• Thiazide diuretic-mild to moderate HTN, edema
• PO-monitor for electrolyte imbalance (as with all diuretics)
• May cause hypokalemia and increases in blood glucose, cholesterol, triglycerides and uric acid levels. 

Hydrochlorothiazide

(Esidrix, AKA HCT)

• Loop diuretic - HTN, HF, edema, Kidney failure
• PO, IV/IM
• Boxed warning: potent diuretic
• incompatible with NSAIDs and ACEI
• may cause vision changes and if injected rapidly, hearing loss
• pH incompatible with milrinone, diltiazem, Ciprofloxacin, labetolol, etc. (pH <7.0ppts)

Furosemide

(Lasix)

• Potassium sparing diuretic, HTN, HF, Edema, primary aldosteronism (aldosteron receptor antagonist), Hypokalemia
• PO- may cause hyperkalemia, gynecomastia
• dont give with potassium supplements, ACEI or ARBs
• Boxed warning: tumorigenic, not for initial therapy

Spironolactone

(Aldactone)

• Beta 1 blocker- HTN, MI, angina, CHF, certain tachycardias
• PO, IV - may be given as an intraosseus infusion during CPR
• Caution with asthmatics, diabetics and hyperthyroid patients
• Boxed warning: rebound angina/MI 

Metoprolol

(Lopressor, Toprol-XL)

• alpha 1 blocker- HTN, BPH
• PO - severe 1st dose syncope
• May cause edema

Doxazosin 

(Cardura)

• Vasodilator - HTN (severe)
• PO, IV, IM, not used alonge, use with diuretic to control sodium retention and beta blocker to control reflex tachycardia
• May cause lupus erythematosus-like syndrome
• Monitor complete blood counts and antinuclear antibody (ANA) titer
• May cause angina or MI

Hydralazine

(Apresoline)

• Nitrate vasodilator- HTN, acute congestive HF, to induce hypotension- light sensitive; do not use if color changed (should be reddish-brown powder)
• IV infusion after dilution
• Boxed warning; 1 must be diluted before IV infusion; 2: may cause precipitous BP drop, 3. may cause fatal cyanosis. 

Nitroprusside

(Nitropress) 

• ACEI- HTN, HF, diabetic nephropathy
• PO- PRODRUG
• boxed warning: fetotoxic

Benazapril 

(Lotensin)

• ACEI , HTN, HF, if vent dysfunction after MI, diabetic nephropathy. PRODRUG of enalaprilat
• PO, IV (as enalaprilat, anactive metabolite of Enalapril).
• Boxed warning, fetotoxic.

Enalapril 

(Vasotec)

• ACEI- HTN, HF, if vent dysfunction after MI, diabetic nephropathy
• PO, 1 hr before meals
• Boxed warning: fetotoxic

Captopril 

(Capoten)

• ARB=HTN, diabetic nephropathy. Can be used in CHF. 
• PO
• Boxed warning: fetotoxic. 

Irbesartan 

(Avapro)

• ARB-HTN, HF, left ventricular dysfunction after acute MI, diabetic nephropathy
• PO
• Boxed warning, fetotoxic

Valsartan 

(Diovan)

• ARB: HTN, if vent hypertrophy, diabetic nephropathy
• Boxed warning: fetotoxic

Losartan

(Cozaar)

• Dopamine agonist- HTN
• PO, IV (prodrug converted to alpha methyl norepinephrine)
• May cause a positive Coombs test, hemolytic anemia or liver failure; also sedation, dry mouth, constipation, sexual dysfunction and sodium retention.
• Antihypertensive of choice for pregnant women. 

Methyldopa

(Aldomet, Aldopril)

• Alpha 2 agonist - HTN, chronic pain
• PO (tablets, capsules, solutions), epidural injectable (for chronic pain), TD
• Discontinuation syndrome (severe hypertension) alleviated by restarting clonidine. May cause sedation, dry mouth, constipation, sexual dysfunction and sodium retention.
• Boxed warning: epidural not for obstetrics due to risk of hypotension 

Clonidine

(Catapres)

• Peripheral D1 agonist- short term HTN management (up to 48 hours in adults and 4 hours in kids)
• IV infusion

Fenoldopam

(Corlopam)

• HTN combo
• PO

• Losartan + HCT (Hyzaar)
• Propanolol + HCT (Inderide)
• amlodipine + Benazepril (Lotrel)

• nitrate vasodilator - angina or MI, acute HF
• Tolerance controlled by keeping doses 10-12 hours apart
• half life is about 3 minutes (short-acting)
• LOTS of formulations, paste may be mistaken for hand cream and capsules may be broken and waved under the nose
• TD and topical ointment/cream must be applied to non-hairy skin, but NOT on hands or feet
  TD patch has aluminum backing, remove before defribillation to avoid burns, etc.
• Nitrates can oxidize hemoglobin to methemoglobin 

Nitroglycerin 

(Nitro-bid, Nitrostat)

• CCB- angina, HTN
• PO, only-long duration (T1/2 up to 2 days)
• May worsen angina at initiation of therapy, control with nitrate
• CCBs must be individually titrated to correct dose

Amlodipine

(Norvasc)

• CCB-Class IV antiarrythmic, HTN
• PO (HTN), slow IV (antiarrhythmic) PO onset delayed up to 1 week.
• Inhibits p450s. Lots of drugs interactions
• ~5% of patients develop gingival hyperplasia. Severe constipation
• CCBs must be individually titrated to correct dose. 1/3 dose in pateints with severe liver dysfunction. Monitor for liver dysfunction. 

Verapamil

(Covera-HS, Verelan, Isoptin SR, calan)

• CCB- Angina, HTN, Class IV antiarrhythmic
• PO, enteric solutions, IV bolus/Infusion (inject slowly)
• Inhibits P450s
• Oral onset should be within. Short t 1/2 (2-11 hours)
• Incompatible with furosemide. Lots of drug interactions
• 5-20% of pateints develop gingival hyperplasia
• CCBs must be individually titrated to correct dose. 

Diltiazem

(Cardizem, Tiazec)

• Direct Renin Inhibitor - HTN
• PO
• Boxed warning, fetotoxic in 2nd and 3rd trimesters

Aliskiren

(Tekturna)

• Beta Blocker (Mixed beta 1&2 blocker), migraine, HTN, angina, class II antiarrythmic, subaortic hypertrophic stenosis, pheochromocytoma; anxiety, thyrotoxicosis & essential tremor
• PO
• Boxed warning, rebound angina/MI

Propranolol

(Inderal)

• pFOX inhibitor - angin (chronic stabile)
• Not yet FDA approved

Trimetazidine

(Vastarel)

• pFOX inhibitor- angina in combo with anti hypertensive drug
• PO - lots of drugs interactions

Ranolazine 

(Ranexa)

• Synthetic catecholamine (mainly a beta 1 agonist) - acute HF, MI, shock
• IV (dilute prior to use)

Dobutamine

(Dobutrex, Novaplus)

3 PDE - acute HF

IV

Milrinone

(Primacor)

• Natriuretic Peptide - acute HF
• IV

Nesiritide 

(pronestyl, Procanbid)

• Class la anti-arrythmic
• IV/IM, PO
• Boxed warning; prolonged used leads to a positive ANA (antinuclear antibody) test for lupus

Procainamide 

(Pronestyl, Procanbid)

• Local anesthetic, class lb anti arrhythmic
• Topical, epidural
• See anesthetics lecture

Lidocaine

(Xylocaine)

• Antiepileptic drug (AED), class lb anti arrhythmic. Drug of choice to treat digitalis toxicity
• PO, IV (must be given slowly, but within 1 hour or making solution.) IM only as a last resort
• Lots of ADRs- induces P450s

Phenytoin

(Dilantin)

• PO class LC anti arrhythmic
• Bozed warning: proarrhythmic

Flecainide

(Tambocor)

• Class III anti arrhythmic 
• PO, IV
• Lots of individual variation, requires loading dose.
• Lots of ADRs - big boxed warnings section
• Pulmonary fibrosis or hypersensitivity pneumonitis
• Up to 100% of patients get micro-deposits of crystalline material in their corneas

Amiodarone

(Cordarone, nexterone, pacerone)

• Class V anti arrhythmic
• PO, IV/IM
• Cardio toxic at low potassium levels (diuretics cause hypokalemia) Hypokalemia and hypomagnesemia lead to cardiotocixity. 
• Dont take with pGP inhibitor
• 10% of population have GIT bacteria that eat digoxin leading to treatment failure when taken PO.
• If taken with PO antibiotic (e.g tetracycline), GIT bacteria are killed and digoxin toxicity may result. 
• may increase by 20% risk of death in afib patients.

Digoxin

(Lanoxin)

Treat poisoning with digibind

• Class V anti arrhythmic
• IV only, very short half life
• antagonized by methyl xanthines (including coffee)

Adenosine

(adenocard)

• 5% or 25% IV for hypovalemic shock, burns, hypoproteinemia, hyperbilirubinemia.
• Not with midazolam, Vancomycin, or verapamil: may cause pulmonary edema.
• Not with ACEI: increased risk of ACEI ADRs