CPJE PNN Top 400

Diuretics

SULFA allergy with all thiazides

LOOPs watch for SULFA allergy except for Ethacrynic Acid

TD - not if renal impairment

- low Na, Cl, K, Mg

- high Ca, glucose, lipid, UA

- sexual dysfunction, rash, photosensitivity

- risk of lithium toxicity (low Na)

- risk of digoxin toxicity (low K and Mg)

- risk of allopurinol hypersensitivity

- pregnancy cat B

LD - okay if renal impairment

- decrease all electrolytes low Na, Cl, K, Mg, Ca

- high glucose, lipid, UA

- sexual dysfunction, rash, photosensitivity

- lupus, ototoxicity (ethacrynic acid)

- ethacrynic acid 50mg = furosemide 40mg = torsemide 20mg = bumetanide 1mg

Bumex

bumetanide

loop diuretic

sulfa allergy

Edema - 0.5, 1, 2 mg

PO - 0.5-2mg x 1; redose in 4-5 hrs x 2 doses

max 10mg/d

BID

1 mg bumex = 40mg lasix

Edecrin

ethacrynic acid

loop diuretic

PO/IV

highest ototoxicity of the loop diuretics

only loop diuretic without SULFA

Lasix

furosemide

loop diuretic

1:2 - IV:PO

protect IV from light

tabs, oral solution, IM/IV

- HTN - 20-40 mg BID

- Edema, HF - 20-80mg/dose, up to 600mg/d

QD/BID

Demadex

torsemide

loop diuretic

SULFA allergy

htn - 5mg QD

max 100mg/d

chlorthalidone

thiazide-like diuretic

12.5mg

max 100mg QD

longer acting/more potent than HCTZ

hydrochlorothiazide

thiazide diuretic

12.5-25mg QD (up to 50mg)

daily in 1-2 divided doses

minimal response and more electrolyte disturbances seen with doses >50mg daily

Maxzide, Dyazide - triamterene with HCTZ

Diuril

chlorothiazide

thiazide diuretic

PO - 500-2000 mg QD

IV- 500-1000mg QD/BID

Lozol

indapamide

thiazide-like diuretic

1.25mg

max 5mg QD

Zaroxolyn

metolazone

thiazide-like diuretic

2.5-5mg QD

target dose 20mg

thiazide-related that can be used in renal failure

K-sparing diuretics

hyperkalemia

hyponatremia

rash, HA

weak diuretic

Midamor

amiloride

K-sparing

5mg QD (max 20mg/d)

Dyrenium

Triamterene

K-sparing

100-300mg QD/BID

max 300mg/d

form - capsules only

Aldactone

spironolactone

aldosterone antagonists

gynecomastia

BP lowering in pts with hyperaldosteronism

HTN - 50-100mg QD/BID

Edema - 25-200 mg QD/BID

HF (NYHA class 3-4) - 12.5-25mg QD (max 50mg)

with food

Inspra

eplerenone

aldosterone antagonists

CYP3A4 substrate

HTN - 50mg QD

max - 50 mg BID

CHF (post MI) - 25-50mg QD

ACEI

- DM, CHF, MI, CKD

- less effective in African Americans

- preferred in lipid disorders and sexual dysfunction

- ↑ lithium toxicity

- watch for hyperkalemia

- avoid NSAIDs

"CAPTOPRIL"

- Cough (dry, hacking)

- Angioedema (rare but potentially fatal)

- Potassium (hyperK)

- Taste change (metallic, sweet, salty)

- Orthostasis (hypotension)

- Pregnancy

- Rash (caution due to renal artery stenosis)

- Increase in K

- Leukocytosis (captopril)

BBW - bilateral renal artery stenosis and pregnancy

- enhance potential for allergic or hypersensitivity reactions to Allopurinol

- enhance myelosuppressive effect of Azathioprine

Lotensin

benazepril

ACEI

10-80mg QD

Capoten

captopril

ACEI

25-450mg BID/TID (50mg TID)

shortest acting

EMPTY stomach

Vasotec

enalapril

ACEI

5-40mg QD

only ACEI that comes in IV form (enalaprilat IV Q6h)

oral solution - Epaned

Monopril

fosinopril

ACEI

10-80mg QD

safest in renal impairment

Zestril, Prinivil, Qbrelis

lisinopril

ACEI

10-80mg QD

Qbrelis - oral solution

Zestoretic, Prinzide

lisinopril with HCTZ

ACEI

Univasc

moexipril

ACEI

7.5-30mg QD

Empty stomach

Aceon

perindopril

ACEI

4-16mg QD

Accupril

quinapril

ACEI

10-80mg QD/BID

Altace

ramipril

ACEI

2.5-20mg QD caps

only ACEI that comes in capsules

Mavik

trandolapril

ACEI

1-2mg-8mg QD

ARB (angiotensin-2 receptor blockers)

do not use in pregnancy

does not affect bradykinin (less cough)

can be used if patient has cough with ACEI

Atacand

candesartan

ARB

8-32mg QD

Teveten

eprosartan

ARB

400-800mg QD

Avapro

irbesartan

ARB

150-300mg QD

Avalide - irbesartan + HCTZ

Cozaar

losartan

ARB

25-100mg QD

Hyzaar

losartan with HCTZ

ARB

Diovan

valsartan

ARB

80-320mg QD

Diovan HCT

valsartan with HCTZ

ARB

Benicar

olmesartan

ARB

20-40mg QD

Micardis

telmisartan

ARB

20-80mg QD

Edarbi

azilsartan

ARB

80mg QD

- protect from light and moisture

- original container has a desiccant

Beta blockers

indicated for post-MI, angina, tachycardia, stable HF, migraine

- C/I - AV block, bradycardia (negative chronotropic effects), asthma/COPD, Raynaud's phenomenon, cold extremities

- s/e - dyslipidemia, weight gain, fluid retention, fatigue, depression, decrease libido, dizziness (take with food), orthostasis, mask hypoglycemia

- negative inotropic

- take QHS

- bronchospasm

- glucose intolerance/hypoglycemia

- hyperkalemia (non-selective BB)

ISA - "APP" - Acebutolol, Pindolol, Penbutolol

Renal - "BreNALS" - Bisoprolol, Nadolol, Atenolol, Labetalol, Sotalol

IV BB - "MAPLES" - Metoprolol, Atenolol, Propranolol, Labetalol, Esmolol, Sotalol

B1 selective (cardioselective)- "AMEBBBA" - Atenolol, Metoprolol, Esmolol, Bisoprolol, Betaxolol, Bystolic (Nebivolol), Acebutolol

Normodyne, Trandate

labetalol

BB (with alpha-1 blocker [vasodilation])

take with food

safe to use in pregnancy

PO 800mg BID (2400mg/d)

IV

renal excretion

Bystolic

nebivolol

BB

increases nitric oxide (vasodilation)

5-40mg QD

Tenormin

atenolol

BB

PO 25-50 mg QD (100mg QD)

renal excretion - separate orange, apple, grapefruit, green tea by 4 hrs

Tenoretic - atenolol + chlorthalidone

Coreg, Coreg CR

carvedilol

BB (alpha 1 - beta 1 activity)

take with FOOD

HF - 3.125mg BID

HTN - 6.25mg BID

Coreg 3.125mg BID = Coreg CR 10mg QD

Cartrol

carteolol

BB

ophthalmic only

Ocupress - gluacoma

Brevibloc

esmolol

BB

IV only - hypertension emergency

Inderal LA, Innopran XL

propranolol

BB

IR - BID empty stomach

ER - QD with or without food

(caps may be opened and sprinkled)

IV - 1-3mg/dose

Hemangeol oral solution for - infantile hemangiomas

CYP2D6 and 1A2 substrates

Lopressor

metoprolol tartrate

BB

IR - take with FOOD, BID

25-200mg

Zebeta

bisoprolol

BB

HTN 2.5mg QD (max 20mg)

HF 1.25mg QD (max 10mg)

ZIAC - bisoprolol + HCTZ

renal excretion (50%)

Corgard

nadolol

BB

40-320 mg QD

Renal excretion

Toprol XL

metoprolol succinate

BB

can be split in half but not chew

QD

For HF - start at 12.5mg, increase to target 200mg/day

Sectral

acebutolol

BB

4000-1200 mg/d - BID

DILE + ANA (antinuclear Ab)

Kerlone

betaxolol

BB

5-20mg QD

ophthalmic - Betoptic-S

Betapace, Sorine, Sotylize (oral solution)

sotalol

BB

AF/flutter (symptomatic)

- IV 75mg over 5 hrs BID

- PO 80mg BID

Ventricular arrhythmias

Baseline QTc interval and CrCl

Adjust dose if CrCl ≤60 ml/min

CCBs

hypotension (HA, dizziness)

flushing

constipation

bilateral edema

gingival hyperplasia

rash, itching, photosensitivity

non-DHP - more bradycardia

- C/I with BB, AV block

- effective for arrhythmias

- preferred if CKD and diabetic nephropathy

- gingival hyperplasia, constipation

DHP - more reflex tachycardia (vasodilation)

- C/I if acute MI

- ineffective for arrhythmias

- HA, flushing, edema

Calan SR, Veralan, Veralan PM, Isoptin, Covera

verapamil

non-DHP CCB (more on heart than periphery)

PO and IV (for ventricular rate control)

inhibitor and substrate of 3A4

less edema but most constipation

Calan SR - with food

Verelan - caps may be opened and sprinkled

Cardizem, Tiazac, Taztia XT, Dilt-XR, Matzim LA

diltiazem

non-DHP CCB (more on heart than periphery)

PO and IV (for ventricular rate control)

inhibitor and substrate of 3A4

IR (Cardizem) - before meals and QHS

Dilt-XR - EMPTY stomach

Tiazac - caps may be opened and sprinkled

Norvasc

amlodipine

DHP-CCB

2.5-10mg/d QD

safest choice CCB in HF

Katerzia - oral susp

substrate of CYP3A4/weak inhibitor of CYP3A4

Lotrel - amlodipine + benazepril

Exforge - amlodipine + valsartan

Azor - amlodipine + olmesartan

Plendil

felodipine

DHP-CCB

2.5-10mg/d QD

substrate of CYP3A4

ER

don't crush or chew

Procardia, Procardia XL, Adalat CC

nifedipine

DHP-CCB

substrate of CYP3A4 - avoid grapefruit juice

IR - 10-30mg TID

ER - 60-120mg QD

EMPTY stomach

Angina and Raynaud's

do not use IR for HTN - use ER

avoid sublingual administration

Cardene

nicardipine

DHP-CCB

PO - 60-120mg/d TID

IV - HTN emergency, infusion 5mg/hr

max 15mg/hr

IV onset 15min

- duration 4-6hrs

Nymalize

nimodipine

DHP-CCB

oral administration only (oral solution 60mg/20ml)

subarachnoid hemorrhage

60mg Q4h for 21 consecutive days

DynaCirc

isradipine

DHP-CCB

5-20mg/d QD/BID

Sular

nisoldipine

DHP-CCB

8.5-60mg/d QD (ER)

EMPTY stomach

Cleviprex

clevidipine

DHP-CCB

IV - rapid onset and offset

onset 2-4 min

duration 5-15min

start 1-2mg/hr (4-6 mg/h, max 21mg/hr)

>1000ml not rec per 24 hr due to lipid load

C/I - soy or egg allergy, acute pancreatitis, defective lipid metabolism

milky-appearing lipid emulsion

use within 12 hours of puncturing vial

Central alpha 2-agonists

dry mouth, constipation, sedation, sexual dysfunction, orthostasis, depression, dec concentration, rebound HTN, bradycardia

Catapres, Catapres TTS, Kapvay

clonidine

central alpha 2-agonists

resistant hypertension

off label - opioid withdrawal, anxiety, sleep

0.1, 0.2, 0.3 mg tabs - BID

1 patch Q7 days - overlap when switching from PO, helps with adherence and dysphagia

Kapvay - clonidine ER for ADHD - 0.1mg ER BID

duraclon - pain management (cancer pts with severe intractable pain unresponsive to opioids)

Tenex, Intuniv

guanfacine

central alpha 2-agonists

Tenex - HTN - 1-2mg QHS

Intuniv - ADHD - 1,2,3,4 mg ER tabs (1-7mg QD)

Guanabenz (Wytensin) - 4 and 8mg tabs

Aldomet

methyldopa

central alpha 2-agonists

PO tabs, IV

sedation, drug induced lupus, hepatitis, bone marrow suppression, hemolytic anemia

500mg BID (max 3000mg/d)

sometimes used in pregnancy, preeclampsia

Apresoline

hydralazine

vasodilator

HTN (PO) - 10mg QID for 2-4 days, increase to 50mg QD

20mg/ml inj

lupus-like symptoms

Safe in pregnancy

- HTN emergency (SBP ≥160 or DBP ≥110)

BiDil - isosorbide dinitrate + hydralazine - for HF

reflex tachycardia

Loniten

minoxidil

direct vasodilators

reflex tachycardia

hair growth

40mg QD

Serpasil

reserpine

adrenergic neuron blockers

bradycardia, depression

0.05-0.25mg

Tekturna

aliskiren + HCTZ

Direct Renin Inhibitor

150-300mg QD

s/e similar to ACEI

pregnancy category D

diarrhea

avoid - orange, apple, grapefruit juice or separate by 4 hrs, high FAT

increased levels with cyclosporine and itraconazole (risk X)

Valturna - aliskiren + valsartan

BPH

alpha 1 blockers

5 alpha reductase inhibitors - preg Cat X

herbal - Saw Palmetto

Alpha-1 blockers

1st dose phenomenon hypotension (dec BP upon standing) - dizziness/HA/palpitations due to reflex tachycardia

associated with intraoperative floppy iris syndrome during cataract surgery

retrograde ejaculation

not recommended unless pt has BPH

Minipress

prazosin

alpha 1-blockers

short acting (more CV s/e), only for HTN (not for BPH)

1-20mg BID/TID

Cardura, Cardura XL

doxazosin

alpha 1-blockers

HTN and BPH

HTN - 1mg, max 16mg QD

BPH - 1mg, max 8mg QD

(XL) - BPH - 4mg, max 8mg QD

titrate due to risk for orthostatic hypotension

Hytrin (brand DSC)

terazosin

alpha 1-blockers

HTN and BPH

HTN - 1-20mg QD/BID

BPH - 1mg, max 10mg QD

QHS

titrate due to risk for orthostatic hypotension

Flomax

tamsulosin

alpha 1-blockers

BPH

0.4-0.8mg QD

SULFA

take 30 min after same meal each day

Rapaflo

silodosin

alpha 1-blockers

BPH

8mg QD with food

caps can be opened and sprinkled onto applesauce

C/I if CrCl <30

no need to titrate

Uroxatral

alfuzosin

alpha 1-blockers

BPH

10mg QD

take with same meal each day

CYP3A4 substrate

- C/I with strong CYP3A4 inhibitors"

Caution with CrCl <30

Avodart

dutasteride

5 alpha reductase inhibitor

BPH

males - oral 0.5mg QD alone or in combo with tamsulosin

Jalyn - dutasteride + tamsulosin

Proscar, Propecia

finasteride

5 alpha reductase inhibitor

Proscar - BPH - 5mg

Propecia - male pattern baldness - 1mg

Lotrel

amlodipine + benazepril

Combination for HTN

Tarka

verapamil + trandolapril

Combination for HTN

with food

Prestalia

amlodipine + perindopril

Combination for HTN

Exforge

Amlodipine + Valsartan

Combination for HTN

Twynsta

amlodipine + telmisartan

Combination for HTN

Azor

amlodipine + olmesartan

Combination for HTN

Tribenzor

amlodipine + olmesartan + HCTZ

combination for HTN

Caduet

amlodipine + atorvastatin

Combination for HTN

Consensi

amlodipine + celecoxib

Combination for HTN

Amturnide

amlodipine + aliskiren + HCTZ

combination for HTN

Edarbyclor

Azilsartan + Chlorthalidone

combination for HTN

Tenoretic

atenolol + chlorthalidone

combination for HTN

Ziac

bisoprolol + HCTZ

combination for HTN

Corzide

nadolol + bendroflumethiazide

combination for HTN

Inderide

propranolol + HCTZ

combination for HTN

Accuretic

quinapril + HCTZ

combination for HTN

Avalide

irbesartan + HCTZ

combination for HTN

Aldactazide

spironolactone + HCTZ

combination for HTN