HEART MED. ADVERSE REACTIONS AND INTERACTIONS TENEX ( guanfacine) � Interactions � With other anti-hypertensive meds. could result in hypotension. With NSAIDs � possibly decreased effect Adverse reactions � Central Nervous System � anxiety, confusion, depression, dizziness, drowsiness, headache, nervousness, weakness Cardiovascular � orthostatic hypotension (hypotension on standing up, Dizziness) Eye, Ear, Nose, Throat � conjunctivitis, dry mouth Gastro-intestinal � constipation, nausea Genito-Urinary � decreased libido, impotence Skin � dermatitis, purpura (hemorrhaging under the skin), rash Cautions: may experience withdrawl symptoms, stopping the drug abruptly can cause dangerous rise in blood pressure, avoid alcohol ( increases central nervous system depression), take at bedtime to minimize day time sedation. Coumadin � to treat pulmonary embolism and venous thrombosis Interactions - With acetaminophen, penicillan,beta blockers, misc. antibiotics, flu vaccine, statin drugs, NSAIDS, aspirin,vit. E. ---increased risk of bleeding With alcohol � increased risk of bleeding Adverse reactions � Central Nervous System � Intracranial hemorrhage, weakness Eye,Ear, Nose, Throat � nose bleeds, intraocular hemorrhage Gastro-intestinal � abd. cramps and pain, diarrhea, hepatitis, nausea, vomiting Genito-urinary � blood in urine, Skin � alopecia, jaundice, petechiae ( small purplish hemorrhagic spots on the skin), purple-toe syndrome, tissue necrosis Beware of any potentially fatal hemorrhage from any tissue or organ. Beware of increased risk of intracranial hemorrhage, observe for TIA�s ( transcient ischemic strokes � loss of feeling on one side of face, slurred speech, dragging one side or the other � all lasting for only seconds of minutes). Don�t eat soy � decreases vitamin K and could increase bleeding. Avoid alcohol. Eat lost of dark green leafy veges � high in Vit. K. Notify doctor if have unusual bleeding, dizziness, easy bruising, gum bleeding, headache, red,black, or tarry stools, red or brown urine. Don�t take OTC drugs. PERCOCET � mixture of oxycodone and acetaminofen for pain. Oxycodone has the potential for abuse. Alters the perception of and emotional response to pain at the spinal cord and higher levels of the central nervous system by blocking the release of inhibitory neurotransmitters such as GABA and acetylchoine. Interactions � With anti-hypertension drugs � possibly exaggerated anti-hypertensive effects and risk of orthostatic hypotension. With coumadin � risk of bleeding With MAO inhibitors � possibly fatal reactions, including cardiac arrest, coma, respiratory depression, seizures, and severe hypertension. With alcohol use � increased acetaminophen- induced hepatotoxicity Adverse Reactions Central Nervous System � confusion, dizziness, drowsiness, increased risk of falling,hallucinations, headache, restlessness, sedation Cardio-vascular � hypotension, orthostatic hypotension, palpitations Eye, Ear, Nose, Throat � Blurred vision dry eyes, lens opacity Gastro-intestinal � Abd. pain, constipation, elevated liver function tests Genito-urinary � decreased libido, erectile dysfunction, renal tubular necrosis, urinary hesitancy, urine retention Respiratory � respiratory depression Skin � flushing, urticaria (sudden eruptions with intense itching) May also cause excessive bleeding, physical and psychological dependence and withdrawl symptoms. Take with full glass of water of food, use increased amounts of fiber. Notify doctor with possible signs of toxicity such as excessive light-headedness, extreme dizziness, itching, swelling, trouble breathing NORVASC � anti-hypertensive, calcium channel blocker Interactions � With beta blockers- possibly excessive hypotension Adverse reactions � Central Nervous System � anxiety, dizziness, fatigue, headache, lethargy, light-headedness, syncope ( transcient loss of consciousness resulting from inadequate flow of blood to the brain), tremor. Cardio-vascular � arrythmias, hot flashes, hypotension, palpitations, peripheral edema Eyes, Ears, Nose, Throat � dry mouth, pharyngitis Gastro-intestinal � abd. cramps, abd. pain, constipation, diarrhea, indigestion, nausea Genito-urinary � decreased libido, impotence, urinary frequency Musculo � muscle pain Skin � dermatitis, flushing, rash Respiratory � labored, difficult breathing Immediately notify doctor of dizziness, arm or leg swelling, difficulty in breathing, hives or rash. Take with food. Check blood pressure often Do not take with grapefruit juice � intensifies activity. PROCARDIA � calcium channel blocker Interactions � With beta blockers � increased risk of hypotension With calcium supplements � interfere with action of procardia With other anti-hypertensives � increased risk of hypotension With grapefruit juice � intensifies activity With alcohol � increased hypotensive effect With NSAIDS � possible decreased effect Adverse reactions � Central Nervous System � anxiety, confusion, dizziness, drowsiness, headache, nervousness, nightmares, psychiatric disturbances, tremor, weakness Cardiovascular � arrythmias, bradycardia, tachycardia, chest pain, heart failure, hypotension, palpitations, peripheral edema Eyes, Ears, Nose, Throat � altered taste, blurred vision, dry mouth, nose bleed, nasal congestion, pharyngitis, sinusitis, tinnitus Gastro-intestinal � anorexia, constipation, diarrhea, elevated liver function tests, hepatitis, nausea,vomitting Genito-urinary � dysuria, polyuria, nocturia, sexual dysfunction Blood � anemia, thrombocytopenia (abnormal decrease in number of platelets) leukopenia ( decrease of white blood cells) Musculo � joint stiffness, muscle cramps Respiratory � congestion, cough, respiratory infection, wheezing Skin � dermatitis, erythema multiforme ( small dark red papules, wheals, vesicles, or tubercles, usually on the extremeties including the palms and soles. May appear in concentric rings, separate rings, or disc shaped patches. Immune reaction to drugs), flushing, photosynsitivity, rash, urticaria Regularly monitor blood pressure and pulse. Watch for signs of fluid retention such as peripheral edema and weight gain. May cause enlargement of breasts and hyperglycemia ( elevated blood sugar). Do not stop abruptly. Avoid alcohol. Notify doctor of chest pain, difficulty in breathing, ringing in ears, and swollen gums. Take extra fiber and water. EXERCISE REGULARLY. See dentist often. Long, hot showers may cause dizziness. Avoid prolonged exposure to the sun. TOPROL � beta blocker Interactions � With calcium channel blockers � increased risk of heart failure, increased therapeutic effects of both drugs With MAO inhibitors � increased risk of hypertension With other anti-hypertensives � additive hypotensive effect With NSAIDS, aspirin � decreased therapeutic effect Adverse reactions � Central Nervous System � anxiety, confusion, depression, dizziness, drowsiness, fatigue, hallucinations, headache, insomnia, weakness, Cardiovascular � arrythmia, bradycardia, chest pain, heart failure, orthostatic hypotension Eyes, Ears, Nose, Throat � nasal congestion Gastro-intestinal � constipation, diarrhea, nausea, vomiting Genito-urinary � impotence Musculo � back pain, myalgia (tenderness and pain in the muscles) Respiratory � bronchospasms Skin � rash May be at risk of AV block (atrioventricular block) � if results from depressed AV node conduction, may need appropriate drugs or temp. pacemaker. Must discontinue use slowly. Take with food. Check pulse often and notify doctor if gets below 60 bpm . COMBINED REACTIONS OF ALL MEDS Central Nervous System - anxiety, nervousness, confusion, headache, hallucinations, nightmares, psychiatric disturbances, weakness, drowsiness, fatigue, depression, intracranial hemorrhage Cardiovascular ------------ orthostatic hypotension, chest pain, palpitations, heart failure, Arrythmias Eyes, Ears, Nose, Throat �conjunctivitis, dry mouth, dry eyes, blurred vision, nasal congestion, nose bleeds, intraocular hemorrhage, sinusitis, tinnitis Gastro-intestinal -----------constipation, nausea, abdominal pain and cramps, diarrhea, vomiting, anorexia, elevated liver function tests, hepatitis. Genito-urinary ------------ decreased libido, impotence, painful urination, frequent urination, night time urination, erectile dysfunction, blood in urine, urinary retention Skin - -----------------------dermatitis, purpura, rash, urticaria, photosensitivity, jaundice, petechiae Musculo ------------------- back pain, tenderness and pain in the muscles, joint stiffness, muscle Cramps Respiratory ----------------broncho spasms, respiratory depression, congestion, cough, respiratory infection, wheezing, Blood ----------------------anemia, decreased platelets, decreased WBC SEPARATE INTERACTIONS TENEX, NORVASC, PROCARDIA, TOPROL � all interact to create greater risk of increased hypotension and orthostatic hypotension. TOPROL reacts with NORVASC AND PROCARDIA � increased risk of heart failure and increased hypotension PROCARDIA reacts with CALCIUM SUPPLEMENTS � decreases activity, so can�t take calcium supplements and risk of osteoporosis increases COUMADIN interacts with TOPROL � risk of increased bleeding PERCOSET reacts with COUMADIN � increased bleeding PERCOSET AND TOPROL react with MAO INHIBITORS � don�t take St. Johns Wort, natural MAO inhibitor ALL interact with ALCOHOL � increases central nervous system depression, bleeding, acetaminophen- induced hepatotoxicity, increased hypotensive effect NORVASC AND PROCARDIA � react with grapefruit juice � intensify activity MOST interact with NSAIDs (ibuprofen) and aspirin- increased bleeding, decreased therapeutic effect ALL cause constipation � take extra fiber ALL can cause depression, nausea, and headaches MOST cause muscle, joint, back pain ALL cause decreased libido and impotence MOST cause congestion and breathing problems ALL cause skin problems DON�T STOP TAKING ANY OF THEM ABRUPTLY- can cause dangerous rise in B/P or anxiety and nervousness, arrythmias