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Hypertension, HF, ACS, ICS

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sgthuan's version from 2017-07-10 20:54

HTN,ACS,ICS,HF

genericbrandclassdrug pearl
chlorothiazideDiurilthiazide diuretics*** available in IV form, NOT effective if CrCl < 30, sulfa allergy, hypoK, hypoNa, hypoMg, hyperCa, hyper-uric acid, hyperglycemia, hyper-lipid(LDL, TG), photosensitivity
chlorthalidoneNONEthiazide diuretics12.5-25mg qd, NOT effective if CrCl < 30, sulfa allergy, hypoK, hypoNa, hypoMg, hyperCa, hyper-uric acid, hyperglycemia, hyper-lipid(LDL, TG), photosensitivity
HCTZMicrozidethiazide diuretics12.5-50mg qd, *** Sulfa Allergy, NOT effective if CrCl < 30, hypoK, hypoNa, hypoMg, hyperCa, hyper-uric acid, hyperglycemia, hyper-lipid(LDL, TG), photosensitivity
metolazoneZaroxolynthiazide diuretics2.5-5mg qd, ***WORK with CrCl < 30, ** Sulfa Allergy, hypoK, hypoNa, hypoMg, hyperCa, hyper-uric acid, hyperglycemia, hyper-lipid(LDL, TG), photosensitivity
furosemideLasixLoop diuretics20-40mg qd or BID MAX 600, *** IV to PO 1 to 2, *** SULFA allergy, SE hypoNa,K,Mg,Ca, hyperuricemia, hyperglycemia, increased HCO3 --> metabolic alkalosis, photosensitivity, ototoxicicy, **** store injection at room temperature, NO RENAL adjustment
bumetanideBumexLoop diuretics0.5-1mg qd MAX 10, IV to PO 1 to 1, *** SULFA allergy, SE hypoNa,K,Mg,Ca, hyperuricemia, hyperglycemia, increased HCO3 --> metabolic alkalosis, photosensitivity, ototoxicicy, NO RENAL adjustment
torsemideDemadexLoop diuretics10-20mg qd MAX 200, IV to PO 1 to 1, *** SULFA allergy, SE hypoNa,K,Mg,Ca, hyperuricemia, hyperglycemia, increased HCO3 --> metabolic alkalosis, photosensitivity, ototoxicicy, NO RENAL adjustment
ethacrynic acidEdecrinLoop diuretics50-200mg qd MAX 400, IV to PO 1 to 1, *** NO SULFA allergy, SE hypoNa,K,Mg,Ca, hyperuricemia, hyperglycemia, increased HCO3 --> metabolic alkalosis, photosensitivity, ototoxicicy, NO RENAL adjustment
amlodipineNorvascCCB - DHP - peripheral arterial vasodilation2.5-10mg qd MAX 10mg, caution with CHF - ***this is the SAFEST for CHF, peripheral edema, HA, flushing, palpitation, reflex tachycardia, **gingival hyperplasia, major substrate of 3A4, ***preferred agent to use with BB in stable angina
nifedipineAdalat CC, Procardia XLCCB - DHP - peripheral arterial vasodilation30-90mg qd, caution with CHF, peripheral edema, HA, flushing, palpitation, reflex tachycardia, gingival hyperplasia, IR formula is NOT for chronic HTN, major substrate of 3A4, *** OK to use in stable angina, *** Extended release ONLY Recommended for Pregnancy HTN (120-160/80-105)
nicardipine IVCardene IVCCB - DHP - peripheral arterial vasodilationIV formula, *** require light protection during administration, major substrate of 3A4
diltiazemCardizem CD&LA, Cartia XT, Diltzac, Dilt-XR, Taztia, TiazacCCB - non-DHP - negative inotrope & chronotropeCI - hypotension SBP<90, AV block, edema, constipation, HA, gingival hyperplasia, IR formula is indicated for angina, major substrate of 3A4, *** used for antiarrythmias for rate control, maybe AVOID in CHF
verapamilCalan, Calan SR, Covera HS, Verelan PMCCB - non-DHP - negative inotrope & chronotropeCI - hypotension SBP<90, AV block, ** severe CHF with EF<30%, SE edema, HA, gingival hyperplasia, ***CONSTIPATION, major substrate of 3A4, *** used for antiarrythmias for rate control, maybe AVOID in CHF
benazeprilLotensinACEI5-40mg qd
enalaprilVasotecACEItarget HF 10-20 BID
lisinoprilPrinivil, ZestrilACEI5-40mg qd --> Target HF 20-40qd, BBW Cat.X, CI - hx of angioedema, s/e - angioedema, cough, hyperK, hypotension
trandolaprilMavikACEItarget HF 4mg qd
quinaprilAccuprilACEI5-40mg qd, Target HF 20 BID
ramiprilAltaceACEI2.5-20mg qd, Target HF 10mg qd
candesartanAtacandARB8-32mg qd, Target HF 32mg qd
irbesartanAvaproARB75-300mg qd
losartanCozaarARB25-100mg qd, Target HF 50-150mg qd
olmesartanBenicarARB10-40mg qd
telmisartanMicardisARB40-80mg qd, BBW Cat.X, CI - hx of angioedema, s/e - angioedema, cough, hyperK, hypotension
valsartanDiovanARB80-320mg qd, Target HF 160mg BID
sacubitril + valsartanEntrestoneprilysin inhibitor + ARB50-100mg BID, Target HF 200mg BID, Warning angioedema, renal impairment, hyperK, hypotension
eplerenoneInsprapotassium sparing diuretics50mg qd or BID, Target HF 50mg qd, ***selective aldosterone receptor blockers - NO endocrine S/E, CI - hyperK > 5.5 and T2DM with microalbuminuria, S/E dehydration, hypoNa
spironolactoneAldactonepotassium sparing diuretics25-100mg qd, Target HF 25 BID, *** non-selective aldosterone receptor blockers - gynecomastia, breast tenderness irregular menses, CI - hyperK > 5.5, S/E dehydration, hypoNa
atenololTenorminBB - B1 selectiveBBW do NOT d/c abruptly, CI - AV block, mask hypoglycemia, S/E decreased HR&libido, hypotension, fatigue, depression
acebutololSectralBB - B1 selectiveBBW do NOT d/c abruptly, CI - AV block, mask hypoglycemia, S/E decreased HR&libido, hypotension, fatigue, depression, ***BB with ISA do not decrease HR - not recommended in post-MI (CAPP)
metoprolol tartrate & succinateLopressor, Toprol XLBB - B1 selectiveTarget HF 200mg qd, BBW do NOT d/c abruptly, CI - AV block, mask hypoglycemia, S/E decreased HR&libido, hypotension, fatigue, depression, ***Take with FOOD, **tartrate IV to PO is 1 to 2.5, RECOMMENDED with CHF only, tartrate has IV formula
bisoprololZebetaBB - B1 selectiveTarget HF 10mg qd, BBW do NOT d/c abruptly, CI - AV block, mask hypoglycemia, S/E decreased HR&libido, hypotension, fatigue, depression, *** RECOMMENDED with CHF only
esmololBreviblocBB - B1 selectiveIV Injection, BBW do NOT d/c abruptly, CI - AV block, mask hypoglycemia, S/E decreased HR&libido, hypotension, fatigue, depression
nebivololBystolicBB - B1 selective & Nitric Oxide dependent vasodilationBBW do NOT d/c abruptly, CI - AV block, mask hypoglycemia, S/E decreased HR&libido, hypotension, fatigue, depression
nadololCorgardBB - non-selectiveBBW do NOT d/c abruptly, CI - AV block, mask hypoglycemia, S/E decreased HR&libido, hypotension, fatigue, depression, *** may cause hyperglycemia by decreasing insulin release
propranololInderalBB - non-selectiveBBW do NOT d/c abruptly, CI - AV block, mask hypoglycemia, S/E decreased HR&libido, hypotension, fatigue, depression, *** may cause hyperglycemia by decreasing insulin release, **highly lipophilic - cross BBB
pindololNONEBB - non-selectiveBBW do NOT d/c abruptly, CI - AV block, mask hypoglycemia, S/E decreased HR&libido, hypotension, fatigue, depression, *** may cause hyperglycemia by decreasing insulin release
labetalolTrandateBB - non-selective + alpha1 blockertab&injection, BID dose, BBW do NOT d/c abruptly, CI - AV block, mask hypoglycemia, S/E decreased HR&libido, hypotension, fatigue, depression, *** may cause hyperglycemia by decreasing insulin release, *** Recommended for Pregnancy HTN (120-160/80-105)
carvedilolCoreg, Coreg CRBB - non-selective + alpha1 blockerIR BID Target HF 25-50 BID, CR qd Target HF 80mg qd --> dosing conversion, BBW do NOT d/c abruptly, CI - AV block, mask hypoglycemia, S/E decreased HR&libido, hypotension, fatigue, depression, ** may cause hyperglycemia by decreasing insulin release, ***Take with FOOD, **** RECOMMENDED with CHF only
aliskirenTekturnadirect renin inhibitor150-300 qd, BBW Cat.X, CI - hx of angioedema and use with aliskiren in T2DM, s/e - angioedema, cough, hyperK, hypotension, *** AVOID in bilateral renal artery stenosis
clonidineCatapres, Catapres-TTS patchcentrally-acting Alpha 2 Agonists 0.1-0.2 BID, do NOT d/c abruptly, S/E dry mouth, HA, fatigue, constipation, decreased HR, hypotension, sexual dysfunction *** used in resistant HTN & pts can't swallow, patch changed every week & removed before MRI
guafacineTenex (IR), Intuniv (ER - for ADHD)centrally-acting Alpha 2 Agonists1-2 qHS, do NOT d/c abruptly, S/E dry mouth, HA, fatigue, constipation, decreased HR, hypotension, sexual dysfunction
methyldopaNONEcentrally-acting Alpha 2 Agoniststab & injection, *** positive Coomb test - hemolytic anemia, *** drug-induced lupus erythematosus, **** Recommended for Pregnancy HTN (120-160/80-105)
hydralazineApresolineDirect Vasodilator (mostly arterioles)10-50mg QID & IV formula, CI - mitral valvular rheumatic heart disease & CAD, S/E HA, hypotension, reflex tachycardia, palpitations, *** Drug induced lupus erythematosus
minoxidilNONE, RogaineDirect Vasodilator (mostly arterioles)5-40md qd, S/E fluid retention, tachycardia, hair growth
hydralazine + isosorbide dinitrateBidilvasodilator20/37.5 TID, Target HF 2tab TID, decrease preload & afterload --> improve survial, indicated for intolerance to ACE & black pts with class III-IV
doxazosinCardura, Cardura XLAlpha-1 Blocker - peripheral vasodilator of arterioles and veins1-4mg qd, S/E orthostatic hypotension, fatigue, HA, edema, XL formula leave ghost shell in the stool, ***Used in combination with BPH
prazosinMinipressAlpha-1 Blocker - peripheral vasodilator of arterioles and veins1-5mg BID, S/E orthostatic hypotension, fatigue, HA, edema, ***Used in combination with BPH
terazosinHytrinAlpha-1 Blocker - peripheral vasodilator of arterioles and veins1-2mg qHS, S/E orthostatic hypotension, fatigue, HA, edema, ***Used in combination with BPH
losartan + HCTZHyzaar
amlodipine + olmesartanAzor
amlodipine + atorvastatinCaduet
amlodipine + benazeprilLotrel
amlodipine + valsartanExforgeARB/CCB
lisinopril + HCTZZestoreticACEI/thiazide
olmesartan + HCTZBenicar HCTARB/thiazide
valsartan + HCTZDiovan HCTARB/thiazide
enalapril + HCTZVasereticACEI/thiazide
irbesartan + HCTZAvalideARB/thiazide
verapamil + trandolaprilTarkaCCB/ACEI
aliskiren + HCTZTekturna HCTrenin inhibitor/thiazide
atenolol + chlorthalidoneTenoreticBB/thiazide
bisoprolol + HCZTZiac
nebivolol + valsartanByvalson
triamterine + HCTZMaxzide, Dyazide
clopidogrelPlavixP2Y12 inhibitor - ThienopyridinesLD 300-600 (for PCI), MD 75mg qd, *** Prodrug requires 2C19 --> test to check 2C19 genotype, **** Avoid 2C19 inhibitor - omeprazole & esomeprazole, causes thrombotic thrombocytopenic purpura (TTP), 2nd prevention - combination with aspirin for 12 months
prasugrelEffientP2Y12 inhibitor - ThienopyridinesLD 60mg (with PCI), MD 10mg qd, only with ACS is to be managed with PCI, keep in the ORIGINAL container, 2nd prevention - combination with aspirin for 12 months (with PCI only)
ticagrelorBrilintaP2Y12 inhibitorLD 180, ***"MD 90mg BID x 1 year, then 60mg BID", maintenance dose of aspirin < 100, 2nd prevention - combination with aspirin for 12 months, ** tablets can be crushed and mixed with water to be given via NG tube
abciximabReoproG2b/3a antagonistIV injection, ** NOT recommended for medical management of ACS or WITHOUT PCI, SE - thrombocytopenia --> platelet function comes back in 24-48h, *** MUST FILTER
eptifibatideIntegrilinG2b/3a antagonistIV injection, CI - thrombocytopenia < 100K & hx of hemorrhagic stroke, platelet function come back in 4-8h
tirofibanAggrastatG2b/3a antagonistIV injection, CI - thrombocytopenia < 100K & hx of hemorrhagic stroke, platelet function come back in 4-8h
alteplaseActivaseFibrinolytics - converting plasminogen to plasmin0.9mg/kg IV --> ** MAX 90mg, ONLY for STEMI, *** the ONLY Fibrinolytic agent FDA-approved for acute ischemic Stroke --> exclude intracranial hemorrhage --> treatment within 3h-4.5h of system onset, ***used if PCI is not impossible within 90m (door to balloon) or 120m of 1st medical contact, Door to Needle is 30m, **** do NOT use if BP > 185/110
tenecteplaseTNKaseFibrinolytics - converting plasminogen to plasminONLY for STEMI, ***used if PCI is not impossible within 90m (door to balloon) or 120m of 1st medical contact, Door to Needle is 30m
reteplaseRetavaseFibrinolytics - converting plasminogen to plasminONLY for STEMI, ***used if PCI is not impossible within 90m (door to balloon) or 120m of 1st medical contact, Door to Needle is 30m
aspirin + ER dipyridamoleAggrenoxvaried200-25mg BID, *** For thrombotic stroke prevention
vorapaxarZontivityProtease activated receptor-1 antagonist (PAR-1 on platelet)2.08mg qd, used in pts with MI or PAD to reduce ASCVD, ***thrombotic event prevention, use in combination with aspirin and/or clopidogrel, 3A4 substrate, --> in ACS chapter
ranolazineRanexaantianginal - inhibit late-phase Na+CI liver cirrhosis, 3A4 inducer or inhibitor, Warning QT prolong, SE dizziness, HA, constipation, nausea, *** NO clinical effects on HR and BP, **** FOR ICS, substitute or add-on to BB
amiodaroneCordaroneclass 3 - also cover Na & BBvery long half-life, cat. X, BBW proarrhythmic, pulmonary & hepatic toxicity, hospitalized for loading, SE hypotension, bradycardia, like iodine --> hypo & hyperthyroidism, optic neuropathy, SJS/TEN, photosensitivity --> *** BLUE skin discoloration, **** DOC in CHF, **** DDI decrease dose of digoxin by 50% & warfarin by 30-50%, MAX simvastatin 20mg
dronedaroneMultagclass 3BBW *** class 4 CHF, permanent A.fib, cat. X, Warning hepatic & pulmonary toxicity, SE QT prolong, increase SCr
sotalolBetapace, Betapace AFnon-selective BBBBW loading dose in hospital, **** CrCl < 60 dose adjust --> Torsa
digoxinLanoxin, DigitekDig - positive inotropes, negative chronotropesusually 0.125mg qd, *** decrease dose by 20-30% when going from oral to IV, CI - V.fib, SE dizziness, mental disturbances, *** narrow therapeutic 0.8-2 for A.fib & 0.5-0.9 for CHF, *** Toxicity - N/V, bradycardia, loss of appetite --> antidote - DigiFab, CrCl<50 dose adjust --> hypoK, hypoMg, hyperCa increase the risk, ** usually give with BB or CCB for rate control, *** do NOT decrease exercise induced HR but will decrease resting HR, ** Yellow/green vision, blurriness and halos for glaucoma
nitroglycerin ointment 2%Nitro-BIDvasodilator - LONG acting nitratedose BID --> require 10-12h nitrate free period to decrease tolerance
nitroglycerin patchNitro-Dur, Minitranvasodilator - LONG acting nitratewear on for 12-14 hours, off for 10-12 hours
isosorbide mononitrate IR/ERImdur, Monoketvasodilator - LONG acting nitrateIR used BID (8am&3pm), ER QAM
isosorbide dinitrate IR/ERIsordil, Dilatratevasodilator - LONG acting nitrateIR used BID or TID, ER used BID, *** this is the PREFERRED agent to use with hydralazine for systolic CHF
ivabradineCorlanorHCN blocker - decrease HRindicated for chronic HF with class II-III with resting HR > 70, target HR 50-60 WITH all appropriate 1st line
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