1
, Common side effects: orthostatic hypotension, excessive diuresis, tinnitus, vertigo, hyperuricemia note all
these are precursors to toxicity
Thiazides Hydrochlorothiazide, Chlorothoazide, ,Chlorthalidone, Indapamide, Metolazone
1st line for HTN, Chronic Calcium Kidney Stones, HF, Idiopathic hypercalciuria, Nephrogenic diabetes
insipidus, Osteoporosis. Other common side effects: orthostatic hypotension, dizzy, drowsy, syncope,
weakness, nausea, GI irritation, elevated BUN, depressed respirations lethargy
Carbonic anhydrase inhibitors- Acetazolamide N/V/D, Drowsy, Parathesis, confusion, tinnitus, myopia,
anorexia, change in taste; polyuria, mild electrolyte changes
Uses: Edematous states ( HF, cirrhosis, pulmonary edema, nephrotic syndrome), hypercalcemia
Ethacrynic Acid
Note it's the only diuretic with "acid" in its name
8. Management of edema
Loops for volume excess
9. CHF drugs including diuretic choices
1- Loops -fluid
2- ACEIs or ARBs
3-BB - Diastolic after stable (B-Day)
4- Digoxin - Systolic ,AFib, (Dig A Syst)
5- Spironolactone - if above not effective
6- Nitrates & Hydralazine *AA only* Think Michael Jordan goes Hy in his NIkes
CCBs ( Amlodipine/Felodipine) only for angina or HTN if EF is preserved
2- Clinical pearls for CHF- Improve SX: ACEIs, ARBs, BBs (metoprolol, Bisoprolol, Carvedilol) , Dig ( only after
diuretics & ACEIs)
Prolong survival: ACEIs, ARBS, BB, Hydralazine/Nitrates(AA only) Aldosterone Antagonists
BB NEVER IN ACTIVE FAILURE
Dig does not improve mortality but improves SX decreases Hospitalization..
CAUTION:: Loops without Spironolactone **with hyperkalemia DIG CAN BECOME TOXIC"
Neuro/Psych:
10. Know migraine management and prophylactics (see migraine lecture)
dark, quiet room
*NSAIDS or APAP
*Triptans (sumatriptan/imitrex, zolmatriptan/zomig, rizatriptan/maxalt)
-nasal, oral, subq
-use no more than 2d/wk
-CI-recent use of MAOIs, ergots, or SSRIs, CVD, CAD, TIA, HTN, pregnancy
*Ergots (ergotamine tartrate/cafergot) not used often, expensive
-nasal, oral, rectal, IM, IV, siblingual
-CI-recent use of triptans, CVD, CAD, TIA, HTN, pregnancy
*Caffeine (Excedrin)
*antiemetics
Migraine prevention
*beta blockers (metoprolol, propranolol, timolol)
-takes 2-3 months for full benefit- can decrease frequency and severity by 50%
-AE- drowsiness, exercise intolerance, depression
-CI-CHF, asthma
*anticonvulsants (valproate, topiramate) effective but both have major AE
-valproate AE- dizziness, platelet dysfunction, hair loss, hepatotoxic, teratogenic
-topiramate AE- cognitive dysfunction, weight loss, renal stones
*butterbur- PA free only, otherwise can cause liver damage and severe illness
11. Herbal migraine management
2
, Butter bur root. It should be PA free or could result in liver damage.
Feverfew (Tanacetumparthenium) - Action: Antiinflammatory effects Uses: migraine prevention
Interactions: Anticoagulants, antiplatelet drugs, aspirin (Pg. 99)
12. What drugs can cause serotonin syndrome?
SSRIs and TRIPTANS
13. What migraine prophylactic medication class to avoid in patients with asthma.
Beta Blockers such as Propranolol
cyproheptadine (Periactin) - The drug may produce an atropine-like action, so it must be used with
caution in patients treated for bronchial asthma (pg. 487)
14. Know the common side effects of methylphenidate Ritalin
Most common: Nervousness & Insomnia
Other common side effects:
Decreased appetite
Abdominal pain
HA
Depression
Irritability
Weight loss
Rebound effect
Side effects like if I don't have my stimulant COFFEE!!Page 453
Also: Temporary slowing of growth rate/Height and weight should be monitored with long term use
ADHD management –
15. At what age can ADHD dx be made?
DX typically before age 7
16. Stimulants including: Side effects -eg HA, tics, appetite suppression, elevated BP
Stimulants: work by increasing “background” dopamine levels in the synapses. However, diagnostic trials
of stimulant medications have failed to distinguish between children with and those without AD/HD.
Amphetamine Like Drugs(Methylphenidate, ritalin, metadate, concerta) 1st LINE OF TREATMENT
MOA: mild cortical stimulant with CNS actions similar to amphetamines. Inhibits reuptake of
norepinephrine & dopamine
Side effects: (may subside after a few weeks) common –These are drugs including methylphenidate and
dexmethylphenidate
Side effects
Increased BP
Exacerbation of behavior
Agitation and aggression
Watch for abuse
Mania psychotic symptoms
Blurred vision
Temp stunting of growth
Decreased appetite
HA
Depression
Rebound SX
NERVOUSNESS & INSOMNIA MOST COMMON
monitor height weight and BP *
Amphetamines - (Adderall,
Vyvanse)
MOA: Norepinephrine released from central noradrenergic neurons.
Side effects:These drugs include dextroamphetamine
3
, Common side effects: orthostatic hypotension, excessive diuresis, tinnitus, vertigo, hyperuricemia note all
these are precursors to toxicity
Thiazides Hydrochlorothiazide, Chlorothoazide, ,Chlorthalidone, Indapamide, Metolazone
1st line for HTN, Chronic Calcium Kidney Stones, HF, Idiopathic hypercalciuria, Nephrogenic diabetes
insipidus, Osteoporosis. Other common side effects: orthostatic hypotension, dizzy, drowsy, syncope,
weakness, nausea, GI irritation, elevated BUN, depressed respirations lethargy
Carbonic anhydrase inhibitors- Acetazolamide N/V/D, Drowsy, Parathesis, confusion, tinnitus, myopia,
anorexia, change in taste; polyuria, mild electrolyte changes
Uses: Edematous states ( HF, cirrhosis, pulmonary edema, nephrotic syndrome), hypercalcemia
Ethacrynic Acid
Note it's the only diuretic with "acid" in its name
8. Management of edema
Loops for volume excess
9. CHF drugs including diuretic choices
1- Loops -fluid
2- ACEIs or ARBs
3-BB - Diastolic after stable (B-Day)
4- Digoxin - Systolic ,AFib, (Dig A Syst)
5- Spironolactone - if above not effective
6- Nitrates & Hydralazine *AA only* Think Michael Jordan goes Hy in his NIkes
CCBs ( Amlodipine/Felodipine) only for angina or HTN if EF is preserved
2- Clinical pearls for CHF- Improve SX: ACEIs, ARBs, BBs (metoprolol, Bisoprolol, Carvedilol) , Dig ( only after
diuretics & ACEIs)
Prolong survival: ACEIs, ARBS, BB, Hydralazine/Nitrates(AA only) Aldosterone Antagonists
BB NEVER IN ACTIVE FAILURE
Dig does not improve mortality but improves SX decreases Hospitalization..
CAUTION:: Loops without Spironolactone **with hyperkalemia DIG CAN BECOME TOXIC"
Neuro/Psych:
10. Know migraine management and prophylactics (see migraine lecture)
dark, quiet room
*NSAIDS or APAP
*Triptans (sumatriptan/imitrex, zolmatriptan/zomig, rizatriptan/maxalt)
-nasal, oral, subq
-use no more than 2d/wk
-CI-recent use of MAOIs, ergots, or SSRIs, CVD, CAD, TIA, HTN, pregnancy
*Ergots (ergotamine tartrate/cafergot) not used often, expensive
-nasal, oral, rectal, IM, IV, siblingual
-CI-recent use of triptans, CVD, CAD, TIA, HTN, pregnancy
*Caffeine (Excedrin)
*antiemetics
Migraine prevention
*beta blockers (metoprolol, propranolol, timolol)
-takes 2-3 months for full benefit- can decrease frequency and severity by 50%
-AE- drowsiness, exercise intolerance, depression
-CI-CHF, asthma
*anticonvulsants (valproate, topiramate) effective but both have major AE
-valproate AE- dizziness, platelet dysfunction, hair loss, hepatotoxic, teratogenic
-topiramate AE- cognitive dysfunction, weight loss, renal stones
*butterbur- PA free only, otherwise can cause liver damage and severe illness
11. Herbal migraine management
2
, Butter bur root. It should be PA free or could result in liver damage.
Feverfew (Tanacetumparthenium) - Action: Antiinflammatory effects Uses: migraine prevention
Interactions: Anticoagulants, antiplatelet drugs, aspirin (Pg. 99)
12. What drugs can cause serotonin syndrome?
SSRIs and TRIPTANS
13. What migraine prophylactic medication class to avoid in patients with asthma.
Beta Blockers such as Propranolol
cyproheptadine (Periactin) - The drug may produce an atropine-like action, so it must be used with
caution in patients treated for bronchial asthma (pg. 487)
14. Know the common side effects of methylphenidate Ritalin
Most common: Nervousness & Insomnia
Other common side effects:
Decreased appetite
Abdominal pain
HA
Depression
Irritability
Weight loss
Rebound effect
Side effects like if I don't have my stimulant COFFEE!!Page 453
Also: Temporary slowing of growth rate/Height and weight should be monitored with long term use
ADHD management –
15. At what age can ADHD dx be made?
DX typically before age 7
16. Stimulants including: Side effects -eg HA, tics, appetite suppression, elevated BP
Stimulants: work by increasing “background” dopamine levels in the synapses. However, diagnostic trials
of stimulant medications have failed to distinguish between children with and those without AD/HD.
Amphetamine Like Drugs(Methylphenidate, ritalin, metadate, concerta) 1st LINE OF TREATMENT
MOA: mild cortical stimulant with CNS actions similar to amphetamines. Inhibits reuptake of
norepinephrine & dopamine
Side effects: (may subside after a few weeks) common –These are drugs including methylphenidate and
dexmethylphenidate
Side effects
Increased BP
Exacerbation of behavior
Agitation and aggression
Watch for abuse
Mania psychotic symptoms
Blurred vision
Temp stunting of growth
Decreased appetite
HA
Depression
Rebound SX
NERVOUSNESS & INSOMNIA MOST COMMON
monitor height weight and BP *
Amphetamines - (Adderall,
Vyvanse)
MOA: Norepinephrine released from central noradrenergic neurons.
Side effects:These drugs include dextroamphetamine
3
