CARDIOVASCULAR SYSTEM
CHF and arrhythmias 2D
dosing by 2hrs. May cause false low serum digoxin
measurements.
Adverse reactions: Angina, orthostatic
hypotension, dizziness, cough, GI upset, pain,
hyperkalemia, upper respiratory infection,
arrhythmias, asthenia; angioneurotic edema
(discontinue if occurs).
How supplied: Tabs 10mg, 20mg– 30, 90, 1000;
40mg– 30, 90
;LISINOPRIL
ZESTRIL AstraZeneca
ACE inhibitor. Lisinopril 2.5mg, 5mg, 10mg, 20mg,
30mg, 40mg; tabs.
Indications: Heart failure inadequately controlled
by diuretics ;/or digitalis. Adjunct to other therapies
within 24 hrs post-MI in hemodynamically stable
patients, to reduce mortality.
Adults: CHF: initially 5mg once daily; range
5–40mg once daily; increase by 10mg at 2 week
intervals; max 40mg once daily; hyponatremia or
moderate to severe renal impairment: initially
2.5mg once daily; supervise closely. Reduce
diuretic dosage before 1st dose (if possible) and
observe until BP is stabilized. Post-MI: 5mg within
24 hrs of onset of symptoms, then 5mg after
24 hrs, then 10mg after 48 hrs, then 10mg once
daily for up to 6 weeks; if systolic BP ;120mmHg
at onset, start with 2.5mg daily for 3 days; or if
systolic BP ;100mmHg, start with 5mg daily, then
reduce to 2.5mg daily as needed; discontinue if
prolonged hypotension (systolic BP ;90mmHg for
;
1 hr) occurs.
Children: Not recommended.
Contraindications: History of ACEI-associated or
other angioedema. Pregnancy (Cat.D in 2nd and 3rd
trimesters).
Warnings/Precautions: Renal impairment.
Dialysis (esp. high-flux membrane). Salt/volume
depletion. Hypertrophic cardiomyopathy. CHF.
Ischemic heart disease. Cerebrovascular disease.
Renal artery stenosis. Surgery. Monitor electrolytes,
renal and liver function. Monitor serum potassium in
diabetics. Monitor WBC count in renal and collagen
vascular disease. Discontinue if angioedema or
laryngeal edema (have SC epinephrine available),
jaundice or elevated liver enzymes occur. Elderly.
Pregnancy (Cat.C in 1st trimester). Nursing mothers:
not recommended.
Interactions: May cause hypotension or
increased BUN with diuretics, hyperkalemia with
K; sparing diuretics or K; supplements. May
increase lithium levels; monitor frequently.
Antagonized by, and increased risk of renal failure
with, NSAIDs.
Adverse reactions: Dizziness, headache, fatigue,
diarrhea, upper respiratory symptoms, cough,
nausea, orthostatic hypotension, hyperkalemia, renal
impairment, angioedema; liver dysfunction, blood
dyscrasias (rare).
How supplied: Tabs– 100
;METOPROLOL
LOPRESSOR Novartis
;-blocker. Metoprolol tartrate 50mg, 100mg; scored
tabs.
; Also: Metoprolol
LOPRESSOR INJECTION
Metoprolol tartrate 5mg; soln for IV inj.
Indications: In stabilized patients after MI, to
reduce mortality.
Adults: See literature. Early treatment: initially
administer three 5mg IV bolus inj given at
approximately 2-minute intervals; monitor BP, HR,
ECG. If full IV dose (15mg) tolerable, give 50mg
(tab) every 6 hours starting 15 mins after the last
IV dose and continue for 48 hours, thereafter, give
maintenance dose of 100mg (tab) twice daily; if full IV
dose not tolerable, give 25–50mg (tab) every 6 hours
starting 15 mins after the last IV dose or as soon
as clinical condition allows; if severe intolerance:
discontinue treatment. Late treatment: if early phase
treatment is contraindicated, intolerable or delayed
therapy needed, start with 100mg (tab) twice daily for
at least three months.
Children: Not recommended.
Contraindications: Significant 1st degree
heart block. 2nd- or 3rd-degree AV block. Systolic
pressure;100mmHg or heart rate ;
45 beats/min.
Moderate-to-severe cardiac failure.
Warnings/Precautions: CHF. Bronchospastic
disease. Hepatic dysfunction. Diabetes.
Pheochromocytoma. Hyperthyroidism. Surgery.
Avoid abrupt cessation. Pregnancy (Cat.C). Nursing
mothers.
Interactions: Bradycardia with catecholamine-depleting drugs. May be potentiated by potent
CYP2D6 inhibitors (eg, fluoxetine, paroxetine,
bupropion, thioridazine, quinidine, propafenone,
ritonavir, diphenhydramine, hydroxychloroquine,
terbinafine, cimetidine), inhalation anesthetics.
Increased risk of bradycardia with concomitant
digitalis. May block epinephrine. Increased rebound
hypertension with clonidine withdrawal.
Adverse reactions: Fatigue, dizziness, depression,
hypotension (discontinue if occurs), diarrhea, rash,
dyspnea, bradycardia, cold extremities, palpitations,
CHF, peripheral edema, bronchospasm, heart block.
How supplied: Tabs– 100; Ampuls (5mL)– 10
;METOPROLOL
TOPROL-XL AstraZeneca
;-blocker. Metoprolol succinate 25mg, 50mg,
100mg, 200mg; scored ext-rel tabs.
Indications: Stable, symptomatic (NYHA Class II
or III) ischemic, hypertensive, or cardiomyopathic
heart failure.
Adults: Class II: initially 25mg once daily; more
severe: 12.5mg once daily. May double dose as
tolerated every 2 weeks; reduce if symptomatic
bradycardia occurs; max 200mg/day.
Children: Not recommended.
