Brand: Zestril, Qbrelis
Class: Antihypertensive; ACE inhibitor
Indications: Hypertension, heart failure (adjunct), acute MI within 24 h in stable patients
Action: Inhibits ACE, so less angiotensin II forms; vessels relax and aldosterone falls
Adverse Effects: Angioedema, fetal toxicity (boxed warning), hyperkalemia, hypotension, renal impairment, dry cough
Contraindications: History of angioedema (any cause), aliskiren in diabetes, within 36 h of sacubitril-valsartan
Interactions: Potassium supplements, potassium-sparing diuretics, NSAIDs, lithium, other RAAS blockers
Nursing Considerations: Check BP and hold per parameters; monitor potassium and creatinine; watch first-dose hypotension with diuretics; tongue or facial swelling is an airway emergency
Patient Teaching: Report face, lip or tongue swelling at once; avoid potassium salt substitutes; call your provider if pregnant
The "-pril" drugs let bradykinin build up, which explains both the nagging dry cough and angioedema, which can appear at any point in therapy.
Card 2
losartan
Answer
Brand: Cozaar
Class: Antihypertensive; angiotensin II receptor blocker (ARB)
Indications: Hypertension, stroke risk reduction in hypertension with LVH, diabetic nephropathy in type 2 diabetes
Action: Blocks angiotensin II at AT1 receptors, causing vasodilation and less aldosterone release
Adverse Effects: Fetal toxicity (boxed warning), hyperkalemia, hypotension, acute kidney injury, dizziness
Contraindications: Hypersensitivity, aliskiren in patients with diabetes
Interactions: Potassium supplements, potassium-sparing diuretics, NSAIDs, lithium, ACE inhibitors or aliskiren
Nursing Considerations: Monitor BP, potassium and creatinine; correct volume depletion before starting; watch renal function in renal artery stenosis or severe HF
Patient Teaching: Rise slowly; avoid potassium salt substitutes; call your provider if pregnant
The "-sartan" drugs block the receptor rather than the enzyme, so bradykinin does not build up and cough is much less common than with ACE inhibitors.
Card 3
sacubitril-valsartan
Answer
Brand: Entresto, Entresto Sprinkle
Class: Heart failure agent; angiotensin receptor-neprilysin inhibitor (ARNI)
Indications: Chronic heart failure (reduces CV death and HF hospitalization), pediatric HF with LV systolic dysfunction
Action: Sacubitril blocks neprilysin, raising natriuretic peptides; valsartan blocks AT1 receptors
Adverse Effects: Fetal toxicity (boxed warning), angioedema, hypotension, hyperkalemia, renal impairment, cough
Contraindications: ACE inhibitor within 36 h, prior angioedema with an ACE inhibitor or ARB, aliskiren in diabetes
Interactions: ACE inhibitors (angioedema), other ARBs, potassium supplements, potassium-sparing diuretics, NSAIDs, lithium
Nursing Considerations: Confirm last ACE inhibitor dose was 36+ h ago; monitor BP, potassium and creatinine; stop and never restart if angioedema occurs
Patient Teaching: Never take with an ACE inhibitor; report face or tongue swelling; call your provider if pregnant
Neprilysin breaks down natriuretic peptides, so blocking it adds the body's own diuresis and vasodilation on top of the ARB.
Card 4
amlodipine
Answer
Brand: Norvasc, Katerzia, Norliqva
Class: Antihypertensive, antianginal; dihydropyridine calcium channel blocker
Indications: Hypertension, chronic stable angina, vasospastic angina, coronary artery disease
Action: Blocks calcium entry into vascular smooth muscle, dilating arteries with little effect on heart rate or conduction
Adverse Effects: Peripheral edema (dose-related), dizziness, flushing, palpitations, hypotension, worse angina at start
Contraindications: Hypersensitivity to amlodipine
Interactions: Simvastatin (max 20 mg/day), CYP3A inhibitors, raises cyclosporine and tacrolimus levels, sildenafil (hypotension)
Nursing Considerations: Check BP and ask about dizziness; inspect ankles and feet for edema; use caution in severe aortic stenosis; titrate slowly in severe hepatic impairment
Patient Teaching: Ankle swelling is common, report it if it bothers you; rise slowly; keep taking it even when BP readings are normal
The "-dipine" calcium channel blockers act on vessels, not the AV node, so they lower BP without slowing the heart rate.
Card 5
verapamil
Answer
Brand: Verelan, Verelan PM; mostly generic (Calan and Calan SR discontinued)
Class: Antihypertensive, class IV antidysrhythmic; nondihydropyridine calcium channel blocker
Indications: Hypertension, angina, rate control in AF or flutter, prevention of recurrent PSVT
Action: Blocks calcium channels in heart and vessels, slowing AV conduction and heart rate and reducing contractility
Adverse Effects: Heart block, bradycardia, hypotension, heart failure, liver enzyme elevation, constipation (most common)
Contraindications: Severe LV dysfunction, SBP under 90, cardiogenic shock, sick sinus or 2nd/3rd degree block without pacer, AF with WPW
Interactions: Beta blockers (heart block), digoxin (levels rise), CYP3A4 inhibitors and inducers, simvastatin and lovastatin limits
Nursing Considerations: Check apical pulse and BP before each dose; watch PR interval and for heart block; assess for heart failure; prevent constipation
Patient Teaching: Swallow ER tablets whole; report fainting, slow pulse or swelling; add fiber and fluids
Verapamil hits the heart and the gut: it slows the AV node and is the calcium channel blocker most known for constipation.
Card 6
carvedilol
Answer
Brand: Coreg, Coreg CR
Class: Antihypertensive, heart failure agent; nonselective beta blocker with alpha-1 blockade
Indications: Chronic heart failure, LV dysfunction after MI, hypertension
Action: Blocks beta-1, beta-2 and alpha-1 receptors, slowing heart rate and dilating vessels
Adverse Effects: Bradycardia, hypotension, orthostasis, worsening HF or fluid retention during titration, masked hypoglycemia
Contraindications: Asthma, 2nd/3rd degree block, sick sinus, severe bradycardia, decompensated HF on IV inotropes, severe liver disease
Interactions: Verapamil or diltiazem, digoxin (levels rise), clonidine, insulin and oral hypoglycemics, CYP2D6 inhibitors
Nursing Considerations: Check apical pulse and BP before dosing; give with food to reduce orthostasis; weigh daily during titration; taper over 1 to 2 weeks
Patient Teaching: Take with food; rise slowly; do not stop suddenly; weigh yourself daily and report rapid gain
The extra alpha-1 blockade is why carvedilol causes more orthostatic dizziness than a beta-1 selective drug, so it is started low and raised slowly.
Card 7
propranolol
Answer
Brand: Inderal LA, InnoPran XL, Hemangeol
Class: Antihypertensive, class II antidysrhythmic; nonselective beta blocker
Indications: Hypertension, angina, AF rate control, post-MI, migraine prevention, essential tremor, hypertrophic subaortic stenosis
Action: Blocks beta-1 and beta-2 receptors, lowering heart rate, contractility and renin release
Adverse Effects: Bradycardia, heart block, hypotension, bronchospasm, heart failure, masked hypoglycemia, fatigue, depression
Contraindications: Cardiogenic shock, sinus bradycardia, AV block greater than first degree, bronchial asthma
Interactions: Verapamil or diltiazem, digoxin, quinidine, cimetidine, rifampin, epinephrine (unopposed alpha hypertension)
Nursing Considerations: Check apical pulse and BP before dosing; assess lung sounds and asthma history; taper, as abrupt stop can trigger angina, MI or thyroid storm
Patient Teaching: Do not stop suddenly; a racing heart may not warn of low blood sugar; report wheezing or slow pulse
Nonselective means it also blocks beta-2 in the lungs and liver, so asthma and hypoglycemia awareness are the two big cautions.
Card 8
digoxin
Answer
Brand: Lanoxin
Class: Inotrope, antidysrhythmic; cardiac glycoside
Indications: Mild to moderate heart failure, ventricular rate control in chronic atrial fibrillation
Action: Inhibits Na-K ATPase, raising intracellular calcium and contractility; slows AV node conduction
Adverse Effects: Toxicity: dysrhythmias, heart block, anorexia, nausea, vomiting, visual changes
Contraindications: Ventricular fibrillation, hypersensitivity to digoxin
Interactions: Amiodarone, quinidine, verapamil raise levels; diuretics (low K or Mg); beta blockers and CCBs (heart block)
Monitoring: Apical pulse for a full minute before each dose; potassium, magnesium, renal function and digoxin levels; signs of toxicity
Antidote: Digoxin immune fab
Nursing Considerations: Hold and notify if apical pulse is below the ordered parameter; low K or Mg, high calcium, renal impairment and older age raise toxicity risk
Patient Teaching: Report poor appetite, nausea or vision changes; do not double a missed dose
Low potassium lets digoxin bind more Na-K ATPase, so a patient on a loop diuretic can turn toxic on an unchanged dose.
Card 9
ivabradine
Answer
Brand: Corlanor
Class: Heart failure agent; HCN channel (If current) blocker
Indications: Stable symptomatic chronic HF to reduce HF hospitalization, pediatric HF from dilated cardiomyopathy
Action: Blocks the If (funny) current in the SA node, slowing heart rate without reducing contractility
Adverse Effects: Bradycardia, atrial fibrillation, phosphenes (luminous visual effects), hypertension, fetal toxicity
Contraindications: Acute decompensated HF, hypotension, bradycardia, sick sinus or 3rd degree block, pacer dependence, severe liver disease
Interactions: Strong CYP3A4 inhibitors (contraindicated), diltiazem, verapamil, grapefruit juice, St. John's wort, other rate-slowing drugs
Nursing Considerations: Check apical pulse and rhythm; stop if atrial fibrillation develops; give with food twice daily; confirm contraception in females
Patient Teaching: Take with meals; drive with care at night if bright flashes appear; avoid grapefruit juice
Ivabradine slows only the SA node pacemaker, so it lowers heart rate in sinus rhythm without the blood pressure drop of a beta blocker.
Card 10
furosemide
Answer
Brand: Lasix, Furoscix, Lasix ONYU
Class: Diuretic, antihypertensive; loop diuretic
Indications: Edema from heart failure, cirrhosis or renal disease, acute pulmonary edema (IV), hypertension
Action: Blocks sodium-potassium-chloride reabsorption in the thick ascending loop of Henle
Adverse Effects: Profound diuresis with dehydration and hypotension, hypokalemia, hyponatremia, hypomagnesemia, ototoxicity, hyperglycemia
Contraindications: Anuria, hypersensitivity to furosemide (caution in sulfonamide allergy)
Interactions: Aminoglycosides (ototoxicity), lithium (toxicity), digoxin (toxicity with low K), NSAIDs, sucralfate (separate by 2 h)
Nursing Considerations: Monitor I&O, daily weight and BP; check potassium, sodium and creatinine; push IV slowly, as rapid injection raises ototoxicity risk
Patient Teaching: Weigh yourself daily at the same time; report muscle cramps, weakness, dizziness or ringing in the ears; eat potassium-rich foods if advised
Loop diuretics are the most potent class, so watch for the patient who is dry, dizzy and hypokalemic rather than just less swollen.
Card 11
hydrochlorothiazide
Answer
Brand: Inzirqo (oral suspension); mostly generic, and in many combination products
Class: Diuretic, antihypertensive; thiazide diuretic
Indications: Hypertension, edema from heart failure, cirrhosis, corticosteroid or estrogen therapy, renal dysfunction
Action: Blocks sodium and chloride reabsorption in the distal convoluted tubule
Adverse Effects: Low K, Na and Mg, hyperglycemia, hyperuricemia and gout, angle-closure glaucoma, non-melanoma skin cancer
Contraindications: Anuria, hypersensitivity to sulfonamide-derived drugs
Interactions: Lithium (toxicity), digoxin (toxicity with low K), NSAIDs (reduced effect), dofetilide (contraindicated)
Nursing Considerations: Monitor BP, potassium, sodium and glucose; watch for gout flares; give in the morning; report sudden eye pain or vision loss
Patient Teaching: Use sunscreen and get regular skin checks; report eye pain or blurred vision right away; if diabetic, check glucose more often
Thiazides lower potassium, sodium and magnesium but raise glucose, uric acid and calcium.
Card 12
spironolactone
Answer
Brand: Aldactone, CaroSpir
Class: Diuretic, heart failure agent; potassium-sparing aldosterone antagonist
Indications: HF with reduced EF, hypertension (add-on), edema in cirrhosis or nephrotic syndrome, primary hyperaldosteronism
Action: Blocks aldosterone in the distal tubule, excreting sodium and water while retaining potassium
Adverse Effects: Hyperkalemia, renal impairment, gynecomastia (dose-related), hyponatremia, menstrual irregularity
Contraindications: Hyperkalemia, Addison disease, concurrent eplerenone
Interactions: ACE inhibitors, ARBs, potassium supplements or salt substitutes, trimethoprim, NSAIDs, lithium
Nursing Considerations: Check potassium and creatinine within 1 week of starting or a dose change, then regularly; potassium supplements are usually stopped
Patient Teaching: Avoid potassium salt substitutes unless prescribed; report muscle weakness or irregular heartbeat; breast tenderness can occur
Unlike loop and thiazide diuretics it spares potassium, so pairing it with an ACE inhibitor or ARB in renal impairment is a hyperkalemia setup.
Card 13
isosorbide mononitrate
Answer
Brand: None currently marketed (Imdur discontinued); generic
Class: Antianginal; long-acting organic nitrate
Indications: Prevention of angina from coronary artery disease; not for acute attacks
Action: Releases nitric oxide, dilating veins more than arteries and lowering preload and oxygen demand
Adverse Effects: Headache, hypotension and orthostasis, dizziness, reflex tachycardia, flushing
Contraindications: PDE-5 inhibitors (sildenafil, tadalafil, vardenafil), riociguat, nitrate hypersensitivity
Interactions: PDE-5 inhibitors and riociguat (severe hypotension), alcohol, other antihypertensives
Nursing Considerations: Give ER tablet once each morning so a low-nitrate period overnight limits tolerance; do not crush; check BP; keep SL nitroglycerin on hand
Patient Teaching: Swallow whole; never combine with erectile dysfunction drugs; do not stop suddenly; headaches usually ease with time
Mononitrate prevents angina; sublingual nitroglycerin treats the attack in progress.
Card 14
atorvastatin
Answer
Brand: Lipitor, Atorvaliq
Class: Lipid-lowering agent; HMG-CoA reductase inhibitor (statin)
Indications: Lower LDL cholesterol, reduce risk of MI, stroke and revascularization in high-risk adults or CHD
Action: Inhibits HMG-CoA reductase, cutting liver cholesterol synthesis and increasing LDL clearance
Adverse Effects: Myopathy, rhabdomyolysis, immune-mediated necrotizing myopathy, liver injury, raised A1C and glucose
Contraindications: Acute liver failure or decompensated cirrhosis, hypersensitivity
Interactions: CYP3A4 inhibitors (clarithromycin, itraconazole), cyclosporine and gemfibrozil (avoid), grapefruit juice over 1.2 L/day
Nursing Considerations: Assess for unexplained muscle pain or weakness and check CK if present; consider liver enzymes before starting; review new antimicrobials
Patient Teaching: Report muscle pain, weakness or dark urine at once; avoid large amounts of grapefruit juice; do not breastfeed
Atorvastatin's long half-life lets it be taken at any time of day, unlike older short-acting statins that are dosed in the evening.
Card 15
ezetimibe
Answer
Brand: Zetia
Class: Lipid-lowering agent; cholesterol absorption inhibitor
Indications: Lower LDL cholesterol with diet, alone or with a statin; familial hypercholesterolemia; sitosterolemia
Action: Blocks the NPC1L1 transporter in the small intestine, reducing absorption of dietary and biliary cholesterol
Adverse Effects: Upper respiratory infection, diarrhea, joint pain, liver enzyme elevation with a statin, rare myopathy and rhabdomyolysis
Contraindications: Hypersensitivity; any contraindication to the statin or fenofibrate it is combined with
Interactions: Bile acid sequestrants (give 2 h before or 4 h after), cyclosporine, fibrates other than fenofibrate
Nursing Considerations: Separate from bile acid sequestrants; apply the partner statin's precautions; assess for muscle symptoms
Patient Teaching: Take at the same time daily; report muscle pain or yellow skin or eyes; keep up diet changes
Ezetimibe works in the gut, not the liver, so it adds LDL lowering on top of a statin.
Card 16
warfarin
Answer
Brand: Jantoven (Coumadin brand discontinued in US)
Class: Anticoagulant; vitamin K antagonist
Indications: DVT and PE, stroke prevention in AF, heart valve replacement, post-MI
Action: Blocks vitamin K recycling, reducing synthesis of clotting factors II, VII, IX and X
Adverse Effects: Major or fatal bleeding (boxed warning), skin necrosis, calciphylaxis, purple toe syndrome
Contraindications: Pregnancy (except mechanical valves), active bleeding, recent or planned CNS or eye surgery, spinal puncture or neuraxial block, malignant hypertension, unsupervised nonadherent patient
Interactions: Amiodarone, fluconazole, many antibiotics (INR up); rifampin (INR down); NSAIDs, antiplatelets, herbals
Monitoring: INR goal usually 2 to 3 for most indications
Antidote: Vitamin K (phytonadione); 4-factor PCC or plasma for urgent reversal
Nursing Considerations: Check INR before dosing and report out-of-range results; assess for bleeding; overlap with heparin as ordered
Patient Teaching: Keep vitamin K intake consistent; avoid NSAIDs and herbals unless approved; report bleeding or black stools
Warfarin follows the INR, and nearly every new antibiotic, antifungal or herbal product can push that number up or down.
Card 17
apixaban
Answer
Brand: Eliquis
Class: Anticoagulant; direct factor Xa inhibitor
Indications: Stroke prevention in nonvalvular AF, DVT and PE treatment, DVT prophylaxis after hip or knee replacement
Action: Directly inhibits free and clot-bound factor Xa, reducing thrombin generation
Adverse Effects: Bleeding, spinal or epidural hematoma with neuraxial procedures (boxed), clots if stopped early (boxed)
Contraindications: Active pathological bleeding, severe hypersensitivity
Interactions: Combined P-gp and strong CYP3A4 inhibitors or inducers (rifampin, St. John's wort), antiplatelets, NSAIDs
Antidote: None specific in US since andexanet alfa was withdrawn (Dec 2025); 4-factor PCC off-label per protocol
Nursing Considerations: Assess for bleeding, hemoglobin and renal function; know the last dose time before procedures; no INR needed; not for prosthetic valves
Patient Teaching: Do not skip or stop doses without your provider; report bleeding or black stools; tell dentists and surgeons
The "Xa" hides in the name: apiXAban and rivaroXAban block factor Xa.
Card 18
rivaroxaban
Answer
Brand: Xarelto
Class: Anticoagulant; direct factor Xa inhibitor
Indications: Stroke prevention in nonvalvular AF, DVT and PE treatment and prophylaxis, CAD or PAD (with aspirin)
Action: Directly inhibits free and clot-bound factor Xa, reducing thrombin generation
Adverse Effects: Bleeding, spinal or epidural hematoma with neuraxial procedures (boxed), clots if stopped early (boxed)
Contraindications: Active pathological bleeding, severe hypersensitivity
Interactions: Combined P-gp and strong CYP3A inhibitors or inducers (avoid), antiplatelets, NSAIDs
Antidote: None specific in US since andexanet alfa was withdrawn (Dec 2025); 4-factor PCC off-label per protocol
Nursing Considerations: Give 15 and 20 mg tablets with food (evening meal for AF); assess bleeding and renal function, avoid if CrCl under 15 for DVT or PE; know last dose time
Patient Teaching: Take 15 and 20 mg doses with a meal; do not stop without your provider; report bleeding
Remember the food rule: the higher-dose rivaroxaban tablets absorb poorly on an empty stomach.
Card 19
dabigatran
Answer
Brand: Pradaxa
Class: Anticoagulant; direct thrombin inhibitor
Indications: Stroke prevention in nonvalvular AF, DVT and PE treatment, DVT prophylaxis after hip replacement
Action: Directly inhibits free and clot-bound thrombin (factor IIa)
Adverse Effects: Bleeding incl. GI, dyspepsia, spinal or epidural hematoma (boxed), clots if stopped early (boxed)
Contraindications: Active pathological bleeding, mechanical prosthetic heart valve, serious hypersensitivity
Interactions: P-gp inducers like rifampin (avoid), P-gp inhibitors (dronedarone, ketoconazole) in renal impairment, NSAIDs
Antidote: Idarucizumab
Nursing Considerations: Give capsules whole, never opened or chewed (raises absorption); dose by CrCl; assess for bleeding and GI upset; know last dose time
Patient Teaching: Keep in the original bottle, not a pill organizer, and use within 4 months of opening; report bleeding
Dabigatran is the oral direct thrombin inhibitor, and it has its own targeted reversal agent, idarucizumab.
Card 20
enoxaparin
Answer
Brand: Lovenox
Class: Anticoagulant; low molecular weight heparin
Indications: DVT prophylaxis, DVT and PE treatment, unstable angina and NSTEMI, STEMI
Action: Binds antithrombin and mainly inactivates factor Xa, with less effect on thrombin
Adverse Effects: Bleeding, spinal or epidural hematoma with neuraxial anesthesia (boxed), HIT, injection site bruising
Contraindications: Active major bleeding, HIT within 100 days or with antibodies, heparin or pork allergy
Interactions: Other anticoagulants, antiplatelets, NSAIDs
Monitoring: Platelet count and signs of bleeding; aPTT and PT are not useful
Antidote: Protamine sulfate, partial only (reverses at most about 60% of anti-Xa activity)
Nursing Considerations: Inject SC in the abdomen, alternating sides; do not expel the prefilled syringe air bubble; do not rub the site; dose reduced if CrCl under 30
Patient Teaching: Rotate sites; site bruising is common, report bleeding elsewhere
Enoxaparin is mostly anti-Xa, which is why protamine reverses it only partly and the aPTT barely moves.
Card 21
clopidogrel
Answer
Brand: Plavix
Class: Antiplatelet; P2Y12 inhibitor (thienopyridine)
Indications: Acute coronary syndrome with aspirin, recent MI, recent stroke, established peripheral arterial disease
Action: Prodrug whose active metabolite irreversibly blocks platelet P2Y12 ADP receptors
Adverse Effects: Bleeding, reduced effect in CYP2C19 poor metabolizers (boxed warning), TTP (rare, can be fatal)
Contraindications: Active pathological bleeding (peptic ulcer, intracranial hemorrhage), hypersensitivity
Interactions: Omeprazole and esomeprazole (avoid), opioids (slow absorption), repaglinide, NSAIDs, warfarin, SSRIs
Nursing Considerations: Assess for bleeding; hold 5 days before high-bleed-risk surgery when ordered; watch for TTP (purpura, confusion, fever); flag omeprazole
Patient Teaching: Do not stop without your cardiologist, especially after a stent; report bleeding or black stools
Clopidogrel is a prodrug activated by CYP2C19, so poor-metabolizer genetics or omeprazole can leave platelets unblocked.
Card 22
ticagrelor
Answer
Brand: Brilinta
Class: Antiplatelet; reversible P2Y12 inhibitor
Indications: ACS or prior MI, high-risk CAD, minor acute ischemic stroke or high-risk TIA
Action: Reversibly blocks platelet P2Y12 receptors; active without metabolic conversion
Adverse Effects: Significant, sometimes fatal bleeding (boxed warning), dyspnea (about 14%), bradyarrhythmia and ventricular pauses
Contraindications: History of intracranial hemorrhage, active pathological bleeding, hypersensitivity
Interactions: Aspirin over 100 mg/day (less effect), strong CYP3A inhibitors or inducers (avoid), opioids, simvastatin over 40 mg
Nursing Considerations: Confirm daily aspirin is 100 mg or less; assess dyspnea, usually mild and transient; not for urgent CABG; hold 5 days before major surgery as ordered
Patient Teaching: Take twice daily and do not stop early; use only low-dose aspirin; report bleeding or shortness of breath
Twice-daily ticagrelor needs no liver activation, and the aspirin with it must stay at 100 mg or less.
Card 23
sotalol
Answer
Brand: Betapace, Betapace AF, Sotylize
Class: Antidysrhythmic (class III and II); nonselective beta blocker
Indications: Life-threatening ventricular arrhythmias, sinus rhythm maintenance in highly symptomatic AF or flutter
Action: Blocks potassium channels to prolong repolarization and blocks beta receptors
Adverse Effects: QT prolongation and torsades de pointes (boxed warning), bradycardia, hypotension, heart failure, bronchospasm
Contraindications: Sinus bradycardia, sick sinus or 2nd/3rd degree block without pacer, long QT, baseline QT over 450 ms (AF use), K under 4 mEq/L, asthma, shock or decompensated HF
Interactions: Other QT-prolonging drugs, class I or III antidysrhythmics, digoxin, diltiazem, verapamil, clonidine
Monitoring: QTc, heart rate, creatinine clearance, potassium and magnesium
Nursing Considerations: Start only with continuous ECG and resuscitation available; dose by CrCl; correct K and Mg first; report QTc 500 ms or more
Patient Teaching: Do not stop suddenly; report fainting, palpitations, vomiting or diarrhea
Sotalol is a beta blocker that also acts like a class III drug, and its torsades risk climbs with dose and with falling kidney function.
Card 24
dofetilide
Answer
Brand: Tikosyn
Class: Antidysrhythmic, class III; potassium channel blocker
Indications: Conversion of AF or flutter to sinus rhythm, maintenance of sinus rhythm after conversion
Action: Blocks the rapid delayed rectifier potassium current (IKr), prolonging repolarization and the QT interval
Adverse Effects: Torsades de pointes, other ventricular arrhythmias, QT prolongation, headache, dizziness
Contraindications: Long QT syndromes, baseline QTc over 440 ms (500 ms with conduction abnormality), CrCl under 20 mL/min
Interactions: Do not combine with verapamil, cimetidine, trimethoprim, ketoconazole, HCTZ, prochlorperazine, megestrol, dolutegravir
Monitoring: QTc, creatinine clearance, potassium and magnesium
Nursing Considerations: Start or restart only during 3+ days in a facility with CrCl calculation, continuous ECG and resuscitation; keep K and Mg normal
Patient Teaching: Never double a missed dose; check with a pharmacist before any new drug, even OTC cimetidine; report fainting
Dofetilide's long contraindicated-drug list mostly blocks its renal excretion, which drives levels and QT up fast.
Card 25
clonidine
Answer
Brand: Catapres-TTS (patch), Onyda XR; Catapres tablets and Kapvay discontinued
Class: Antihypertensive; central alpha-2 adrenergic agonist
Indications: Hypertension; ADHD in children 6 and older (extended-release forms)
Action: Stimulates alpha-2 receptors in the brainstem, reducing sympathetic outflow, heart rate and BP
Adverse Effects: Rebound hypertension if stopped abruptly, drowsiness, dry mouth, dizziness, bradycardia, orthostatic hypotension
Contraindications: Hypersensitivity to clonidine
Interactions: Beta blockers (worse rebound, bradycardia), alcohol and CNS depressants, other AV node-slowing drugs, tricyclic antidepressants
Nursing Considerations: Monitor BP and pulse; taper over 2 to 4 days, never stop abruptly; if stopping both, stop the beta blocker several days before tapering clonidine
Patient Teaching: Do not stop suddenly or run out of medicine; rise slowly; avoid alcohol; sugar-free gum or candy helps dry mouth
Clonidine turns down the sympathetic system, so stopping it suddenly lets BP rebound hard.