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What are some of the side and/or adverse effects of the centrally acting alpha2 agonist, clonidine (Catapres)?
- Central nervous system effects: drowsiness, dizziness
- Dry mouth
- Rebound hypertensive crisis
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What are some of the side and/or adverse effects of the cardiac glycoside digoxin (Lanoxin)?
- Nausea, vomiting, anorexia (may be adverse effects or signs of early toxicity)
- Central nervous system symptoms: headache, visual disturbances, such as yellow vision and blurred vision (these may be adverse effects or signs of early toxicity)
- Cardiac dysrhythmias, especially likely with digoxin toxicity (outside the very narrow therapeutic range of 0.5 to 0.8 ng/mL). Any dysrhythmia may occur, with AV block being most common
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What are some of the side and/or adverse effects of the direct-acting vasodilator drug hydralazine (Apresoline)?
- Headache and palpitations (especially in first few hours following first dose, and usually subsiding spontaneously)
- Tachycardia
- A systemic lupus erythematosus (SLE)-like syndrome may occur (facial rash, joint pain, fever, nephritis, pericarditis) - most likely with high doses
- Fluid retention, edema
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What are some of the side and/or adverse effects of the class IA/sodium channel blocker drugs quinidine (Apo-Quinidine, Novo-Quinidine) and procainamide (Pronestyl)?
- Nausea, vomiting, diarrhea
- Tachycardia (more frequent with quinidine due to anticholinergic effects)
- Hypotension (less severe with oral administration than IV)
- Widen the QRS complex and prolong QT interval
- Ventricular dysrhythmias occur due to toxicity; oral or IV therapy (QRS too wide or QT interval too long)
- Arterial embolism (caused by dislodging small clots) if treating atrial fibrillation
- Speed shock with too rapid IV infusion (flushing, headache, irregular heart rate, severe hypotension, loss of consciousness, cardiac arrest)
- Quinidine: Cinchonism (tinnitus, visual disturbances, headache, nausea, vomiting)
- Procainamide: SLE (systemic lupus erythematosus) seen in 50% of patients after a year of high dose oral therapy)
- Agranulocytosis (procainamide with continued use)
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What are some of the side and/or adverse effects of the angiotensin receptor blocker (ARB) losartan (Cozaar)?
- Angioedema (occurs less than with angiotensin-converting enzyme (ACE) inhibitors, but still a potential risk)
- Headache, insomnia
- Severe hypotension may occur with overdose or in volume depletion
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What are some of the side and/or adverse effects of the class II/beta adrenergic blocker propranolol (Inderal)?
- Bradycardia due to blockade of beta1 receptors; may lead to reduced cardiac output
- Heart failure
- Rebound excitation causing angina pain or myocardial infarction (MI) with sudden withdrawal of beta blocker in patient with coronary heart disease (CHD)
- Peripheral arterial insufficiency (similar to Raynaud's disease)
- Central nervous system (CNS) effects: confusion, fatigue, drowsiness
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What are some of the side and/or adverse effects of the class IV/calcium channel blocker verapamil (Calan)?
- Hypotension, especially with IV dose or overdose
- Bradycardia, especially with IV dose, but also with oral therapy
- Heart failure, peripheral edema of feet and legs
- Lightheadedness, dizziness (caused by vasodilation)
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What are some of the side and/or adverse effects of the fibrate drug gemfibrozil (Lopid)?
- Nausea, vomiting, diarrhea
- Gallstones
- Myopathy (pain in muscles and joints)
- Liver toxicity
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What are some of the side and/or adverse effects of the alpha/beta blocker carvedilol (Coreg)?
- Dizziness, hypotension
- Bradycardia due to blockade of beta1 receptors; may lead to reduced cardiac output
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What are some of the side and/or adverse effects of the alpha1 adrenergic blocker doxazosin (Cardura)?
- Orthostatic hypotension -especially with first dose and with dose increases
- Reflex tachycardia
- Headache
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What are some of the side and/or adverse effects of the class IB/sodium channel blocker lidocaine (Xylocaine)?
- CNS effects (toxicity): confusion, drowsiness, restlessness, paresthesias, muscle twitching or tremors, seizures, respiratory arrest
- Hypotension, bradycardia, heart block with high doses
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What are some of the side and/or adverse effects of the direct renin inhibitor aliskiren (Tekturna)?
- Hyperkalemia
- Cough or angioedema (swelling of mouth, throat)
- Diarrhea, abdominal pain
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What are some of the side and/or adverse effects of the loop diuretic furosemide (Lasix)?
- Electrolyte imbalance: hyponatremia, hypochloremia, severe fluid loss (dehydration), and hypokalemia
- Hypotension
- Ototoxicity (all loop diuretics): temporary or permanent depending on the specific drug
- Hyperglycemia (especially in patients who have diabetes mellitus)
- Increased uric acid levels (hyperuricemia) with possible gouty arthritis in susceptible patients
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What are some of the side and/or adverse effects of the class III/potassium channel blocker amiodarone (Cordarone)?
- Nausea, vomiting, constipation
- Pulmonary toxicity with pneumonitis (causing fever, cough, shortness of breath) - occur most frequently with long-term and/or high-dose use and may lead to pulmonary fibrosis
- Visual effects: optic neuropathy with possible blindness and corneal microdeposits, which may cause severe sensitivity to light, blurred vision
- Cardiac effects: bradycardia and hypotension (common with IV dose)
- Heart failure may be worsened by amiodarone therapy
- Blue-grey discoloration of skin
- CNS effects: dizziness, tremor, hallucinations
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What are some of the side and/or adverse effects of the calcium channel blocker (dihydropyridine) drug nifedipine (Adalat, Procardia)?
- Reflex tachycardia causing increased angina pain in patients with angina; this effect is more likely with faster-acting tablets than the sustained-release form
- Lightheadedness, dizziness (caused by vasodilation)
- Facial flushing, perception of heat (caused by vasodilation)
- Peripheral edema of feet and legs
- Hypotension, especially with overdose
- Gingival hyperplasia (growth of gum tissue, bleeding gums)
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What is a side and/or adverse effect of the aldosterone antagonist spironolactone (Aldactone)?
Hyperkalemia
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What are some of the side and/or adverse effects of the class IC/sodium channel blockers flecainide (Tambocor) and propafenone (Rythmol)?
- Visual effects: blurred vision, difficulty focusing
- Worsening of heart failure; edema
- Widen QRS complex; prolongs QT and PR intervals
- Potential for 1st degree atrioventricular (AV) block; multiple dysrhythmias may occur
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What are some of the side and/or adverse effects of the HMG-CoA reductase inhibitor (statin) drug simvastatin (Zocor)?
- Myopathy (pain in muscles and joints, which can progress to rhabdomyolysis [breakdown of muscle protein causing kidney damage])
- Liver toxicity
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What are some of the side and/or adverse effects of the nitrate drugs nitroglycerin (Nitrostat, Nitro-Dur, Nitro-Bid) and isosorbide dinitrate (Isordil)?
- Headache (severe at first, reduced with treatment)
- Orthostatic hypotension
- Tachycardia
- Tolerance develops quickly to all forms (decreased effectiveness)
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What are some of the side and/or adverse effects of the beta adrenergic blockers atenolol (Tenormin) and metoprolol (Lopressor)?
- Bradycardia due to blockade of beta1 receptors; may lead to reduced cardiac output
- Heart failure - shortness of breath, edema, coughing at night
- Rebound excitation causing angina pain or myocardial infarction (MI) with sudden withdrawal of beta blocker in patient with coronary heart disease (CHD)
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What are some of the side and/or adverse effects of the phosphodiesterase inhibitor milrinone (Primacor)?
- Hypokalemia
- Cardiac dysrhythmias, hypotension
- Anginal chest pain
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What are some of the side and/or adverse effects of the potassium-sparing diuretic spironolactone (Aldactone)?
- Hyperkalemia
- Menstrual irregularities, abnormal hair growth (e.g. on face), and deepening of voice may occur in women; gynecomastia (growth of breast tissue) may occur in men
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What are some of the side and/or adverse effects of the sympathomimetic drug dobutamine (Dobutrex)?
- Tachycardia
- Cardiac dysrhythmias
- Possible angina pain
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What are some of the side and/or adverse effects of the thiazide diuretic hydrochlorothiazide (HydroDIURIL)?
- Electrolyte imbalance: hyponatremia, hypochloremia, severe fluid loss (dehydration), and hypokalemia
- Hyperglycemia (especially in patients who have diabetes mellitus)
- Increased uric acid levels (hyperuricemia) with possible gouty arthritis in susceptible patients
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What are some of the side and/or adverse effects of the adrenergic neuron blocker reserpine (Serpalan, Sk-Reserpine)?
- Severe depression and risk for suicide, which may linger after reserpine is discontinued
- Bradycardia and orthostatic hypotension
- Gastrointestinal symptoms: diarrhea, abdominal cramping
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What are some of the side and/or adverse effects of the angiotensin-converting enzyme (ACE) inhibitor captopril (Capoten)?
- Severe hypotension following first dose (most likely in patients taking diuretics, with high blood pressure (BP), or who have hyponatremia)
- Dry, nonproductive cough due to increase in bradykinin
- Rash and report of metallic taste in mouth
- Angioedema (swelling of mouth, throat [due to inhibition of kinase II])
- Hyperkalemia
- Neutropenia (decrease in white blood cells with increased risk of infection)
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