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HYGROTON; THALITONE

Thiazide diuretic

• 1) Thiazide diuretics
• 2) ACEi
• 3) ARBs
• 4) CCBs (both classes)
• 5) β Blockers (esp post-MI)

• First line treatment for HTN
• Increase excretion of H2O, Na, Cl and Mg
• Decrease excretion of Ca
• Dosed in AM to reduce nocturnal diuresis

• Chlorthalidone (HYGROTON; THALITONE)
• Chlorothiazide (DIURIL)
• Hydrochlorothiazide/HCTZ (MICROZIDE; HYDRODIURIL)
• Indapamide (LOZOL)
• Metolazone (ZAROLOXYN)

DIURIL

Thiazide diuretic

MICROZIDE; HYDRODIURIL

Thiazide diuretic

LOZOL

Thiazide diuretic

ZAROLOXYN

Thiazide diuretic

Increase excretion of H2O, Na, Cl, Mg, and Ca

Used for more severe forms of HTN, with drugs that cause Na retention

• 2nd dose given in early afternoon to avoid nocturnal diuresis
• Ethacrynic acid (EDECRIN)
• Furosemide (LASIX)
• Bumetanide (BUMEX)
• Torsemide (DEMADEX)

EDECRIN

Loop diuretic

LASIX

Loop diuretic

BUMEX

Loop diuretic

DEMADEX

Loop diuretic

• Useful for avoiding K depletion and augment the effects of other diuretics
• Most frequently used w/HCTZ

• Dosed in AM or afternoon to avoid nocturnal diuresis
• Amiloride (MIDAMOR)
• Triamterene (DYRENIUM)

MIDAMOR

K sparing diuretic

DYRENIUM

K sparing diuretic

• Dosing depends on indication; low dose for HTN
• Spironolactone (ALDACTONE)
• Eplerenone (INSPRA)

• Contraindications:
• - Hypersensitivity - Severe hyperkalemia
• - Pregnancy (anything interfering w/RAS DO NOT USE in pregnancy)
• - Anuria/renal failure

• Dosing: 150-300mg daily
• Aliskiren (TEKTURNA)
• Aliskiren/HCTZ (TEKTURNA HCT)
• Aliskiren/Valsartan (VALTURNA)

• IV and oral dosing are not always equal
• Captopril (CAPOTEN)
• Benazepril
• Enalapril & Enalaprilat
• Fosinopril
• Lisinopril (PRINIVIL; ZESTRIL)
• Quinapril
• Ramipril (ALATACE)
• Trandolapril
• Moexipril
• Perindopril

• S/E:
• - Dry cough (most effective: change to ARBs)
• - Angioedema
• - Dizziness/lightheadedness
• - Hyperkalemia
• - increase in Scr (25-35%)

CAPOTEN

ACEi

PRINIVIL; ZESTRIL

ACEi

ALATACE

ACEi

• Generally 1-2 times daily
• Losartan (COZAAR)
• Candesartan (ATACAND)
• Irbesartan (AVAPRO)
• Valsartan (DIOVAN)
• Telmisartan (MICARDIS)
• Eprosartan (TEVETEN)
• Olmesartan (BENICAR)

S/E: similar to ACEi; no cough; angioedema (?)

COZAAR

ARBs

ATACAND

ARBs

AVAPRO

ARBs

DIOVAN

ARBs

MICARDIS

ARBs

BENICAR

ARBs

• Dihydropyridines (-pine)
• Generally 1-2 times daily for long acting DHPs
• • Amlodipine (NORVASC)
• • Felodipine (PLENDIL)
• • Isradipine (DYNACIRC)
• • Nicardipine (CARDENE)
• • Nisoldipine (SULAR)
• • Nifedipine (ADALAT, PROCARDIA)
• - vasodilate SM
• For HTN, angina (chest pain), Raynaud’s phenomenon (Nifedipine), pre-term labor (Nifedipine)
• Non-Dihydropyridines
• Avoid combination w/β blocker and non DHP (both cause bradycardia)
• Non-DHPs usually given IV in emergencies
• • Diltiazem (CARDIZEM)
• • Verapamil (CALAN, ISOPTEN)
• - works at SM and heart (CO)
• For HTN, angina, arrhythmias, migraines (treat/prevent-verapamil)

• S/E:
• Bradycardia (non-DHPs) Reflex tachycardia (DHPs)
• Edema (DHP) Hypotension
• Gingival hyperplasia Constipation

• Dosing usually 1-2 times daily
• IV dose < PO
• Non-selective
• • Propranolol (INDERAL, INDERAL LA) Dosed up to QID
• • Nadolol (CORGARD) ↓ dose in kidney impairment
• • Timolol (BLOCADREN)

• ISA (Intrinsic Symapathomimetic Activity)
• Partial agonists
• Resting HR, CO and peripheral blood flow are not reduced
• May increase mortality
• • Pindolol (VISKEN)
• • Acebutolol (SECTRAL)
• • Penbutolol (LEVATOL)
• • Carteolol (CARTROL)
• Cardioselective
• Dose dependent (higher doses=decrease in selectivity)
• • Metoprolol (LOPRESSOR, TOPROLOL XL)
• • Atenolol (TENORMIN) ↓ dose in kidney impairment
• • Betaxolol (KERLONE)
• • Bisoprolol (ZEBETA)
• • Nebivolol (BYSTOLIC)

• Labetalol (TRANDATE; NORMODYNE)
• Carvedilol (COREG; COREG CR)
• These agents also inhibit α1 adrenoceptors
• Less effect on HR and CO
• Don’t use w/asthma/COPD
• Labetalol preferred in pregnancy

• Give 1st dose HS to avoid orthostatic hypotension (head rush, dizzy when stand up)
• Usually avoided in women
• More effective if used w/beta blocker or diuretic
• Prazosin (MINIPRES) 2-3 times daily
• Terazosin (HYTRIN) 1-2 times daily
• Doxazosin (CARDURA) daily

Should always be used w/beta blocker and diuretic

• Hydralazine (APRESOLINE)
• Minoxidil (LONITEN; ROGAINE)

• Goal: < 120/80 mmHg
• First line therapy: ACEi and diuretic (Loop in advanced disease)
• Add on therapy:
• • beta blocker: Bisoprolol, Carvedilol and Metoprolol succinate
• • ARBs no better than ACEi but may provide added benefit; Candesartan and Valsartan
• • Aldosterone antagonists: Spironolactone and eplerenone

• Goal: < 130/80 mmHg
• First line therapy: beta blockers (w/o ISA) and ACEi
• Alternative therapy: ARBs
• Add on therapy: Aldosterone antagonists

• Chronic stable angina
• Goal: < 130/80 mmHg
• First line therapy: beta blocker
• Alternative/Add on: CCBs (long acting-Verapamil, Diltiazem); ACEi/ARB; Thiazides

• Acute coronary syndrome (ACS)
• Goal: < 130/80 mmHg
• Alternative therapy: Non-DHP CCBs; ARBs
• Add on therapy: DHP CCBs; Thiazides

• Goal: < 130/80 mmHg
• First line theraphy: ACEi or ARB
• Thiazide considered 2nd line
• Alternative: Non-DHP CCBs
• Add on therapy: DHP CCBs; beta blocker (Cardioselective or carvedilol)
• Combinations of drugs are usually needed to achieve target BP goal

• Goal: < 130/80 mmHg
• First line therapy: ACEi or ARB (combo may be more effective)
• Alternative: Non-DHP CCBs
• Add on therapy: DHP CCBs; beta blocker (Cardioselective)
• Combinations of drugs are usually needed to achieve target BP goal

• Goal: < 130/80 mmHg
• First line therapy: Thiazide and ACEi combo
• Alternative: ARB (Losartan)
• Add on therapy: others may be effective

• Bed rest and lifestyle medications (decrease Na, more fruits and veggies)
• Medications:
• First line agent- Methyldopa (central alpha2 agonist)
• Alternative- Labetalol (beta blocker)
• CCBs (NOT immediate release Nifedipine)- Hypotension w/fetal distress

AVOID: ACEi, ARBs, direct renin inhibitors