Aspirin (Ecotrin) 81, 325

• Cox 1 and 2 inhibitor, non-reversible, not a prodrug CYP2C9
• Chronic use can compromise antiplatelet effects, monitor for GI ulceration
• No specific antidote, consider platelet transfusion with or without DDAVP – Hold 7 to 10 days before surgery.

Cilostazol (Pletal) 50, 100

• Inhibits platelet phosphodiesterase III, reversible, not a prodrug, CYP3A4, CYP2C19, CYP1A2, CYP2D6. Administer before meals or 2 hours after meals.
• Contraindicated in patients with heart failure of any severity
• Hold 2 to 3 days before surgery

Clopidogrel (Plavix) 75, 300

• Inhibits  P2Y12 component of ADP receptors, non reversible, prodrug, CYP2C19, CYP3A4
• No specific antidote, consider platelet transfusion with or without DDAVP
• Hold 5 to 10 days before surgery

Prasugrel (Effient) 10, 60

• Inhibits P2Y12 component of ADP receptors, non-reversible, prodrug, CYP3A4, CYP2B6
• Reduce maintenance dose to 5mg in patients less than 60kg
• Contraindicated in patients with a history of stroke or TIA – Not recommended for patients over 75 years old
• No specific antidote, consider platelet transfusion with or without DDAVP – Hold 5 to 7 days before surgery

Ticagrelor (Brillinta) 90, 180

• Inhibits p2Y12 component of ADP receptors, reversible, not a prodrug, CYP3A4, CYP3A5
• Used with aspirin 81mg, BID dosing, monitor for bradyarrythmia, dyspnea
• No specific antidote, consider aminocaproic acid, tranexamic acid, recombinant factor VIIa – Hold at least 5 days before surgery

Ticopidine (Ticlid) 250

• Inhibits p2Y12 component of ADP receptors, non-reversible, prodrug, CYP3A4
• Black Box Warning: hematologic toxicities (aplastic anemia, TTP)
• Frequent CBC monitoring, BID dosing – No specific antidote, consider platelet transfusion with or without DDAVP
• Hold 5 to 10 days before surgery

Benazepril (Lotensin) 5, 10, 20, 40

Captopril (Capoten) 12.5, 25. 50. 100 – Not a prodrug

Cilazapril (Inhibace) 1, 2.5, 5

Enalapril (Vasotec) 2.5, 5, 10, 20

Fosinopril (Monopril) 10, 20, 40

Lisinopril (Zestril) 2.5, 5, 10, 20, 40 – Not a prodrug

Moexipril (Univasc) 7.5, 30

Perindopril (Aceon) 2, 4, 8

Quinapril (Accupril) 5, 10, 20, 40

Ramipril (Altace) 1.25, 2.5, 5, 10

Trandolapril (Mavik) 1, 2, 4

• Blocks conversion of Angiotension I to Angiotensin II
• Common kalemia, headache, side effects of hypotension, cough, hyperkalemia, headache, dizziness, fatigue, nausea, angioedema, rash, possible significant renal impairment – Most are prodrugs 17

Candesarten (Atacand) 4, 8, 16, 32

Eprosartan (Teveten) 400, 600

Irbesartan (Avapro) 75, 150, 300

Losartan (Cozaar) 25, 50, 100

Olmesartan (Benicar) 20, 40

Azilsartan (Edarbi) 40, 80

Valsartan (Diovan) 40, 80, 160, 320

• Common side effects of hypotension, hyperkalemia, headache, dizziness, fatigue, nausea, rash
• Indications of hypertension, acute MI, cardiac failure, DM related chronic renal disease

Eplerenone (Inspra) 25, 50, 100

Spironolactone (Aldactone) 25, 50, 100

• Indications of hypertension, acute MI, cardiac failure, DM related chronic renal disease

DHP:

Amlodipine (Norvasc) 2.5, 5, 10

Nefidipine (Procardia) 10, 20, 30, 60, 90

Non-DHP:

Verapamil (Calan) 80, 120

Benzothiazepine Diltiazem (Cardizem) 30, 60, 90, 120

• Indications of angina, ventricular rate control, hypertension

Propranolol (Inderal) 10, 20, 40, 60, 80

Metoprolol (Lopressor) 25, 50, 100, 200

Atenolol (Tenormin) 25, 50, 100

• Indications of MI, hypertension, angina, arrhythmias, heart failure

Escitalopram (Lexapro) 10, 20

Sertraline (Zoloft) 25, 50

Fluoxetine (Prozac) 10, 20, 30, 40

Paroxetine (Paxil) 10, 20, 30, 40

Bupropion (Wellbutrin) 75, 150, 300

Atorvastatin (Lipitor) 10, 20, 40, 80

Simvastatin (Zocor) 10, 20, 40, 80

Rosuvastatin (Crestor) 10, 20, 40

• Side effects of short-term memory loss, liver damage, muscle pain/cramping, hyperglycemia
• HMG-CoA reductase inhibitors, rate determining step in cholesterol synthesis

Lansoprazole (Prevacid) 15, 30

Omeprazole (Prilosec) 20, 40

Dexlansoprazole (Dexilant) 30, 60

• Side effects of headache, nausea, diarrhea, abdominal pain, fatigue, rash, flatulence
• Blocks H/K ATPase of gastric parietal cells
• Indications of GERD, PUD, stress gastritis, dyspepsia

Sildenafil (Viagra) 25, 50, 100, 180

Vardenafil (Levitra) 5, 10, 20

Tadalafil (Cialis) 5, 10, 20

INR of 2-3 in most conditions

INR of 2.5-3.5 in mechanical heart valves

INR needs to be regularly monitored to ensure in therapeutic range

• Contraindicated in pregnancy
• Side effects/complications of hemorrhage, necrosis, osteoporosis, purple-toe syndrome
• Drug interactions important because narrow therapeutic index of Warfarin
  • Greens, herbs and spices, antibiotics, alcohol, cranberry juice, etc.