Beta Blockers, Calcium Channel Blockers, and Diuretics

Labetalol

Normodyne; beta blocker; HTN; oral and injectable dosage forms

Carvedilol

Coreg; beta blocker; HTN, HF indication

Nebivolol

Bystolic; beta blocker; HTN

Propranolol

Inderal; beta blocker; HTN, angina, migraine

Atenolol

Tenormin’ beta blocker; HTN, angina

Metoprolol tartrate/succinate

Lopressor/Toprol-XL; beta blocker; HTN, HF; Lopressor available in oral and injectable dosage forms, Toprol-XL availble in extended-release

Diltiazem

Cardizem; non-DHP CCB; HTN, rate ctrl; oral and intravenous formulations

Verapamil

Calan, Verelan; non-DHP CCB; HTN, rate ctrl

Amlodipine

Norvasc; DHP CCB; HTN

Nifedipine

Procardia; DHP CCB

Nicardipine

Cardene IV; DHP CCB; HTN; intravenous formulation for hypertensive crisis

Felodipine

Plendil; DHP CCB; HTN

Nisoldipine

Sular; DHP CCB; HTN

Triamterene/HCTZ

Dyazide, Maxzide; K-Sparing + thiazide; HTN

Furosemide

Lasix; loop diuretic; edema; oral and injectable formulations

Bumetanide

Bumex; loop diuretic; edema; oral and injectable formulations

Torsemide

Demadex; loop diuretic; edema; oral and injectable formulations

Spironolactone

Aldactone; K-sparing + aldosterone ant.; HF

Hydrochlorothiazide

Microzide; thiazide; HTN

Chlorthalidone

Thalitone; thiazide-like; HTN

Mechanism/Therapeutic Rationale

• beta blockers: lower HR & BP

• CCBs: non-DHP (HR-slowing) vs DHP (vasodilation, lowers BP and angina)

• diuretics: “water pills”; lower BP, used for heart failure/edema, increase urine output

Common SEs

• beta blockers: fatigue, bradycardia, masks symptoms of low blood glucose

• non-DHP CCB: bradycardia, heart block

• DHP: peripheral edema

• loops/thiazides: hypokalemia, polyuria

• K-sparing: hyperkalemia

Serious/Black-Box Risks

• abrupt beta-blocker stop → rebound ischemia (chest pain)/MI; severe heart block

• Verapamil/Diltiazem → heart block in combo with other rate slowers (beta-blockers)

• Loops → profound diuresis and dehydration

High-Yield Interactions & Contra-Indications

• beta blockers + non-DHP CCB or digoxin → brady/heart block

• beta blockers mask hypoglycemia in diabetics on insulin

• K-sparing diuretics + ACEi/ARB/NSAID → hyperkalemia

• Absolute CIs: heart block (beta-blockers and non-DHP), anuria (all diuretics), severe asthma (some beta blockers)