CCB's

Benzothiaxepines (diltiazem)

Combination

Lotrel-amlodipine plus benazepril

Indication:most potent utilized.Tx.stable angina pectoris(esp. dihydropyridines).mng.angina from coronery art. spasm, atrial tachy, Afib(nondihyd's),type I diabetes, Raynauds, ISH, Inc.risk CAD. Verapamil & Diltizem reduce CV mortality,proteinuria,diabetic neuropathy progression

Reacts/Consids; caution w/HF,2nd/3rd block(unless paced)acute HF,renal/hepatic impairment. Potentiate w/grapefruit,cause LE edema. Avoid recent MI. Cause peripheral edema,h/a,dizziness,flushing, adbominal pain, drowsiness

Diuretics---Thiazide diuretics (HCTZ)

Indication: management of HTN as sole or to enhance effect of another medications 

React/Consids: Caution is severe renal disease(precipitate axotemia), impaired hepatic function. Contra. w/anuria,hepatic coma, precoma, allx, hyersensitivity to class or sulfonamide derived drugs.May cause hypokalemia,hyperuricemia,blood lipids. Occ. urticaria, skin rash, postural HTN, GI distress, loss of appetite,impotence,vertigo. Less effective w/creatinine >/= 1.8

Indications:Mild-to-mod. HTN, edema assoc. w/CHF, HTN assoc. w/hepatic & renal disease incl.nephrotic syndrome, most likely effec creatinine >/=1.8

React/Consids: cause hypokalemia,hyponatremia,low mag, dehydration,postural hypotension, tinnitus,hyperuricemia (causing gout) Incr. sensitivity to sunlight. Those who can't be controlled w/thiazides most likely won't be controlled with furosemide

Indication: K sparing tx of HTN/edema who develope hypokalemia. block effects of serum aldosterone-better reg. na+ and H2O homeostasis, maintaining stable intravascular volume

React/Contra: unnecessary in pt's recieving diuretics fro uncomplicated ess. HTN when have normal diet. Cause nervousness, skin rash, confusion, sunlight sens., confusion, irregular rhythm, SOB, lethargy, weakness. Hyperkalemia risk incr.w/use of ACE/ARB. Caution in renal impairment

Indication: treat fluid retention and HTN. Use in pt's refractory HTN, need for K+ sparing diuretic

Reaction/Consids: may exaberate hyperkalemia, metabolic acidosis, gynecomastia, gout, renal/hepatic impairment. May cause GI issues. DO NOT use K+ supplements, other diuretics. Signs of allergic rx contact medical help: hives, diff. breathing,angioedema, anph. rx. May cause numbness, muscle pain, weakness, uneven heartbeat, drowsiness,restless, lightheadedness,urination pattern change, shallow breathing,stomach pain,low fever,loss of appetite, dark urine, clay colored stools, jaundice

Indications: tx mild-to-mod arterial HTN, may be used in combination w/other antihypertensives, especially thiazide type, Component of core measure in client after ACS.

React/Consids: cause sinus brady, atrioventricular block, hypotension, SOB,depression,dizziness, fatigue,vivid dreams,diarrhea,n/v, incr. trigly, incr. sex dysfunction, pruritis,skin hyperpigmentation,alopecia,xerosis, urticaria. Caution w/ COPD, asthma, PVD. May increase risk of type II diabetes.

Indication: use alone or w/thiazide, in pt. w/comorbidities of HF, MI, left ventricular dysfunction, renal insufficiency,glomerulosclerosis. diabetes w/nephropathy may benefit, may prev. stroke. Core measure after ACS

React/Consid: may exacerbate hyperkalemia, incr. risk of angioedema. Avoid in pregnancy. With aldosterone receptor blocker may cause orthostatic hypotension,sinus tachy, fatique,dizziness,syncope,h/a, hyperkalemia. Renal adjustment is indic. in renal insuff. Do not dose in presence of bilateral renal artery disease.

Indications: use alone or w/other meds. ARB alt. to ACE in pt who develope chronic cough,pay attention to cause of cough, assess etiology r/t worsening HF.

React/Consids: Avoid in pregnancy. May exaberate hyperkalemia, angioedema,renal impairment. cause diarrhea, dyspnea, orthostatic hypotension,syncope,dizziness,insomnia,angioedema, vasculitis,hyerkalemia,incr. LFT,hyperbilirubinemia, decre. HCT/HGB.

Indications: use alone or w/other meds. ARB alt. to ACE in pt who develope chronic cough,pay attention to cause of cough, assess etiology r/t worsening HF.

React/Consids: Avoid in pregnancy. May exaberate hyperkalemia, angioedema,renal impairment. cause diarrhea, dyspnea, orthostatic hypotension,syncope,dizziness,insomnia,angioedema, vasculitis,hyerkalemia,incr. LFT,hyperbilirubinemia, decre. HCT/HGB.

Indications: w/comorbidities of BPH, prostatism, dyslipidemia. Alone/in combination w/diuretics, beta-adrenergic blocking agents, calcium channel blockers, ACEI's.

React/Consids: not as first line or solo, higher rate of stoke, HF, (ALLHAT). Alters lipids metabolism by decreasing LDL-C.VLDL-C. May cause mild sexual dysfunction, dizziness, lightheadedness, h/a, drowsiness, fatique, N/V, peripheral edema, nasal congestion, palpitations.

Indication: effect. lower BP by decr. central sympathetic outflow

React/Consids: cause drowsiness, impotence, dry mouth, incr. respirations, incr. GI motility, miosis, decr. LVRL. Less common effects-depression, Coombs-positive anemia (w/alpha-methlydopa).Abrupt withdrawal may lead to rebound HTN.

Indications: good for HTN in pregnancy. Injectable hydralazine used as 1st line in tx. of hypertensive emergencies. direct vasodilator important in tx. of severe HF.

React/Consids: cause peripheral edema, h/a, tachy, angina, hirutism mastlagia, bullous rash. orthostatic hypotension

Combination Drug Therapy

ACE/CCB amlodipine-benazepril (Lotrel) enalapril-felodipine (Lexxel) trandolapril-verapamil (Tarka)

ACE/DIURETICS benazepril-hydrochlorothiazide (Lotensin/HCTZ) Captopril-hydro. (Capozide) enalapril-hydro (Vaseretic) Fosinopril-hydro (monopril/HCTZ) Lisinopril-hydro (Prinizide)

ARB/DIURETICS candesartan-hydro (Atacand HCT) eprosartan-hydro (Teveten HCT) Irbesartan (avalide) losarten-hydro (Hyzaar) olmesartan-medoxomil (Benicar) telmisart-hctz (micardis)

valsartan-hydro (Diovan HCT)

Indications:Not for initial therapy. See compelling indications listed with meds.

React/Consids: see appropriate categories

Indications: as per drug

React/Consids: as per drug

Indication: HTN when normokalemia is essential

React/Consids: see drugs