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What are some contraindications that would make taking the class IV/calcium channel blocker verapamil (Calan)? risky for the patient?
- Severe hypotension
- Cardiogenic shock
- Second or third degree atrioventricular (AV) block
- Wolff-Parkinson-White syndrome
- Sick sinus syndrome
- Extended-release tablets are contraindicated for patients younger than 18 years.
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What are some contraindications that would make taking the class IB/sodium channel blocker lidocaine (Xylocaine)risky for the patient?
- Allergy to lidocaine or amide anesthetics
- Supraventricular dysrhythmias
- Untreated bradycardia, heart block
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What are some contraindications that would make taking the class IC/sodium channel blockers flecainide (Tambocor) and propafenone (Rythmol) risky for the patient?
- Allergy to flecainide
- Second or third degree atrioventricular (AV) block
- Certain types of bundle branch block or prolonged QT interval
- Recent myocardial infarction (MI)
- Shock
- Electrolyte imbalance (correct before starting flecainide therapy)
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What are some contraindications that would make taking the alpha/beta blocker carvedilol (Coreg) risky for the patient?
- Severe unstable heart failure
- Asthma or other chronic respiratory disorders
- Heart block or severe bradycardia
- Cardiogenic shock
- Lactation
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What are some contraindications that would make taking the centrally acting alpha2 agonist clonidine (Catapres) risky for the patient?
- Anticoagulant therapy
- Transdermal patch: Polyarteritis nodosa or scleroderma
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What are some contraindications that would make taking the alpha1 adrenergic blocker doxazosin (Cardura) risky for the patient?
- Allergy to doxazosin or other alpha1 adrenergic blockers
- Hypotension; history of syncope
- Child
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What are some contraindications that would make taking the calcium channel blockers (dihydropyridines) nifedipine (Adalat, Procardia) risky for the patient?
- Allergy to nifedipine
- Acute myocardial infarction
- Unstable angina
- Aortic stenosis
- Obstruction in gastrointestinal (GI) tract
- Child
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What are some contraindications that would make taking the direct-acting vasodilator (hydralazine) drug, hydralazine (Apresoline) risky for the patient?
- Mitral valve dysfunction caused by rheumatic heart disease
- Myocardial infarction
- Tachycardia
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What are some contraindications that would make taking the phosphodiesterase inhibitor milrinone (Primacor) risky for the patient?
- Allergy to phosphodiesterase inhibitors
- Aortic or pulmonary valve disorder
- Acute myocardial infarction (MI)
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What are some contraindications that would make taking the class II/beta adrenergic blocker propranolol (Inderal) risky for the patient?
- Sinus bradycardia or second-to third-degree heart block
- Pulmonary edema
- Mitral or aortic valve disease
- Cardiogenic shock
- Peripheral vascular disease, Raynaud's disease
- Asthma, severe COPD, or other chronic respiratory disorder
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What are some contraindications that would make taking the class IA/sodium channel blocker drugs quinidine (Apo-Quinidine, Novo-Quinidine) and procainamide (Pronestyl) risky for the patient?
- Allergy to quinidine or quinine (quinidine)
- Allergy to procainamide or procaine or yellow dye #5 (procainamide)
- Bundle branch block or widened QT wave
- Severe heart block
- "Torsades de pointes" dysrhythmia
- Quinidine: Severe heart failure (HF), hypotension, thyrotoxicosis
- Procainamide: Low white blood cell count (WBC) or agranulocytosis, myasthenia gravis, systemic lupus erythematosus
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What are some contraindications that would make taking the fibrate drug gemfibrozil (Lopid) risky for the patient?
- Gall bladder disease
- Liver dysfunction
- Severe renal impairment
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What are some contraindications that would make taking the cardiac glycosides digoxin (Lanoxin) risky for the patient?
- Ventricular fibrillation or tachycardia, unless caused by heart failure
- Digoxin toxicity
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What are some contraindications that would make taking the sympathomimetic drug dobutamine (Dobutrex) risky for the patient?
- Allergy to sympathomimetics or sulfites
- Ventricular tachycardia
- Hypertrophic aortic stenosis
- Dehydration
- Child younger than age 2
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What are some contraindications that would make taking the HMG-CoA reductase inhibitor (statin) drug simvastatin (Zocor)risky for the patient?
- Pregnancy (risk category X)
- Lactation
- Current liver disease, jaundice, elevated transaminase or greatly elevated aspartate aminotransferase (AST) or alanine aminotransferase (ALT)
- Renal failure
- Rhabdomyolysis or myopathy
- Multiple sclerosis
- Child younger than 10 years old
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What are some contraindications that would make taking the potassium-sparing diuretic, spironolactone (Aldactone) risky for the patient?
- Pregnancy (risk category D)
- Renal failure and severe renal insufficiency, or increase in renal impairment
- Hyperkalemia
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What are some contraindications that would make taking the class III/potassium channel blocker amiodarone (Cordarone) risky for the patient?
- Pregnancy (risk category D)
- Lactation
- Allergy to amiodarone or benzyl alcohol
- Shock
- Bradycardia, heart block or sinus node dysfunction
- Severe hepatic disease
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What are some contraindications that would make taking the angiotensin receptor blocker (ARB) losartan (Cozaar) risky for the patient?
- Pregnancy (risk category D for second and third trimesters [fetal damage])
- Allergy to losartan
- Child younger than 6 years old
- Child older than 6 who has a very low creatinine clearance
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What are some contraindications that would make taking the loop diuretic furosemide (Lasix) risky for the patient?
- Allergy to furosemide or sulfonamides
- Pre-eclampsia or eclampsia of pregnancy
- Hepatic coma
- Electrolyte imbalance or dehydration
- Increase in oliguria
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What are some contraindications that would make taking the nitrate drugs nitroglycerin (Nitrostat, Nitro-Dur, Nitro-Bid) and isosorbide dinitrate (Isordil) risky for the patient?
- Allergy or tolerance to nitroglycerin or isosorbide
- Head injury, increased intracranial pressure
- Severe anemia
- Glaucoma (sustained-release forms)
- Gastrointestinal (GI) disease including hypermotility (sustained release isosorbide)
- IV nitroglycerin: Hypotension, hypovolemia (correct before administering)
- Constrictive pericarditis
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What are some contraindications that would make taking the beta adrenergic blockers atenolol (Tenormin) and metoprolol (Lopressor) risky for the patient?
- Sinus bradycardia or greater than first degree heart block
- Moderate to severe heart failure
- Cardiogenic shock
- Atenolol: Peripheral vascular disease, Raynaud's disease
- Metoprolol: Child younger than 6 years old
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What are some contraindications that would make taking the adrenergic neuron blocker reserpine (Serpalan, Sk-Reserpine) risky for the patient?
- Pregnancy (risk category D)
- Lactation
- Previous allergy to rauwolfia alkaloids
- Depressive disorder
- Peptic ulcer or ulcerative colitis
- Use of MAOI antidepressants
- Child
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What are some contraindications that would make taking the direct renin inhibitor aliskiren (Tekturna) risky for the patient?
- Pregnancy risk category D (second and third trimesters) - fetal injury
- Lactation
- Allergy to aliskiren
- Hyperkalemia, hypercalcemia, or dehydration
- Child or adolescent younger than 18
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What are some contraindications that would make taking the thiazide diuretic hydrochlorothiazide (HydroDIURIL) risky for the patient?
- Allergy to thiazides or sulfonamides
- Greatly decreased urine output (anuria)
- Electrolyte imbalance
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What are some contraindications that would make taking the aldosterone antagonist spironolactone (Aldactone) risky for the patient?
- Serum potassium above normal levels (greater than 5.0 mEq/L)
- Type 2 diabetes mellitus with microalbuminuria
- Increased serum creatinine or decreased creatinine clearance
- Lactation
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What are some contraindications that would make taking the angiotensin-converting enzyme (ACE) inhibitor drug captopril (Capoten) risky for the patient?
- Pregnancy (risk category D [fetal damage])
- Lactation
- Angioedema or allergy to ACE inhibitors
- Hypotension
- Liver disease with elevated liver enzymes
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