Top Drugs 2025 Past Paper PDF

Top Drugs 2025 1 Brand Indication(s) Adjust Route Boxed warning...

Top Drugs 2025 1 Brand Indication(s) Adjust Route Boxed warning Contraindications Side Effects Major DDI Other Comments Inhaled Steroids: Inhibition of inflammatory response in the airways, and they also increase the sensitivity of beta-2 receptors Beclomethasone Qvar, Qnasl N inhalation Common: Throat Irritation, Cough, Thrush, Headache Rinse mouth and throat after use Budesonide Pulmicort Asthma, COPD, allergic N inhalation Serious: Vertigo, Upper Respiratory Infections, Status asthmaticus Systemic side effects are not common Fluticasone Flovent, Flonase rhinitis N inhalation Pneumonia Risk, HPA Axis Suppression, Growth Avoid grapefruit juice (fluticasone) Mometasone Asmanex N inhalation Retardation (Children/High Dose) ICS/ LABA Combination: Combination of corticosteroid and LABA will improve pulmonary function and control over using the products alone. (ICS) Corticosteroids have anti-inflammatory, immunosuppressive, and antiproliferative actions. LABAs relaxes bronchial smooth muscle by action on beta-2 receptors Fluticasone/ Avoid grapefruit juice Advair N Diskus, HFA salmeterol LABAs used as monotherapy can Salmeterol (Serevent) - LABA monotherapy Common: Hoarseness, Cough, Thrush, Headache, Fluticasone/ vilanterol Breo Ellipta N inhalation increase the risk of asthma- Avoid grapefruit juice Acute bronchospasm, status Nasal Congestion Budesonide/ Asthma, COPD related deaths and Beta blockers Symbicort N inhalation asthmaticus Serious: Upper Respiratory Infections (Pneumonia), A- formoterol hospitalizations, especially in Fib, Hypokalemia formoterol (Perforomist) - LABA monotherapy pediatric and adolescent patients Mometasone/ Dulera N inhalation formoterol Short Acting Muscarinic Antagonist: Anticholinergic agent that works on M3 receptors that leads to a decrease in secretions and bronchodilation Common: Dry Mouth, Bitter Taste, Anticholinergic COPD Nebulized, Ipratropium Atrovent N Effects, Bronchitis Anticholinergic agents Acute asthma (off-label) HFA Serious: Bronchospasm, MI, Anaphylaxis Long Acting Muscarinic Antagonist: Induction of bronchodilation via inhibition of the M3 receptor on airway smooth muscle. It is long acting with anticholinergic activity and affinity on M1 through M5. Common: Constipation, Xerostomia, Headache, Cough, COPD Respimat, Tiotropium Spiriva N Anticholinergic Effects Anticholinergic agents HandiHaler contains a capsule for inhalation Asthma (Respimat only) Handihaler Serious: Closed angle glaucoma Short Acting Beta Agonist: Activation of Beta-2 Receptors in the bronchial smooth muscle results in relaxation and inhibition of mediator release from mast cells Common: Tachycardia, Tremor, Nausea, Pharyngitis, ProAir, Ventolin, inhalation, Cough, Hypokalemia, Feeling Nervous Albuterol Asthma (rescue) N Non-selective beta blockers Levalbuterol (Xopenex) - R-albuterol Proventil nebulized, PO Serious: A-Fib, Hypertension, Hyperglycemia, Bronchospasm, Palpitations SABA/SAMA Combination Combivent COPD Respimat, Anticholinergic agents Albuterol/ Ipratropium N See individual drug side effects DuoNeb Acute asthma (off-label) nebulized Non-selective beta blockers Leukotriene Modifier: Montelukast: Inhibits leukotriene receptors, which inhibits airway edema and facilitates bronchodilation; Zileuton – Decreases the formation of leukotrienes, which causes bronchodilation. Common: Headache, Dizziness, Dyspepsia, Flu-Like Asthma, exercise induced Symptoms, Cough, Upper Respiratory Tract Infection, Increased risk for Montelukast Singulair bronchospasm, allergic N PO Abdominal Pain Take in evening neuropsychiatric events rhinitis Serious: Suicidal thoughts, Altered Behavior, Cholestatic Hepatitis Phosphodiesterase 4 inhibitor: PDE4 Inhibitor that increases cAMP levels, leading to a reduction in lung inflammation. Common: Weight Loss, Nausea, Vomiting, Decrease in Moderate-severe liver impairment Roflumilast Daliresp COPD N PO Appetite, Insomnia, Backache, Headache, Influenza (Child Pugh B or C) Serious: Diarrhea, Suicidal thoughts Systemic glucocorticoids: cause inhibition of inflammatory response. Suppresses neutrophil migration and decreases inflammatory mediators and reverses capillary permeability. Acute: increased appetite, wt gain, Na/H2O retention, Dexamethasone DexPak, Decadron N PO, IV, opth hypokalemia, CNS, indigestion, HTN, hyperglycemia, = immunosuppression, impaired wound healing, mask PO, rectal, Relative Potency: Dexamethasone 0.75 mg Hydrocortisone Cortef, Solucortef Inflammatory conditions N symptoms of infection, acne, myopathy CYP3A4 inx enema, inj Live vaccines, serious systemic Methylprednisolone 4 mg (RA, asthma, COPD None Chronic: Cushing (moon face, buffalo hump, somatic Live vaccines Medrol, infections Prednisone / Prednisolone 5 mg Methylprednisolone exacerbations, acute gout) N PO, inj muscle wasting), dermal thinning, diabetes, glaucoma, Decreased oral contraceptive Solumedrol Hydrocortisone 20 mg cataracts, amenorrhea, growth retardation, acne, HPA axis suppression: must taper slowly if receiving Prednisone Deltasone N PO pancreatitis, GI bleed/esophagitis/ ulcers, over 10-14 days of therapy Prednisolone Millipred N PO, opth osteoporosis/fractures, hirsutism Xanthine Derivative: Blocks PDE causing increased cAMP, which promotes epinephrine release. The result is bronchodilation CYP1A2 inx Common: Nausea, Vomiting, Insomnia, Tremor, Decreased oral contraceptives Dosing based on ideal body weight Theophylline Theo-24 Asthma, COPD N PO, IV Restlessness, Headache, Irriitabillity Ciprofloxacin Therapeutic range 5-15 mcg/mL Serious: A-fib, Tachyarrhythmia, Seizures Carbamazepine Phenytoin  Top Drugs 2025 2 Brand Indication(s) Adjust Route Boxed warning Contraindications Side Effects Major DDI Other Comments Thyroid Hormones: Increases cellular metabolism and plays an important role in growth, development, CNS and bone functions, food metabolism and body temperature Take 30 minutes-1 hour before breakfast PO, injection, Common: increased appetite, weight loss, insomnia, Levothyroxine Synthroid N Untreated thyrotoxicosis, Separate 4 hours from antacids, iron, calcium Hypothyroidism IV hyperhidrosis, Increased heart rate, restlessness, Not for weight loss untreated adrenal insufficiency supplements Liothyronine Cytomel TSH suppression N PO, IV insomnia, tremor, palpitation, angina Desiccated thyroid Armour thyroid N PO Serious: menstrual irregularities, heat intolerance Combination of T3/T4 Antithyroid agents: Inhibit the synthesis of thyroid hormones Change to methimazole in 2nd and 3rd trimesters of Methimazole Tapazole N PO Common: hypothyroidism, GI upset, pruritic pregnancy maculopapular rash, arthralgias Hyperthyroidism Hepatotoxicity Serious: hepatotoxicity, agranulocytosis, Propylthiouracil N PO Preferred antithyroid in first hypothrombinemia Preferred in thyroid storm trimester of pregnancy 5-HT3 Antagonist: Antagonize 5-HT3 receptors peripherally and centrally to block the vomiting signal in the brain (chemoreceptor trigger center) to prevent NV Granisol IV, PO, SC, Granisetron None Sancuso (patch) transdermal QT prolonging agents Nausea and Vomiting Common: constipation, HA, fatigue Ondansetron Zofran H IV, PO Use with apomorphine Serotonergic agents including chemo-induced Serious: prolonged QT, serotonin syndrome Apomorphine (HTN) Newer agent with longer half life Palonosetron Aloxi None IV PO: Netupitant/Palonosetron (Akynzeo) H1 antagonist: suppresses the vasodepressor response to histamine while only slightly inhibiting acetylcholine. Common: sedation, dry mouth CNS depression Meclizine Antivert Motion sickness, vertigo None PO None Hypersensitivity Serious: CNS depression, blurry vision, anaphylaxis Anticholinergic agents Dopamine receptor antagonist: block dopamine receptors in the CNS including the chemoreceptor trigger zone (among other mechanisms). Do not use in children 6 Protamine=antidote Bleeding (Except for DIC) IV device months) Low Molecular Weight Heparin: Bind to AT and have greater affinity of inhibiting Factor Xa than Factor IIa. Active Major Bleed, Thrombocytopenia associated ACS, VTE treatment, VTE Subcut, Spinal/Epidural Hematomas: May with positive antiplatelet antibody Common: Anemia, Increased LFTs, Thrombocytopenia More predictable anticoagulant response than UFH, and Enoxaparin Lovenox prophylaxis, Ischemic R Bleeding risk injection result in long-term paralysis. in the presence of Enoxaparin, Serious: Bleeding, pneumonia, hyperkalemia does not usually require Anti-Factor Xa levels Prophylaxis Hypersensitivity (Heparin, Pork, Benzyl Alcohol)  Top Drugs 2025 5 Brand Indication(s) Adjust Route Boxed warning Contraindications Side Effects Major DDI Other Comments Vitamin K Antagonist: Competitively inhibits vitamin K reductase (VKORC1), which reduces Vitamin K epoxide and causes depletion of Factors II, VII, IX, X, Proteins C and S. Pregnancy (except mechanical S-enantiomer being more potent. Common: Minor bleeding Bleeding risk heart valves at high Initial dose in healthy outpatients: 10mg daily X 2 days. Serious: Hemorrhage, skin necrosis, purple toe CYP2C9 inx thromboembolism risk) or pre- Start warfarin on the same day as the parenteral Coumadin Fatal bleeding (Vitamin K is the syndrome CYP1A2 inx Warfarin Anticoagulation N PO eclampsia, Hemorrhagic anticoagulant; continue both minimum of 5 days and INR Jantoven antidote) Tablet colors: Please Let George Bush Bring Peaches CYP3A4 inx Tendencies, Blood Dyscrasias, is 2 or greater for X 24 hours. To Your Wedding (1, 2, 2.5, 3, 4, 5, 6, 7.5, 10 mg: pink, Amiodarone; Bactrim; Metronidazole; Uncontrolled HTN, Antidotes: Phytonadione (Vitamin K), Prothrombin lavender, green, brown, blue, peach, teal, yellow, white) Most antibiotics; Vitamin K Noncompliance, Major surgery complex concentrate (Kcentra) Antiplatelet / COX inhibitor: inhibition of platelet function by acetylation of the platelet cyclooxygenase (COX) resulting in the irreversible blockade of the formation of thromboxane A2 Common: Heartburn, Dyspepsia, Abdominal discomfort, Higher doses: action is similar to NSAIDs Children/teens for viral infection cardioprotection, pain, fever, Hypertension S/s of toxicity: tinnitus Aspirin Bayer N PO, rectal Severe skin rash: stop Bleeding risk OA, RA Serious: GI bleeding, Increased bleeding risk, renal Food and water minimize ADRs. immediately impairment, Aspirin Allergy (Asthma), Reye’s syndrome Dipyridamole/Aspirin- Aggrenox P2Y12 Inhibitors: Irreversibly inhibit P2Y12 (On ADP Receptors) on platelets, which results in inhibition of platelet activation and aggregation. ACS, Stroke, Established Prodrug, CYP2C19 poor Bleeding risk (Lowest Risk) Stop 5 days before elective surgery Clopidogrel Plavix N PO Active bleeding PAD, PCI metabolizers CYP2C19 inx Avoid grapefruit juice Not recommended in patients 75 years and older unless ACS patients managed with Active bleeding, history stroke or Prasugrel Effient N PO Fatal bleeding Bleeding, Hematoma, Pruritus (Clopidogrel) Bleeding risk high risk PCI TIA Dyspnea, Increased SCr and Uric Acid (Ticagrelor) Stop 7 days before elective surgery Fatal bleeding, Aspirin doses Stop 5 days before elective surgery Active bleeding, severe hepatic Bleeding risk Ticagrelor Brilinta ACS N PO greater than 100mg reduce Avoid grapefruit juice impairment CYP3A4 inx effectiveness Reversible Fibrinolytics: Breaks down clots by binding to fibrin in a thrombus and converting plasminogen to plasmin. 2nd Generation, due to clot-specific binding. Acute ischemic stoke, PE, Alteplase Activase N IV, injection Risk of bleeding Bleeding risk STEMI Serious: arrhythmias, intracranial hemorrhage, Tenecteplase TNKase STEMI N IV Risk of bleeding angioedema, Pulmonary Edema Bleeding risk Reteplase Retavase STEMI N IV Risk of bleeding Bleeding risk ACE-Inhibitors: Competitive inhibitor of ACEI, which prevents the conversion of Angiotensin I to Angiotensin II, which is a potent vasoconstrictor. Lower levels of ATII causes an increase in plasma renin activity and reduction in aldosterone secretion. Bradykinin degradation is also inhibited. Benazepril Lotensin N PO ARBs; Entresto w/in 36 hrs History of angioedema, Use with Common: Dizziness, Headache, Cough (Non- Hyperkalemia risk Enalapril Vasotec Hypertension N PO, IV Enalaprilat - IV formulation aliskiren in patients with diabetes Productive), Fatigue, Hypotension Allopurinol (SJS/TEN) Lisinopril Zestril Heart failure N PO Fetal toxicity Max dose: 40mg/day; +HCTZ (Zestoretic) 36 hour wash out period when Serious: SJS, Angioedema, Renal Effects (AKI), Alteplase (angioedema) Quinapril Accupril Post-MI N PO switcihng to and from Entresto Hyperkalemia Aliskiren Ramipril Altace N PO Nephrotoxicity Swallow capsule whole Angiotensin Receptor Blocker: Angiotensin II receptor antagonist. It deters vasoconstriction and aldosterone-secreting effects by specifically intercepting the binding of angiotensin II to the AT(1) receptor Losartan Cozaar Hypertension N PO ACE Inhibitors +HCTZ (Hyzaar) Heart failure (Candesartan, Common: Hypotension, hyperkalemia Aliskiren Valsartan Diovan N PO Use with aliskiren in patients with +HCTZ (Diovan HCT), +Amlodipine (Exforge) Losartan, and Valsartan) Fetal toxicity Serious: Elevates serum creatinine, angioedema Entresto Olmesartan Benicar N PO diabetes +HCTZ (Benicar HCT), risk of sprue-like enteropathy Post-MI Hyperkalemia risk Irbesartan Avapro Diabetic nephropathy N PO Lithium toxicity Angiotensin Receptor Blocker: Angiotensin II receptor antagonist. It deters vasoconstriction and aldosterone-secreting effects by specifically intercepting the binding of angiotensin II to the AT(1) receptor ACE-inhibitors within 36 hours Angioedema, Concomitant Common: Hypotension, Hyperkalemia, Dizziness Sacubitril/ Valsartan Entresto Class II- IV heart failure H PO Fetal toxicity Hyperkalemia risk No washout period when switching from ARB Aliskiren use in DM Patients Serious: Renal failure, Angioedema Lithium toxicity Alpha/Beta agonist: Sympathomimetic that acts on both alpha and beta receptors. Relaxation of bronchial SM and vasoconstriction to counter the vasodilation of anaphylaxis. Cardiogenic shock, septic Pheochromocytoma, ventricular Dopamine Intropin N IV Necrosis/extravasation shock fibrillation Common: palpitations, sweating, dizziness, HA, anxiety, Epinephrine EpiPen Anaphylaxis, shock N IM None oliguria Beta blockers (resistance to epi) Counsel patient on proper use of the device. Hypotension, cardiac arrest, None Serious: cardiac dysrhythmia, HTN Norepinephrine Levophed N IV drug of choice for septic shock shock Centrally-acting alpha-2 agonists: Stimulates pre-synaptic alpha-2 receptors in the brain and reduces sympathetic outflow of NE, which reduces SVR and HR Common: Dry mouth, Somnolence, Headache, Fatigue, Do not switch ER and IR formulations mg-to-mg. Reduce PO, patch, Dizziness, Bradycardia, Hypotension. (Patch: Clonidine IR Catapres HTN N NonDHP CCB; Beta-blockers dose gradually over 2 to 4 days to avoid withdrawal. injection Application Site Reactions) Patch is applied weekly and taken off before MRI. Serious: AV block Alpha blockers: Bind to alpha-1 receptors which results in peripheral vasodilation of arterioles and veins. Common: Orthostatic hypotension, peripheral edema, Doxazosin Cardura HTN N PDE-5 inhibitors Cardura XL: OROS formulation, ghost tablet in stool PO somnolence, dizziness, vertigo, headache Terazosin Hytrin BPH N PDE-5 inhibitors Serious: Priapism, Intraoperative floppy iris syndrome,  Top Drugs 2025 6 Brand Indication(s) Adjust Route Boxed warning Contraindications Side Effects Major DDI Other Comments Beta-Blocker: Block beta adrenergic receptors and thus inhibit the effects of catecholamines to reduce heart rate, cardiac output, and blood pressure Beta-1 Selective Blockers +chlorthalidone (Tenoretic) Label: Angina, HTN, MI Beta agonists decrease efficacy of Esmolol (Brevibloc)- alternative short acting IV push and Atenolol Tenormin H PO, IV Off-label: Afib beta blockers infusion Label: HTN +HCTZ (Ziac) Beta agonists decrease efficacy of Bisoprolol Zebeta Off-label: Angina, Afib, H PO Sinus bradycardia, 2nd or 3rd Common: Hypotension, Bradyarrhythmia, Cold Preferred in HF (metoprolol succinate, bisoprolol, Abrupt discontinuation- Taper beta blockers Heart failure degree heart block, cardiogenic Extremities, Dizziness, Fatigue, Depression, Mask carvedilol) over 1-2 weeks (Atenolol, shock, overt cardiac failure signs/symptoms of hypoglycemia (Except Sweating) IV:PO ratio 1:2.5 Label: Angina, HTN, MI Metoprolol Tartrate) Metoprolol tartrate Lopressor N PO, injection Serious: Bronchospasm, Bradycardia Use total daily dose for conversion between tartrate and Off-label: Afib CYP2D6 inx succinate salt formulations Label: Angina, HTN, MI, Decreased beta agonist effects Use total daily dose for conversion between tartrate and Metoprolol succinate Toprol Heart Failure N PO succinate salt formulations Off-label: Afib Nebivolol Bystolic Label: HTN N PO Same as above + Severe liver Beta agonists Nitric oxide-dependent vasodilation Non-selective Beta-1 and Beta-2 Blockers Label: angina, HTN Nadolol Corgard Off-label: Afib, migraines, R PO esophageal varices, tremor Label: Angina, arrhythmias, May cause hyperglycemia in patients with diabetes essential tremors, HTN, Common: Hypotension, Bradyarrhythmia, Dizziness, Propranolol has high lipid solubility (associated with Sinus bradycardia, 2nd or 3rd Beta agonists migraine prevention, MI, Abrupt discontinuation- Taper Fatigue, Depression, Mask signs/symptoms of more CNS side effects) Propranolol Inderal N PO, injection degree heart block, cardiogenic Clonidine; Verapamil; Diltiazem pheochromocytoma over 1-2 weeks (Nadolol) hypoglycemia (Except Sweating) More effective for tremors and migraine prophylaxis than shock, overt cardiac failure (bradycardia) Off-label: performance Serious: Bronchospasm, Bradycardia, AV Block other beta blockers anxiety, esophageal varices Non-selective beta blockers used in portal hypertension Label: HTN, migraine Timolol Betimol prevention, MI N PO Off-label: Afib Non-selective Beta Blocker and Alpha-1 Blocker Label: Heart failure, HTN Take with food Carvedilol Coreg, Tiazac Off-label: angina, Afib, MI, N PO Common: Hypotension, Bradyarrhythmia, Dizziness, Beta agonists Carvedilol IR and carvedilol CR dosing conversions are esophageal varices Peripheral Edema, Weight Gain, Fatigue, Erectile not 1:1 Abrupt discontinuation- Taper Severe hepatic impairment Dysfunction, Hyperglycemia, Mask signs/symptoms of Label: Hypertension over 1-2 weeks hypoglycemia (Except Sweating) Labetalol Trandate Off-label: Hypertensive H PO, injection Serious: Intraoperative floppy iris syndrome, AV Block Beta agonists 1st line for HTN in pregnancy Urgency Non-DHP Calcium Channel Blockers: Inhibit calcium ions from entering vascular smooth muscle and myocardial cells, but are more selective for myocardial cells. They have Negative Inotropic and Chronotropic Effects. Angina 2nd/3rd degree AV block, Cardizem HTN hypotension, Sick Sinus Common: Edema, Hypotension, Constipation (More in Diltiazem Cartia XT N PO, IV 6 A-Fib rate control (Diltiazem Syndrome Verapamil), Dizziness, Headache CYP 3A4 inx Taztia XT off label) Diltiazem: acute MI, pulmonary Serious: Gingival hyperplasia, AV block, MI, pulmonary PGP inx Calan SR PSVT Prophylaxis congestion edema Verapamil H PO, IV Verelan (Verapamil) Verapamil: LV dysfunction, DHP Calcium Channel Blockers: Inhibit Calcium ions from entering the vascular smooth muscle cells. This causes peripheral vasodilation (Decreased SVR and BP). CYP3A4 inx Amlodipine Norvasc H PO Simvastatin (max 20 mg if used with +Benazepril (Lotrel), +Valsartan (Exforge) CAD (stable angina) Common: peripheral edema, reflex tachycardia, amlodipine) HTN hypotension, dizziness, headache, flushing, fatigue Procardia, Printzmetal's angina Adalat CC: Strong 3A4 induces, Serious: Gingival hyperplasia, MI Nifedipine ER N PO CYP3A4 inx Shell of drug may be seen in stool Adalat CC cardiogenic shock Nicardipine Cardene R/H IV Aortic stenosis CYP3A4 inx Direct vasodilators: Vasodilation of arterioles, with little effect on veins, causing a decrease in SVR and a reduction in BP. HTN Common: Headache, Edema, Palpitations, Tachycardia, CAD, Mitral Valvular Rheumatic Administer without regard to meals, but consistently. Hydralazine Apresoline CHF, pregnancy-induced N PO, injection Hypotension Heart Disease +Isosorbide Dinitrate (BiDil) HTN (off label) Serious: SLE  Top Drugs 2025 7 Brand Indication(s) Adjust Route Boxed warning Contraindications Side Effects Major DDI Other Comments HCN channel blocker: Selective and specific inhibition of the hyperpolarization-activated cyclic nucleotide-gated (HCN) channels “funny channels” within the SA Node, resulting in prolonged diastolic depolarization, slowing firing in the SA Node, and ultimately reducing the HR. Acute Decompensated HF, BP < 90/50, Sick Sinus Syndrome, SA Block or 3rd Degree AV Block For use in patients with stable, symptomatic HF with Common: Bradycardia, Hypertension, A-Fib CYP3A4 inx (Unless Pacemaker), Resting HR LVEF < 35%, who are in rhythm with resting HR > 70 Ivabradine Corlanor Heart failure N PO Serious: Bradyarrhythmia, Luminous Phenomena (D/C QT prolonging agents < 60 prior to treatment, Severe and are on max tolerated doses of beta blockers or have Drug), Prolonged QT Interval, TdP CCBs (bradycardia) Hepatic Impairment(Child-Pugh a CI to beta blockers. C), Pacemaker Dependence, Strong CYP3A4 inhibitors Nitrates: Form free radical nitric oxide, which causes smooth muscle relaxation. A vasodilatory effect is seen on peripheral arteries and veins; more directed effect on veins, coronary arteries, cerebral arteries IR tablets should be BID with 7 hour between doses. Isosorbide Imdur N PO Administer ER formulations daily upon rising with a half mononitrate glass of fluid PDE-5 inhibitors Tolerance to nitrates can develop, so a 14 hours (IR) or Common: Headache, Flushing, Lightheadedness, Isosorbide dinitrate Isordil N PO 18 hours (SR) nitrate free period is recommended. Do Angina Dizziness, Weakness, Hypotension not crush or chew SR tablets Serious: Syncope, Methemoglobinemia, Tachyphylaxis PO, Maximum dose is 3 tablets, 3 sprays, or 3 packets per Transdermal, Nitroglycerin Nitrostat N Concomitant use with PDE-5 inhibitors 15-minute period. Take one dose, then call 911 if pain is Injection, phosphodiesterase inhibitors unchanged or worse. Rectal Continuous BP monitoring required - due to risk of Hypertensive crisis hypotension Metabolism produces cyanide Common: headache, tachycardia Acute CHF Increases ICP - monitor Nitropress and excessive hypotension. Not Serious: excessive hypotension, TEN, Nitroprusside MI R IV PDE-5 Inhibitors Use lowest dose for shortest duration possible - due to Nipride used for direct injection (must be Methemoglobinemia, thiocyanate/cyanide toxicity Pulmonary HTN cyanide formation diluted, preferably D5W) (increased risk in renal/hepatic impairment) Esophageal varices Requires light protection - use only clear solutions - blue color indicates degradation to cyanide Cardiac glycoside: Inhibits the Na/K ATPase Pump which results in a positive inotropic effect (Increased CO). A parasympathetic effect provides a negative chronotropic effect (Decreased HR). PGP Inx HF: 0.5-0.9 ng/mL Common: Nausea, Vomiting, Dizziness, Headache, CYP3A4 Inx Antidote: DigiFab Digitek A-Fib Mental Disorder Digoxin R PO, injection Ventricular fibrillation Amiodarone Dosing: 20 vials (800 mg), start with 10 vials IV, observe Lanoxin Heart failure Serious: Cardiac Dysrhythmia, Ischemia, Sinus Dronedarone response, repeat as needed Bradycardia, SA Block, Thrombocytopenia nDHP CCBs Digoxin Immune Fab (DigiFab)= antidote Fibric Acid Derivatives: PPAR-Alpha Activators, which upregulate the expression of apoC-II and ApoA-I and ApoC-II. Increase in HDL, and a decrease in LDL and TG. Colchicine Tricor, Antara, Fenofibrate N Statins Trillpix Warfarin Active Liver Disease, Severe Common: Abdominal Pain, Dyspepsia, URTIs, LFT Colchicine Hypertriglyceridemia, Renal Impairment (eGFR 500, History of TG induced Administer with meal and liquid Serious: Pancreatitis Reduced exposure of pravastatin Hypercholesterolemia pancreatitis  Top Drugs 2025 8 Brand Indication(s) Adjust Route Boxed warning Contraindications Side Effects Major DDI Other Comments HMG-CoA Reductase Inhibitors: Inhibit HMG CoA reductase to block the rate-limiting step of cholesterol synthesis. CYP3A4 inx PGP inx Atorvastatin Lipitor N Rhabdomyolysis Risk: Colchicine Daptomycin; Fenofibrate Gemfibrozil PGP inx CYP3A4 inx Max 10 mg/day: verapamil, diltiazem, dronedarone Simvastatin Zocor N Max 20 mg/day: amiodarone, Active liver disease, pregnancy, amlodipine, lomitapide, ranolazine Statins should be taken at night, with the exception of Common: Myalgia, Abdominal Pain, Increased Rhabdomyolysis Risk: Colchicine breastfeeding, strong 3A4 rosuvastatin, atorvastatin, and pravastatin. Dyslipidemia, Prevention of LFTs/CPK Daptomycin; Fenofibrate PO inhibitors (simvastatin and Avoid grapefruit juice. CV disease Serious: Hepatotoxicity, Rhabdomyolysis, Myopathy, Gemfibrozil lovastatin), cyclosporine High-intensity Regimens: Atorvastatin 40-80 mg daily, Diabetes, Cognitive Impairment PGP inx Rosuvastatin Crestor N (pitavastatin) Rosuvastatin 20-40 mg daily Rhabdomyolysis Risk: Atazanavir Pravastatin Pravachol N Colchicine; Daptomycin; PGP inx CYP3A4 inx Max 20 mg/day: danazol, diltiazem, dronedarone, verapamil, amlodipine Lovastatin Mevacor N Max 40 mg/day: amiodarone, ticagrelor Rhabdomyolysis Risk: Colchicine; Daptomycin; Fenofibrate; Gemfibrozil Nicotinic acid: B-complex vitamin that has antihyperlipidemic effects. It may involve actions such as reduced esterification of hepatic triglycerides, decreased release of free fatty acids from adipose tissue and increased activity of lipoprotein lipase which enhances the removal of chylomicron triglyceride from the plasma. It increases high-density lipoprotein (HDL) and reduces triglycerides, total cholesterol and LDL Hyperlipidemia, Active liver disease, active peptic Common: N/V, flushing Niacin ER Niaspan N PO Statin (rhabdomyolysis) hypertriglyceridemia ulcer, arterial bleeding Serious: hepatotoxicity, rhabdomyolysis Fish Oil: highly purified ethyl ester concentrate of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), possible mechanisms of action include the inhibition of acyl coenzyme A:1,2-diacylglycerol acyltransferase and increased peroxisomal beta-oxidation in the liver Omega-3 Acid Ethyl Common: Indigestion, altered taste, eructation (burping) Lovaza N PO Stop prior to elective surgeries due to increased risk of Esters Serious: anaphylaxis Hypersensitivity to fish and/or bleeding Hypertriglyceridemia antiplatelets/anticoagulants shellfish Common: arthralgias, constipation, gout, Indicated as adjunct to diet when TG > or equal to Icosapent Ethyl Vascepa N PO musculoskeletal pain, peripheral edema 500mg/dL Serious: hemorrhage, A-fib/flutter Loop Diuretics: Block the sodium and chloride reabsorption in the thick ascending Loop of Henle. They increase the secretion of sodium, chloride, magnesium, calcium, and water. Common: Electrolyte Imbalances (↓K, ↓Na, ↓Cl, ↓Mg, ↓Ca), Increased HCO3/Metabolic Alkalosis, Edema IV to PO = 1:2 Furosemide Lasix N PO, IV Profound diuresis leading to Hyperuricemia, Hyperglycemia, Triglycerides, Total HTN Oral Equivalent: Furosemide 40mg electrolyte abnormalities Cholesterol Anuria Serious: Photosensitivity, Ototoxicity Nephrotoxic agents Bumetanide 1mg (Patients may require potassium Torsemide 20mg supplementation) Common: electrolyte Imbalances (↓K, ↓Cl), Ethacrynic Acid 50mg Bumetanide Bumex Edema N PO, IV Hyperuricemia, Azotemia Serious: SJS, Thrombocytopenia, Encephalopathy Potassium-Sparing Diuretic: Aldosterone receptor blockers in the DCT and Collecting Ducts, Na and Water excretion are increased, while conserving K and H ions. Triamterene directly blocks the epithelial sodium channel (ENaC) on the lumen side of the collecting tubule. Edema, hypertension, Spironolactone Hyperkalemia (K>5.5) anuria, Hyperkalemia risk Aldactone hypokalemia, primary N PO Also blocks androgen; dose adjust if eGFR < 50 in HF (aldosterone antag) renal impairment Nephrotoxic agents aldosteronism, CHF Common: Gynecomastia and Breast Tenderness CHF, hypertension Above + type 2 diabetes with (spironolactone), Somnolence, Diarrhea, Vomiting, Eplerenone Hyperkalemia risk Inspra Off Label: primary N PO microalbuminuria, SCr>2 in males Nausea, Hair Loss, Hypertriglyceridemia (eplerenone) Avoid grapefruit juice (aldosterone antag) Nephrotoxic agents aldersteronism or 1.8 in females, CrCl 5.5) anuria, Hyperkalemia risk Triamterene Dyrenium Edema N PO Hyperkalemia renal impairment, severe hepatic Avoid grapefruit juice Nephrotoxic agents disease  Top Drugs 2025 9 Brand Indication(s) Adjust Route Boxed warning Contraindications Side Effects Major DDI Other Comments Thiazide Diuretics: Inhibit Sodium reabsorption in the distal convoluted tubules, causing increased excretion of Sodium, Chloride, and Water, as well as Potassium and Hydrogen Ions. Common: Hypokalemia, Hypomagnesaemia, Hydrochlorothiazide Administer in the morning to avoid nocturia + Microzide Edema N PO Hypersensitivity (sulfonamide) Hyponatremia, Hyperca