; this increases force
of contraction, increases renal perfusion, decreases heart rate, and decreases AV node
conduction velocity
Side: Effects: -CNS (headache, weakness, drowsiness, visual disturbances, mental status
change
-CV (arrythmias)
-GI (GI upset, anorexia)
Contraindications: -contraindicated w/ allergy to digitalis preparations, ventricular
tachycardia, ventricular fibrillation, heart block, sick sinus syndrome, IHSS, acute MI,
renal insufficiency and electrolyte abnormalities
-use cautiously w/ pregnancy & lactation
-increased incidence of cardiac arrythmias w/ K-losing diuretics
-hold drug if pulse is <60 in adult, <90 in infant
Amiodarone
Aldactone
(spironolactone)
(Cardarone)
USE: Life threatening Arrhythmia, Ventricular tachycardia or fibriliation
Side: Effects: Can be fatal, side effects may last several months, worsening of
arrhythmia, can harm unborn fetus, wheezing, blurred vision, numbness,
nausea.
Contraindications: cardiogenic shock; severe sinus-node dysfunction,
causing marked sinus bradycardia; second- or third-degree atrioventricular
block; and when episodes of bradycardia have caused syncope (except when
used in conjunction with a pacemaker). Hypersensitivity to iodine.
Labetolol
Colace
USE: Hypertension
Mechanism: Beta-adrenergic blocking agent (Beta blocker)
Side: Effects: Impaired thinking and reactions, slow or uneven heartbeats,
syncope, shortness of breath, swelling of ankles, depression, insomnia,
impotence.
Contraindications: Bronchial asthma, overt cardiac failure, greater-thanfirst-degree heart block, cardiogenic shock, severe bradycardia, other
conditions associated with severe and prolonged hypotension.
(Docusate)
Lasix (furosemide)
USE: For adults and pediatric patients for the treatment of edema associated
with congestive heart failure, cirrhosis of the liver, and renal disease, including
the nephrotic syndrome. Oral Lasix may be used in adults for the treatment of
hypertension
Mechanism: Lasix is a diuretic which is an anthranilic acid derivative. (Lasix
(furosemide) is a potent diuretic which, if given in excessive amounts, can lead
to a profound diuresis with water and electrolyte depletion)
Side: Effects: pancreatitus, jaundice, anorexia, oral and gastric irritation,
cramping diarrhea, constipation, nausea, vomiting, systemic vasculitis,
interstitial nephritis, necrotizing angitis, aplastic anemia, thrombocytopenia,
agranulocytosis, hemolytic anemia, leukopenia, anemia
Contraindications: Lasix is contraindicated in patients with anuria and in
patients with a history of hypersensitivity to furosemide.
Cozaar
USE: for the treatment of hypertension. It may be used alone or in combination with
other antihypertensive medications. It is also indicated for the management of chronic
stable angina.
Mechanism: Diltiazem hydrochloride is a calcium ion cellular influx inhibitor (slow
channel blocker or calcium antagonist).
Side: Effects: Cardiovascular: Angina, arrhythmia, AV block (second- or third-degree),
bundle branch block, congestive heart failure, ECG abnormalities, hypotension,
palpitations, syncope, tachycardia, ventricular extrasystoles.Nervous System: Abnormal
dreams, amnesia, depression, gait abnormality, hallucinations, insomnia, nervousness,
paresthesia, personality change, somnolence, tinnitus, tremor.Gastrointestinal:
Anorexia, constipation, diarrhea, dry mouth, dysgeusia, mild elevations of SGOT,
SGPT, LDH, and alkaline phosphatase (see hepatic warnings), nausea, thirst, vomiting,
weight increase.
Contraindications: Diltiazem is contraindicated in (1) patients with sick sinus
syndrome except in the presence of a functioning ventricular pacemaker, (2) patients
with second- or third-degree AV block except in the presence of a functioning
ventricular pacemaker, (3) patients with hypotension (less than 90 mm Hg systolic), (4)
patients who have demonstrated hypersensitivity to the drug, and (5) patients with
acute myocardial infarction and pulmonary congestion documented by x-ray on
admission.