Cardiac

Question 1

Thiazide Diuretics

Answer 1

Drugs- hydrochlorothiazide (microzide), chlorthalidone, indapamide, metolazone (zaroxolyn)
MOA- lower BP by increasing sodium and water excretion, decreased CO and renal blood flow
Used as initial therapy
Useful in combo
ADE- hypokalemia, hyperuricemia, hyperglycemia, hyponatremia, hypomagnesemia, hypovolemia

Question 2

Loop diuretics

Answer 2

Drugs- furosemide, torsemide, bumetanide, etharynic acid
MOA- blocks sodium and chloride reabsorption in the kidneys, decreases renal vascular resistance
ADE- hypokalemia, hypocalcemia, ototoxicity
Used alone or in combo for HTN, CHF, peripheral edema

Question 3

Potassium sparing diuretics

Answer 3

Drugs- amiloride (midamor), triamterene (dyrenium) inhibit sodium transport in late distal and collecting ducts
Spironolatone (aldactone) and eplerenone (inspra) are aldosterone receptor antagonist
MOA- all reduce potassium, aldosterone antagonist have benefit for improving cardiac remodeling and SHF
Used in combo with loop or thiazides to reduce potassium loss
Also used in PCOS
ADE- hyperkalemia, gynecomastia

Question 4

Beta blocker

Answer 4

See neuro slides
Acebutolol, atenolol (tenormin), betaxolol, bisoprolol, carvediolol (coreg), esmolol (brevibloc), labetolol (trandate), metorprolol (lopressor, toprol), nadolol (corgard), nebivolol (bystolic), pindolol, propranolol (inderal, innopran)

Question 5

ACEI

Answer 5

Drugs- benazepril (lotensin), captopril, enalapril (vasotec), fosinopril, lisinopril (prinivil, zestril), moexipril, quinapril (accupril), perindopril, ramipril (altace), trandolapril
MOA- inhibit ACE which converts angiotensin 1 to angiotensin 2, decreases secretion of aldosterone, decrease cardiac preload and after load
Uses- HTN, MI, CHF, CKD, increased risk for CAS
ADE- dry cough, angioedema, increased potassium
Monitor renal function
Tetrogenic

Question 6

ARBs

Answer 6

Drugs- azilsartan (edarbi), candesartan (atacand), irbesartan (avapro), losartan (cozaar), olmesartan (benicar), telmisartan (micardis), valsartan (diovan)
MOA- blocks Angiotensin 1 receptors and decrease angiotensin 2 production
Can be used as first line for HTN especially in DM, CKD, CHF
ADE- similar to ACEI, but cough and angioedema less likely
Do not give with ACEI or in pregnancy

Question 7

Renin inhibitor

Answer 7

Drug- aliskiren (tekturna)
MOA- selective renin inhibitor, inhibits renin and acts earlier in the renin angiotensin aldosterone system
Uses- HTN
do not used with ACEI or ARB
ADE- diarrhea, cough and angioedema but less likely
Tetrogenic
CYP3A4 metabolite

Question 8

CCB

Answer 8

Drugs- amlodpine (norvasc), clevidipine (cleviprex), diltiazem (cardizem, cartia, tiazac), felodipine, isradipine, nicardipine (cardene), nifedipine (adalat, procardia), nisoldipine (sular), verapamil (calan, verelan)
1st line for BP in AA
Subclasses
-diphenylalkylamines- verapamil-slows cardiac conduction and decreased HR for angina, SVT, migraines, clusters
-benzothiazepines- diltiazem-similar to verapamil but less ADE
-dihydropyridines- nifedipine, amlodipine, felodipine, isradipine, nicardipine, nisoldipine, grater affinity for calcium channels, HTN, minimal effect on conduction and HR
MOA- block calcium in the heart and smooth muscles
Uses- HTN in asthma, DM, PVD, angina, afib
ADE- heart blocks, constipation, diltiazem and verapemil should be avoided in CHF or blocks, dizziness, HA, fatigue, peripheral edema

Question 9

Methyldopa

Answer 9

MOA- alpha agonist
ADE- sedation, drowsiness
Uses- HTN in pregnancy

Question 10

Vasodilators

Answer 10

Drugs- hydralazine, minoxidil
Reserved for resistant HTN
MOA- produce relaxation of vascular smooth muscles, increase myocardial contraction and can increase HR and oxygen consumption
Can cause angina, MI or CHF
Can increase sodium and water concentrations
Hydralazine- HTN and pregnancy Induced HTN, ADE- HA, tachycardia, nausea, sweating, arrhythmias, angina, lupus like syndrome
Minoxidil can cause body hair growth so can be used for male pattern baldness

Question 11

HTN crisis

Answer 11

DOC- CCB like nicardipine and clevidipine, nitroglycerin, adrengeruc receptor antagonist like phentolamine, esmolol, labetalol, hydralazine

Question 12

Carbonic anhydrase inhibitors

Answer 12

Drug- acetazolamide (diamox)
MOA- inhibits carbonic anhydrase in proximal tubules, bicarbonate is released more
Uses- glaucoma, altitude sickness
ADE/ metabolic acidosis, potassium depletion, renal stone forming, drowsiness, paresthesia
Avoid in cirrhosis

Question 13

Osmotic diuretics

Answer 13

Drugs- mannitol (osmitrol)
MOA- filtered substances undergo little or no reabsorption so results in higher osmolarity in tubular fluid, Limits additional water reabsorption
Not useful for conditions in which sodium retention occurs
Use- maintain urine flow following acute toxic ingestion of substances that can cause ARF, and increased ICP
ADE- dehydration, extracellular water expansion

Question 14

Sacubitril/valsartan (Entresto)

Answer 14

MOA- combines ARB with neprilysn inhibition and results in increased concentration of vasoactive peptides leading to natriuesis, vasodilation and inhibition of fibrosis
Decrease preload and after load
Uses- use in place of ARB/ACEI in SHF
ADE- similar to ACEI/ARB,
Do not give in hx of angioedem

Question 15

Ivabradine (corlanor)

Answer 15

Class- hyperpolarization activtated cyclic nucleotide gates channel blocker
MOA- acts slowly on If current in SA node to reduce heart rate without reducing contractility, AV conduction, ventricular repolarization, or blood pressure
Uses- SHF
ADE- bradycardia
Not to be used in pregnancy or BF, with heart blocks or potent 3A4 inhibitors

Question 16

Vericiguat (verquvo)

Answer 16

Class- soluble guanylate cyclase stimulator
MOA- directly simulates sodium guanylate and signals activation of cGMP to improve left ventricular compliance, vasodilation, reduce inflammation, and prevent hypertrophy and fibrosis
Uses- SHF recently hospitalized and in GDMT
ADE- minimal but due to vasodilators effects, hypotension, anemia, syncope
Contraindicated in pregnancy or BF
Avoid in use with other nitrates or phosphodiesterase inhubutirs

Question 17

Milirinone

Answer 17

MOA- phosphodiesterase inhibitor that increases cAMP
Results in increase cardiac contractility
Usually given IV for SHF
Dobuatmine and milirinone can be used for intermediate term treatment for OP palliative care
Can also be used for right sided HF and pulmonary HTN

Question 18

Class 1a anti arrhythmics

Answer 18

MOA- acts by blocking voltage sensitive sodium channels, slows phase 0 depolarization in cardiac myocytes and slows down QRS and QT
Drugs- quinidine, procainamide, disopyramide (norpace)
Uses- quinidine for variety, procainamide for atrial and ventricular, disopyramide for afib or flutter or ventricular
ADE- worsen HF, blurred vision, tinnitus, HA, disorientation, psychosis, hypotension if IV, disopyramide anticholinergic SE
D-D- CYP2D6 for quinidine and disopyramide
Do not use in atherosclerosis or HFrEF

Question 19

Class 1B antiarrthymics

Answer 19

Drugs- lidocaine (xylocaine), mexiletine
MOA- sodium channel blocker shortens phase 3 repolarization in cardiac myocytes
ADE- worsening ventricular arrhythmia, syncope, dizziness, tremor, ataxia, paresthesia, confusion, seizures, liver failure, n/v, dyspepsia, dysphasia
Uses- alternative for VT VF, used in combo with amiodarone in VT storm
Mexiletine has narrow therapeutic range
D-D- CYP2D6

Question 20

Class 1C anti arrhythmics

Answer 20

Drugs- flecainide (tambocor) and propafenone (rythmol)
MOA- sodium channel blockers phase 0 depolarization,
ADE- bradycardia, long QT, worsening arrthymias, acute HF, dizziness, hypotension, constipation, HA, tremor, visual disturbances, bronchospasm, liver failure, agranulocytosis, anemia, edema
Uses- af and a flutter, refractory ventricular arrhythmias

Avoid in structural heart disease

Question 21

Class 2 anti arrhythmics

Answer 21

Beta blockers
Atenolol, esmolol, metoprolol
MOA- inhibit phase 4 depolarization in SA and AV node
Uses- tachy arrhythmia

Question 22

Class 3 anti arrhythmics

Answer 22

Drugs- amiodarone (cordarone, pacerone), dofertilide (tikosyn), dronedarone (multaq), ibutilide (corvert), sotalol (betapace, sorine)
MOA- potassium channel blocker, prolongs phase 3
-Amiodarone- refractory SVT or ventricular arrhythmias, afib and flutter, ADE- pulmonary fibrosis, neuropathy, hepatotoxicity, corneal deposits, optic neuritis, blue gray skin discoloration, thyroid issues
-dronedarone- similar to amio, better ADE than amio, but liver failure still issue, do not given in symptomatic CHF, or permanent AF due to increase risk of death
-sotalol- also non selective blocker activity, afib, a flutter, refractory paroxysmal SVT, and ventricular arrhythmia, can be used in LVH or CAD, similar ADE to BB, initiate in hospital for QT monitoring
-dofetilide- first line for AF or HF or CAD, must be IP due to risk of proarrhymias
-ibutilide- DOC for chemical conversion of a flutter, IP due to risk of arrhythmias

Question 23

Class 4 anti arrhythmics

Answer 23

Drugs- diltiazem (cardizem), verapamil (calan, verelan)
MOA- calcium channel blockers, inhibit action potential in SA and AV nodes
ADE- bradycardia, heart block, active HF, peripheral edema; hypotension, dizziness, constipation, gynecomastia, sexual dysfunction, gingival hyperplasia
Uses- atrial arrhythmia, re entrant SVT, reduce ventricular rates in AF or flutter

Question 24

Other anti Arrhythmia

Answer 24

Digoxin (also for CHF)
Adenosine- decreases automaticity in AV node, IV for converting SVT, flushing, CP, and hypotension, very short DOA
Magnesium sulfate- torsades
Ranolazine- similar to amiodarone, antianginal properties, refractory atrial and ventricular arrhythmias in combination with others

Question 25

Anti angina drugs

Answer 25

-Beta blockers- nadolol (corgard), propranolol* (inderal, innopran), sotalol (betapace, sorine), atenolol (tenormin), bisoprolol, metoprolol, nebivolol, as they decrease oxygen demand in myocardium, decrease CO, and BP, first line except vasospastic which can make it worse -CCB- amlodipine (norvasc), felodipine (plendil), nifedipine (adalat, procardia), diltiazem (cardizem), verapamil (calan, verelan), ateriorvasodulators, decrease vascular resistance, decrease after load

Question 26

Non selective versus selective BB

Answer 26

Non selective Nadolol, propranolol, sotalol Selective Atenolol, bisoprolol, metoprolol, nebivolol

Question 27

Nitrates

Answer 27

Drugs- nitroglycerin, isosorbide mono nitrate and isosorbide dinitrite Can also be used in CHF MOA- relax smooth muscle by nitric oxide causing dilation ADE-HA, postural hypotension, facial flushing; tachycardia DO NOT USE WITH PDE 5 INHIBITORS SEVERE HYPOTENSION Tolerance

Question 28

Ranolazine (Ranexa)

Answer 28

MOA- inhibits sodium current improving oxygen supply and demand Improves diastolic function Has anti arrhythmic properties ADE- long QT

Question 29

HMG CoA reductase inhibitors aka statins

Answer 29

Drugs- atorvastatin (Lipitor), fluvastatin (lescol), lovastatin (altoprev), pitavastatin (livalo), pravastatin (pravachol), rosuvastatin (crestor), simvastatin (zocor) MOA- competitive inhibitors of HGM CoA reductase the rate limiting step in cholesterol synthesis, decrease LDL, for ASCVD risk factors ADE- elevated liver enzymes, myalgia, myopathy, rhabdomyolysis,

Question 30

Cholesterol absorption inhibitors

Answer 30

Drugs- ezetimibe (zetia) MOA- selectively inhibits absorption of dietary and biliary cholesterol in small intestine Lowers LDLin combo with statin Do not give in hepatic insufficiency ADE- uncommon

Question 31

Bile acid sequestrants

Answer 31

Drugs- colesevelam (welchol), colestipol (colestid), cholestyramine (questran, prevalite) MOA- binds cholesterol to bile and is excreted via feces Statin preferred but for those who cannot tolerate others Can also be used in diabetes (colesevelam) ADE- GI disturbances like constipation, nausea, flatulence, interfere with vitamin absorption D-D- digoxin, warfarin, thyroid

Question 32

PCSK9 inhibitors

Answer 32

Drug- alirocumab (praluent), evolocumab (repatha) MOA- inhibits protein converts substilisin kexin type 9 in the liver and leads to degradation of LDL receptors Maximize statin therapy or those intolerant to statins or with familiar hypercholesterolemia SQ injection Well tolerated some injection site reactions, allergic reactions, diarrhea, myalgia, URI, nasopharyngitis

Question 33

Adenosine triphosphate citrate lyase inhibitor

Answer 33

Drugs- bempedoic acid (nexletol) MOA- lowers LDL by inhibiting cholesterol synthesis in the liver with ATC further upstream of HGM CoA reductase Uses with max statin therapy and familial hypercholesteremia Well tolerated- can cause hyperuricemia, back pain, muscle spasm, tendon rupture

Question 34

Microsomal triglyceride transfer protein inhibitor

Answer 34

Drug-lomitapide (juxtapid) For familial hypercholesterolemia MOA- inhibits microsomal triglyceride transfer and lows VLDL Uses as adjunct ADE- liver toxicity, chest pain, fatigue, GI distress, infection, respiratory issues D-D- CYP3A4

Question 35

Fibrates

Answer 35

Drugs- fenofibrate (triglide, tricor) and genfibrozil (lopid) MOA- bind to peroxisome proliferator response elements which decrease triglyceride levels throwing increased expression of lipoprotein lipase Used in hypertriglyceridemia ADE- GI issues, gallstones, myositits, muscle weakness Do not give with simvastatin or in severe liver disease, or renal dysfunction or pre existing gall bladder disease, biliary cirrhosis D-D- warfarin

Question 36

Niacin

Answer 36

Reduced triglycerides you 20-50%, and reduces LDL and increases HDL Use in combo with statin MOA- strongly inhibits lipolysis in adipose and reduces production of free fatty acid Used in familial hyperlipidemia or intolerant to other agents like statins ADE- flushing, ASA 30 minutes prior can help, nausea, abdominal pain, predisposition to gout, hepatotoxicity

Question 37

Omega 3 fatty acid

Answer 37

Drugs- lovaza, vascepa MOA- exogenous fatty acid that is used for TG lowering 4 grams can decrease serum concentrations of TG, lower some LDL and raise HDL OTC, naturally eating fish products or rx Can reduce risk of CV evens as secondary prevention with statin ADE- GI, bleeding with anti platelet or anticoagulant

Question 38

ferrous sulfate, ferrous glycine, ferrous fumarate, ferrous aspartate, carbonyl iron

Answer 38

PO iron-ferrous sulfate DOC MOA- elemental iron supplement ADE- GI disturbances, staining of teeth, n/v/c, toxicity- diarrhea, shock, acidosis, gastric necrosis, liver failure, pulmonary edema, vasomotor collapse D-D PPI, antacids, tetracycline, asorbic acid

Question 39

Folic acid

Answer 39

For Anemia due to demand like pregnancy, or poor absorption, alcoholism, dihydrofolate reductase inhibitors, antibiotics or methotrexate, inhibit DNA synthesis like anti seizures

Question 40

Cyanocobalmin and hydroxocobalmin (vitamin b12)

Answer 40

For Anemia, celiac, enteritis, Bariatric surgery, alcoholism, PPI, metformin, megaloblastic Anemia, measurable B12 IM hydroxocobalmin is preferred as fast acting ADE- hypokalemia

Question 41

Erythropoietin (epogen, procrit) and darbepoetin (aranesp)

Answer 41

For anemia EPO regulates blood cell proliferation Can be due to ESRD, HIV, bone marrow disorder, prematurity and malignancy IV in dialysis patients or SQ for others ADE- high concentrations can cause CV events, BBW increased risk of death Pearls- co administer with high potency iron, dialysis need IV, use with caution not for acute treatment

Question 42

Neutropenia drugs

Answer 42

Drugs- filgrastim (neupogen) tbo-filgrastim (granix), and pegfilgrastim (neulasta), sagramostim (leukine) MOA- stimulate granulocyte production in bone marrow to increase neutrophil count and reduce severe neutropenia following chemotherapy and bone marrow transplant ADE- bone pain, sickle cell crisis, growth factor for tumor, splenic rupture, ARDS

Question 43

Drugs for sickle cell

Answer 43

-hydroxurea (droxia, hydrea) oral ribonucleotide reductase inhibitor that reduces frequency of sickle crisis, increased fetal hemoglobin, diluting abnormal HbS is delayed and reduces crisis. Can take 3-6 months. ADE- bone marrow suppression, cutaneous vasculitis -cruzanlizumab (adakveo) Monoclonal antibody blocks interaction between endothelial cells, RBC, platelets, and leukocytes, ADE- infusion related, nausea, arthralgia, back pain, phrexia -voxelotor (oxbryta) inhibits polymerization HbS by binding to alpha chain of HbS,decreased concentration which is thought to lead to sickling Well tolerated- HA, diarrhea, GI issues

Question 44

HTN

Answer 44

Greater than 130/80 on two separate occasions If SBP greater than 20 above goal or DBP 20 above goal need to start two anti hypertensive So those with a BP 160/90 need two drugs from the get go

Question 45

ASA

Answer 45

MOA-inhibits thromboxane A2 synthesis on COX 1 irreversibly, anti aggregation effects Uses- prevent TIA, reduce recurrent MI, decrease mortality on primary and secondary prevention of MI, complete inactivation of platelets occurs ADE- high doses can increase toxicity, increase bleeding time

Question 46

P2Y12 receptor antagonist

Answer 46

Drugs- ticlopidine (ticlid), clopidogrel (plavix), prasugrel (effient), ticagrelor (brillinta), cangrelor (kengreal) MOA- PY212 ADP receptor inhibition block platelet aggregation, block protein needed for platelets to bind to fibrinogen cangrelor is not oral Plavix-prevent CV event in those with recent MI, stroke; prevent thrombosis of ACS, prevent thrombosis post PCI Ticlid- uses similar to plavix but ADE worse reversed if intolerant to others Prasugrel- decrease CV even in ACS Brillinta- prevent VTE in unstable angina, acute MI and PCI Cangrelor -add in during PCI to prevent VTE Requires loading dose D-D- CYP450 PPI ADE- heme reactions, TTP, BBW FOR BLEEDING

Question 47

Glycoprotein 2b/3b inhibitors

Answer 47

Drugs- abciximab (reopro), eptifibatide (integrelin), tirofabib (aggrastat) MOA- GP 2b/3b plays a role in platelet aggregation, blocks binding of fibrinogen Uses- IV with heparin and ASA as add on in PCI, unstable angina when non responsive to others ADE- bleeding

Question 48

Dipyridamole (persantine)

Answer 48

MOA- coronary vasodilator increases cAMP and inhibits phosphodiesterase resulting in less thromboxane , decrease platelet adhesion to surfaces Given with ASA as well Do not give in unstable angina ADE- HA, dizziness, orthostatic BP

Question 49

Cilostazol

Answer 49

Oral anti platelet with vasodilators effects MOA- inhibits phosphodiesterase which prevents breakdown of cAMP and prevents platelet aggregation and vasodilation Uses- can reduce symptoms of intermittent claudication D-D- CYP450, 3A4, 2C18 and many others ADE- HA, diarrhea, abnormal stools, dyspepsia, abdominal pain, thrombocytopenia, leukopenia, INCREASED MORTALITY IN CHF pts

Question 50

Heparin and low molecular weight heparin

Answer 50

Heparin, LMWH enoxaparin (lovenox), dalteparin (fragmin) IV/SQ MOA- binds to antithrombin 3 with inactivation of coagulation factors, inhibits factor Xanax Uses- prevent VTE, acute DVT/PE, prevent post op VTE, DOC for pregnancy women Heparin bolus ADE- bleeding, HIT, osteoporosis OD- use protamine sulfate

Question 51

Argatroban (acova)

Answer 51

MOA- direct thrombin inhibitor uses- prevent or tx of VTE in HIT, Post PCI at risk for HIT ADE- bleeding

Question 52

Bivalurudin (angiomax), desirudin (lprivask)

Answer 52

MOA- direct thrombin inhibitor Angiomax is alternative for heparin in those having PCI at risk for HIT or unstable angina Lprivask is used to prevent DVT in hip replacement ADE- bleeding

Question 53

Fondaparinux (arixtra)

Answer 53

MOA- inhibits factor Xa Uses- DVT, PE, prevent DVT in ortho and abdominal surgery SQ Less monitoring required compared to heparin contraindicated in severe renal disease ADE- bleeding no antidote, HIT but less likely

Question 54

Coumadin (warfarin)

Answer 54

MOA- vitamin K antagonist, factor 2, 7, 9, 10 require vitamin K as a cofactor INR is standard used to monitor, very narrow index Many D-D and good interactions- Tylenol, quinolones, other antibiotics, vitamin K foods Uses- DVT, PE, stroke prevention in afib and prosthetic heart valves, protein C, antiphospholipid, protein S deficiency ADE- bleeding, skin lesion and necrosis, purple toe syndrome, tetrogenic

Question 55

Direct acting Agents

Answer 55

Drugs- dabigatran (pradaxa), MOA- thrombin inhibitors, both clot and bound thrombin and free thrombin are inhibited by Pradaxa Uses- prevent stroke and embolism in non valvular AF, DVT, PE in those who have already gotten parenteral anticoagulants and prevent reduce recurrent DVT/PE Contraindicated in mechanical heart valves, not recommended in bio prosthetic valves ADE- bleeding, Use in caution with renal disease and greater than 75, GI side effects Antidote- idarucizumab (praxbind)

Question 56

Direct oral factor Xanax inhibitors

Answer 56

Drugs- apixaban (Eliquis), betrixaban (bevyxxa), edoxaban (savaysa), rivaroxaban (Xarelto) MOA- oral inhibitors of factor Xa, inhibiting factor Xa decreased production of thrombin from prothrombin Uses- stroke in non valvular AF, DVT, PE, bextrixban for hospitalized pt at risk for DVT/PE ADE- bleeding, renal disease can prolong effects No antidote

Question 57

Thrombolytic agents

Answer 57

MOA- directly or indirectly to covert plasminogen to plasma which cleaves fibrin thus lysing thrombi, increased local thrombi can occur as clot dissolves leading to enhanced platelet aggregation and thrombosis given ASA or heparin to prevent Uses- DVT, PE, used less due to serious bleeding, in MI via intra coronary delivery, dissolve clots in stroke Given IV ADE- hemorrhage as it cannot differentiate between fibrin of an unwanted clot and fibrin of beneficial clot Do not give in pregnancy, healing wounds, CVA, brain tumor, ICP, metastatic CA -alteplase (TPA)-for MI, massive PE, acute ischemic stroke: can cause angioedema, increased risk when combined with ACEI -tenecteplase- recombinant TPA. Used for acute MI

Question 58

Drugs for bleeding

Answer 58

Drugs- amino caproic acid (amicar), tranexamic acid (cyclotron/lysteda) MOA- decreases plasmin formation and fibrinolysis ADE- intravascular thrombosis

Question 59

Protamine sulfate

Answer 59

Antagonizes heparin ADE- hyper sensitivity, dyspnea, flushing bradycardia, hypotension

Question 60

Vitamin K

Answer 60

Phytonadione (mephyton/aquamephyton) Can stop bleeding from warfarin by increase vitamin K Oral, SQ, IV,

Question 61

Idarucizumab (praxbind)

Answer 61

Monoclonal antibody fragment used to reserve bleeding from dabigatran Binds to dabigatran and neutralizes it Used in emergency IV ADE- thrombosis

Question 62

Iron dextran, ferric glycine complex, iron sucrose IV

Answer 62

Dextran- used for intolerant or ineffective oral iron ADE- anaphylaxis, hypotension, HA, fever: uriticaria, arthralgia, persistent pain with injection Glyconate complex- IDA, and CKD in HD, always used with erythropoietin, ADE- transient flushing, hypotension, lightheadness, malaise, fatigue, weakness, severe pain in chest, back, flanks or groins Iron sucrose-uses for IDA, CKD ADE- hypotension, cramps, heart failure, sepsis, taste perversion