Digoxin

Trade: Lanoxin, Toloxin

Indications: Heart failure, Atrial fibrillation, paroxysmal atrial tachycardia

Contradictions: Hypersensitivity, uncontrolled ventricular arrhythmias, AV block, idiopathic hypertrophic subaortic stenosis, constrictive pericarditis

Side Effects: Arrhythmias, ECG changes

Dosage and Route: PO digitalizing dose- 0.75-1.5mg given as 50% of the dose initially and one quarter of the initial dose in each of 2 subsequent doses at 6-12 hr intervals. Maintenance dose- PO 0.125-0.5mg/day depending on patient's weight, renal function, and serum level. Geriatric: PO initial dose should not exceed 0.125mg.

Other: antiarrhythmics, inotropics, digitalis glycosides, Bears heightened risk of causing significant patient harm when used in error. BEERS Drug

CloNIDine

Trade: Catapres, Catapres-TTS, Duraclon, Kapvay

Indications: PO: Mild to moderate hypertension, PO: ADHD, Epidural: management of cancer pain unresponsive to opioids only

Contradictions: hypersensitivity, Epidural: injection site infection, Geriatric: increase of orthostatic hypotension and adverse CNS effects

Side Effects: Cardiac changes, sodium retention

Dosage and Route: PO (immediate release) 100mcg(0.1mg) twice daily, increase by 100-200mcg(0.1-0.2mg)/day every 2-4 days; usual maintenance dose is 200-600mcg(0.2-0.6mg)/day in 2-3 divided doses. PO geriatric: 100mcg(0.1mg) @ HS initially, increase as needed

Other: anti-hypertensive class, adrenergics pharm, DNC extended-release tablets, BEERS Drug 

Norvasc

Trade: amLODIPine, Katerzia, Norliqva

Indications: Hypertension, Chronic stable angina, vasospastic angina, recently documented coronary artery disease w/o HF or ejection fraction <40%

Contradictions: Hypersensitivity, systolic BP <90 mm Hg; Geriatric: increase risk of hypotension, decrease dose recommended

Side Effects: peripheral edema, cardiac changes

Dosage and Route: PO 5-10mg once daily; Geriatric: Initiate therapy at PO 2.5mg/day, increase as needed/tolerated (up to 10mg/day)

Other: antihypertensive class, calcium channel blockers

Lasix

Trade: furosemide

Indications: edema due to HF, hepatic impairment, or renal disease, Hypertension

Contradictions: cross-sensitivity with thiazides and sulfonamides 

Side Effects: erythema multiforme, SJS, toxic epidermal necrolysis, aplastic anemia, agranulocytosis

Dosage and Route: Edema: PO 20-80mg/day as a single dose initially. Hypertension: 40mg twice daily initially. 

Other: diuretics, loop diuretics 

Nitroglycerine

Trade: extended-release: Nitro-Time; Sublingual: Nitrostat; Transdermal patch: Nitro-Dur, Trinipatch; Spray: Nitrolingual, Nitromist, Rho-Nitro

Indications: HF, Acute and long term prophylactic angina pectoris management

Contradictions: increase intracranial pressure, severe anemia, pericardial tamponade, constrictive pericarditis, uncorrected hypovolemia, concurrent use of PDE-5 inhibitor

Side Effects: hypotension, tachycardia, syncope, dizziness, headache

Dosage and Route: Sublingual: 0.3-0.6mg, may repeat every 5 minutes for 2 additional doses to acute attack. Spray: 1-2 sprays, may be repeated every 5 minutes for 2 additional doses for acute attack. PO: 2.5-9mg every 8-12 hrs. Patch: 0.2-0.4mg/hr. 12-14 hrs/day on, 10-12 hrs/day off. 

Other: antianginals, nitrates, sustained-release tablets DNC; SL tablet dissolve under tongue; Spray under tongue. 

Coumadin

Trade: warfarin, jantoven

Indications: prophylaxis and treatment of venous thrombosis, pumonary embolism, atrial fibrilation, and myocardial infarction

Contraindications: uncontrolled bleeding, ulcer disease, brain, eye, or spinal cord injury or surgery, severe liver or kidney disease

Side Effects: Calciphylaxis, bleeding

Dosage and Route: PO 2-5mg/day for 2-4 days, than adjust daily dose by results of INR. Geriatric: start with lower dose

Other: anticoagulants, medication bears a heightened risk if used in error, Avoid cranberry juice while taking

Coreg

Trade: Carvedilol

Indications: Hypertension, HF with digoxin, left ventricular dysfunction after myocardial infarction

Contraindications: history of SJS, pulmonary edema, bradycardia, heart block, asthma, severe hepatic impairment. Geriatric: increased sensitivity to beta blockers, initial dose lower recommended

Side Effects: bradycardia, HF, pulmonary edema, SJS, toxic epidermal necrolysis, hyperglycemia

Dose and Route: PO Hypertension: 6.25mg twice daily; HF: 3.125mg twice daily; Left VD: 6.25mg twice daily

Other: antihypertensive, beta blocker. If pulse is less than 50 bpm, hold, DNC, extended-release capsules may be opened and sprinkled in AS. Wean off drug.

Diovan

Trade: valsartan

Indications: management of hypertension, HF, reduction of death from cardiovascular causes

Contraindications: concurrent with aliskiren in diabetic patients, black patients may not be as effective

Side Effects: angioedema, dizziness, edema

Dose and Route: PO Hypertension: 80mg or 160mg once daily; HF: 40mg twice daily; Post MI: 20mg twice daily

Other: antihypertensive, angiotensin II receptor antagonists

Lovenox

Trade: enoxaprin

Indications: VTE, DVT, PE prevention

Contraindications: Hypersensitivity to enoxaparin and/or benzyl alcohol, active major bleeding, Geriatric: increase risk of bleeding due to age decreased renal function

Side Effects: bleeding, anemia, edema, fever

Dose and Route: Knee replacement: PO 30mg every 12 hrs for 7-10 days; Abdominal surgery: PO 40mg once daily for 7-12 days or until ambulatory

Other: anticoagulants, bears heightened risk when used in error

Lopressor

Trade: metoprolol, toprol XL,

Indications: Angina pectoris, Prevention of MI and decreased mortality in patients with recent MI, Hypertension

Contraindications: Pulmonary edema,  Uncompensated HF, Bradycardia, heart block, or sick sinus syndrome (in absence of a pacemaker), Cardiogenic shock, older adults may have increased sensitivity to beta blockers; initial dose reduced recommended.

Side Effects: bradycardia, HF, pulmonary edema, ED, fatigue, weakness

Dosage and Route: PO 25-100mg/day as a single use and maybe increased every 7 days as needed up to 450mg/day

Other: antianginals, antihypertensive, beta blockers, DNC, however, pills can but cut in half. Check pulse daily an BP weekly.  

HCTZ

Trade: hydroCHLOROthiazide

Indications: HF, renal dysfunction, cirrhosis, glucocorticoid therapy, estrogen therapy, mild-moderate hypertension

Contraindications: hypersensitivity with other other thiazides or sulfonamides

Side Effects: skin cancer, SJS, hypokalemia, pancreatitis

Dosage and Route: PO 12.5-100mg/day in 1-2 doses (upto 200mg/day; not to exceed 50mg/day for with greater likelihood of electrolyte abnormalities)

Other: antihypertensives, diuretics, thiazide diuretics, monitor BP, intake, output, and daily weight, assess for edema daily. 

Flovent

Trade: fluticasone, Flovent Diskus, Flovent HFA

Indications: treatment of asthma as prophylactic therapy

Contraindications: hypersensitivity to milk proteins, acute attack of asthma/status asthmaticus

Side Effects: hypersensitivity reactions, churg-strauss syndrome, headache

Dosage and Route: inhaln 88mcg twice daily initially, may increase dose in 2 weeks if not adequately responding. 

Other: anti-inflammatories (steroidal), corticosteroids

Atrovent

Trade: Atrovent HFA

Indications: COPD, chronic bronchitis and emphysema.

Contraindications: hypersensitivity to ipratropium, atropine, belladonna alkaloids, or bromide. Geriatrics: may be more sensitive to effects

Side Effects: hypotension, palpitations, bronchospasm, cough 

Dosage and Route: Inhaln metered-dose inhaler- 2 inhalations every 6 hrs as needed.  

Other: bronchodilators, antocholinergics, rinse mouth after each use

Albuterol

Trade: Proventil HFA, Ventolin HFA

Indications: treatment or prevention of bronchospasm in asthma or COPD

Contraindications: hypersensitivity to adrenergic amines Geriatric: increased risk of adverse reactions, may require dose decrease

Side Effects: paradoxical bronchospasm, nervousness, restlessness, tremor, chest pain, palpitations

Dosage and Route: PO 2-4mg 3-4 times/day; Geriatric: initial dose should not exceed 2mg 3-4 times daily, may be increased carefully (up to 32mg.day) Inhaln: MDI 2 inhalations every 4-6hrs as needed.

Other: bronchodilators, adrenergics

Symbicort

Trade: budesonide, formoterol

Indications: bronchospasms, COPD

Contraindications: asthma, acute deteriorating COPD or acute respiratory symptoms

Side Effects: paradoxical bronchosasm, hypertension, insomnia, palpitations, tachycardia

Dosage and Route: Inhaln: 20mcg/2mL-unit-dose vial twice daily vi jet nebulizer

Other: bronchodilators, adrenergics, check lung sounds, BP, and pulse before administrating the drug.

Pro-Air

Trade: albuterol sulfate

Indications: COPD, mild-moderate bronchospasms 

Contraindications: angina, heart attack history, hypertension, seizure history

Side Effects: hypertension, palpitations, paradoxical bronchospasm

Dosage and Route: Inhaln: 2 puffs every 4-6 hrs as needed

Other: bronchodilators, assess lungs before each use, check BP weekly

Singulair

Trade: montelukast

Indications: asthma, seasonal allergies, exercise-induces bronchoconstriction (EIB)

Contraindications: acute asthma attacks

Side Effects: SJS, toxic epidermal necrolysis, suicidal behavior/thoughts, eosinophilic conditions

Dosage and Route: PO 10mg/ daily

Other: bronchodilators

Advair Disc

Trade: fluticasone, flovent diskus

Indications: asthma prophylactic treatment

Contraindications: acute asthma attacks

Side Effects: serious allergic reactions, churg-strauss syndrome, headache

Dosage and Route: Inhaln: 88mcg twice daily

Other: anti-inflammatories (steroidal), corticosteroids