Angiotensin Converting Enzyme (ACE) inhibitor

Enalapril

Brand Name: Acetac, Enalapril Stada, Enapril, Invoril, Renitec
Synonyms: Enalaprilat, Enalapril Maleate
Class: Angiotensin Converting Enzyme (ACE) inhibitor
Dose: 2.5-5mg/day oral for adult, children: 0.08 mg/kg up to 5mg once daily
MOA: Competitive inhibitor of angiotensin-converting enzyme(ACE) prevents conversion of angiotensin I to angiotensin ii, a potent vasoconstrictor, results in lower level  of angiotensin ii which cause an increase in plasma rennin activity and a reduction in aldosterone secretion.
Side Effects: Dizziness, headache, fatigue, coughing,hyperkalemia.

Ramipril

Brand Name: Tritace
Class: Angiotensin Converting Enzyme (ACE) inhibitor
Dose: 2.5 mg once daily
MOA: Competitive inhibitor of angiotensin-converting enzyme(ACE) prevents conversion of angiotensin I to angiotensin ii, a potent vasoconstrictor, results in lower level  of angiotensin ii which cause an increase in plasma rennin activity and a reduction in aldosterone secretion.
Side Effects: Nausea, dizziness, & headache, dry cough, hypersensitivity reactions including pruritis, rash and fever.

Captopril

Brand Name: APO-CAPTO, APUZIN, Capoten, Captopril stada, Kimafan
Class: Angiotensin Converting Enzyme(ACE) inhibitor
Dose: Initial dose: 12.5-25mg 2-3 times/day, may increase by increase by 12.5-25mg/dose at 1 to 2 week intervals up to 50mg 3 times/daily, maximum dose 150mg 3 times/day.
MOA: Competitive inhibitor of angiotensin-converting enzyme(ACE) prevents conversion of angiotensin I to angiotensin ii, a potent vasoconstrictor, results in lower level  of angiotensin ii which cause an increase in plasma rennin activity and a reduction in aldosterone secretion.
Side Effects: Rash, pruritis, flushing, angioneurotic edema, taste disturbance, GI irritation,indigestion, dry cough, leucopenia, proteinuria.

Perindopril

Brand Name: Covapril, Coversyl, Coversyl Plus, Perinace
Class: Angiotensin Converting Enzyme(ACE) inhibitot
Dose: 4 mg as single dose, maybe increased to a single 8mg dose.
MOA: Perindopril is a prodrug for perindoprilat which acts as competitive inhibitor of angiotensin-converting enzyme(ACE) prevents conversion of angiotensin I to angiotensin ii, a potent vasoconstrictor, results in lower level  of angiotensin ii which cause an increase in plasma rennin activity and a reduction in aldosterone secretion.
Side Effects: Headache, dizziness, vertigo, paresthesia, vision disturbance, tinnitus, hypotension, cough, dyspnea, GI disorder, rash, pruritus, muscle cramps, asthenia.

Calcium Channel Blocker

Nifedipine

Brand Name: Adalat
Class: Calcium Channel Blocker
Dose: Extended release- 30mg, 60mg, 90mg
MOA: Inhibit calcium ion from entering the slow channel, producing a relaxation of coronary vascular smooth muscle and coronary vasodilation
Side Effects: headache, edema, asthenia, vasodilation, palpitation, constipation, dizziness. Uncommonly, abdominal pain, hypotension, syncope, pruritis, polyuria. Rarely, angina pectoris, gum hyperplasia, abnormal liver function.

Amlodipine

Brand Name: Norvasc
Class: Calcium channel blocker
Dose: 2.5 mg once daily
MOA: Inhibit calcium ion from entering the slow channel, producing a relaxation of coronary vascular smooth muscle and coronary vasodilation
Side Effects: dizziness, flushing, headache, hypotension, peripheral edema, GI disturbance, increased micturation frequency, lethargy, eye pain and mental depression

 

Felodipine

Brand Name: Plendil
Class: Calcium channel blocker
Dose: 2.5-20 mg once daily
MOA: Inhibit calcium ion from entering the slow channel, producing a relaxation of coronary vascular smooth muscle and coronary vasodilation
Side Effects: Flushing, headache, palpitation, dizziness, fatigue, mild gingival enlargement, peripheral edema

Diltiazem

Brand Name: Cardil, Cascor-XL, Herbesser
Class: Calcium channel blocker
Dose: 180-240 mg once daily. Max: 540 mg once daily
MOA: Inhibit calcium ion from entering the slow channel, producing a relaxation of coronary vascular smooth muscle and coronary vasodilation
Side Effects: GI disturbance, headache, ankle edema. Dizziness, tiredness.

Angiotensin II receptor blocker

Telmisartan

Brand Name: Micardis
Class: Angiotensin II receptor blocker
Dose: 40 mg once daily
MOA: Angiotensin ii acts as vasoconstrictor. In addition to cause direct vasoconstriction, angiotensin ii also stimulate the release of aldosterone. Once aldosterone is released, sodium as well as water are reabsorbed. The end result is an elevation in blood pressure.
Side Effects: UTI, upper resp tract infection, anxiety, visual disturbance, vertigo, GI disorder, skin reactions, increased sweating, arthralgia, back pain, leg cramp/pain, myalgia, tendonitis-like symptoms, chest pain, flu-like symptoms.

Losartan

Brand Name: Cozaar
Class: Angiotensin ii receptor blocker
Dose: 50mg once daily
MOA: as a selective and competitive, nonpeptide angiotensin ii receptor antagonist, losartan blocks the vasoconstrictor and aldosterone secreting effects of angiotensin ii
Side Effects: abdominal pain, fatigue, chest pain, edema/swelling, palpitation, tachycardia, hypotension, diarrhea, nausea, back pain, muscle cramps, dizziness, headache, insomnia

Irbesartan

Brand Name: Aprovel
Class: Angiotensin II receptor blocker
Dose: 150mg once daily
MOA: Angiotensin ii acts as vasoconstrictor. In addition to cause direct vasoconstriction, angiotensin ii also stimulate the release of aldosterone. Once aldosterone is released, sodium as well as water are reabsorbed. The end result is an elevation in blood pressure.
Side Effects: dizziness, nausea, vomiting, fatigue, orthostatic hypotension, musculoskeletal pain

Valsartan

Brand: Diovan
Class: Angiotensin ii receptor blocker
Dose: 80 or 160 mg once daily
MOA: Valsartan produce direct antagonism of angiotensin ii receptor. It displace angiotensin ii from AT1 receptor and produce its blood pressure lowering effects by antagonizing AT1 induced vasoconstriction, aldosterone release, water intake and hypertrophic responses.
Side Effects: headache, dizziness, viral infection, neutropenia, upper resp tract infection, hyperkalemia, cough, diarrhea, abdominal back pain, fatigue, edema

Antilipemic

Simvastatin

Brand Name: Zocor, Simvor
Class: Antilipemic agent, HMG-CoA Reductase Inhibitor
Dose: 20mg as sigle evening dose
MOA: Acts by competitively inhibiting 3-hydroxy-3-methyglutaryl coenzyme A (HMG-CoA) reductase, the enzyme that catalyzes the rate limiting step in cholesterol biosynthesis.
Side Effects: GI disturbances, headache, rash, dizziness, blurred vision, dysgeusia,

Pravastatin

Brand Name: Pravachol, Apo-Pravastatin
Class: Antilipemic agent, HMG-CoA Reductase Inhibitor
Dose: Hypercholesterolemia&CHD 10-20 mg once daily at bedtime
MOA: Provastatin is a competitive inhibitor of 3-hydroxy-3-methyglutaryl coenzyme A (HMG-CoA) reductase which is the rate-limiting enzyme involved in de novo cholesterol synthesis.
Side Effects: Headache, altered liver function test, paraesthesia, GI disturbance

Lovastatin

Brand Name: APO-Lovastatin, Altoprev
Class: Antilipemic agent, HMG-CoA Reductase Inhibitor
Dose: Hypercholesterolemia- start with 20 mg/day as the single dose with evening meal. Max dose is 80 mg/day.
MOA: Lovastatin acts by competitively inhibiting 3-hydroxyl-3-mathylglutaryl-coenzyme A (HMG-CoA) reductase, the enzyme that catalyze the rate limiting step in cholesterol biosynthesis
Side Effects: Asthenia, abdominal pain, constipation, diarrhea, dyspepsia, flatulence, nausea, muscle cramps, myalgia, dizziness, headache, skin rash, blurred vision

Atorvastatin

Brand name: Lipitor
Class: Antilipemic agent, HMG-CoA reductase inhibitor
Dose: 10-80 mg once daily
MOA: Inhibitor of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase, the rate-limiting enzyme in cholesterol synthesis(reduce the production of mevalonic acid from HMG-CoA), this then result in a compensatory increase in the expression of LDL receptors on hepatocyte membranes and a stimulation of LDL catabolism.
Side Effects: GI disturbance, headache, myalgia, asthenia, insomnia, angioneurotic edema, muscle cramps, myositis, myopathy, cholestatic jaundice

Beta blocker

Bisoprolol

Name: Bisoprolol Fumarate
Class: Beta Blocker , Beta1 Selective
Dose:   2.5-10 mg once daily
Elderly: Initial dose 2.5 mg/day may be increased by 2.5-5 mg/day
maximum recommended dose 20 mg/day
MOA: Selective inhibitor of beta1-adrenergic receptors, competitively blocks beta1 receptors with little or no effects on beta2 receptors
Side Effects : cardiac failure, bradycardia, hypoglycaemia, fatigue, dyslipidaemia, erectile dysfunction, cold extremities

Atenolol

Class: Beta Blocker , Beta1 Selective
Dose: 25-50 mg once daily, may increase to 100 mg/day.
MOA: Competitively blocks responses to beta-adrenergic stimulation, selectively blocks beta1 receptors with little or no effects on beta2 receptors excepts at high doses.
Side Effects : cardiac failure, bradycardia, hypoglycaemia,, fatigue, dyslipidaemia, erectile dysfunction, cold extremities

Metoprolol

Class: Beta Blocker , Beta1 Selective
Dose:  100-450 mg/day in 2-3 divided dose begin with 50 mg twice daily and increase dose at weekly interval to desired effect.
MOA: Competitively blocks responses to beta-adrenergic stimulation, selectively blocks beta1 receptors with little or no effects on beta2 receptors excepts at high doses. Dose does not exhibit any membrane stabilizing or intrinsic sympathomimetic activity
Side Effects : cardiac failure, bradycardia, hypoglycaemia, fatigue, dyslipidaemia, erectile dysfunction, cold extremities

Labetalol

Class: Beta Blocker  with Alpha Blocking Activity
Dose:  200-400 mg twice daily may require up to 2.4 g/day
MOA:  Blocks alpha-, beta1, and  beta2- adrenergic receptors sites; elevated renin  are reduced.
Side Effects : cardiac failure, bradycardia, hypoglycaemia, fatigue, dyslipidaemia, erectile dysfunction, cold extremities

Carvedilol

Class: Beta Blocker with Alpha Blocking Activity
Dose:  6.25 mg twice daily, maintained for 1-2 weeks then
increased to 12.5 mg twice daily. Dose may be increased to a maximum 25 mg twice daily. Maximum dose 50 mg twice daily               
MOA: A recemic mixture has non-selective beta-adrenoreceptor and alpha-adrenergic blocking activity. No intrinsic sympathomimetic activity have been documented. Associated effect on hypertensive patients include  reduction of cardiac output, xercise-or beta-agonists induced tachycardia, reduction of reflex orthostatic  tachycardia, vasodilation, decreased peripheral vascular resistant.
Side Effects : cardiac failure, bradycardia, hypoglycaemia, fatigue, dyslipidaemia, erectile dysfunction, cold extremities

Alpha Blocker

Terazosin

Brand Name: Hytrin
Class: Alpha  Blocker
Dose:  Initial dose 1 mg at bedtime, slowly increase dose to achieve desired blood pressure up to 20 mg per day, usual dose range: 1-20 mg once daily.
MOA:Competitively inhibits postsynaptic alpha-adrenergic receptors which resultsa in vasodilation of veins and arterioles and a decreased in total peripheral resistance and blood pressure, approximately 50% as potent on a weight by weight basis as prazisin
 Side Effects : Asthenia,Postural hypotension,dizziness,somnolence, impotence, meuromuscular and skeletal weakness, nasal congestion/rhinitis, edema, palpitation, chest pain, peripheral edema, orthostatic hypotension, tachycardia, fatigue, dry mouth, nervousness, drowsiness, urinary incontinence, dyspnea.

Doxazosin

Brand Name: Cardura
Class: Alpha  Blocker
Dose:  1 mg once daily in morning or evening, may be increased to 2 mg once daily. Maximum dose : 16 mg/day
MOA:Competitively inhibits postsynaptic alpha-adrenergic receptors which resultsa in vasodilation of veins and arterioles and a decreased in total peripheral resistance and blood pressure, approximately 50% as potent on a weight by weight basis as prazisin
Side Effects : Postural hypotension,dizziness,headache,impotence, libido decreased, ejaculation disturbances, meuro,uscular and skeletal weakness.

Prazosin

Class: Alpha  Blocker
Dose: initial dose 1 mg/dose 2-3 times/day; usual maintenance dose: 3-15 mg/day in divided doses 2-4 times/day; maximum daily dose: 20 mg  
Hypertension urgency : 10-20 mg once, may repeat in 30 minutes.
MOA: Competitively inhibits postsynaptic alpha-adrenergic reseptors which result in vasodilation of veins and arterioles and a decreased in total peripheral resistance and blood pressure
Side Effects : Orthostatic hypotension,dizziness, palpitation, edema, syncope, headache, drowsiness, vertigo, depression, nervousness, rash, nausea, vomiting, diarrhea, urinary frequency, blurred vision reddened sclera, xerostomia, dyspnea, epistaxis, nasal congestion.

Diuretics

Furosemide

Brand Name: Apo-Furosemide, Lasix, Novo-Semide
Class: Diuretic, Loop
Dose: 20-80 mg/day in 2 divided doses
MOA:Inhibits reabsorption of sodium and chloride in the ascending loop of Henle and distal renal tubule , interfering with the chloride-binding co-transport systems, thus causing of increased excreation of water, sodium, chloride, magnesium, and calcium.
Side Effects :Orthostatic hypotension, thrombophlebitis, dizziness, vertigo, depression, nausea, vomiting, diarrhea.

Spironolactone

Brand Name: Adactone, Novo-Spiroton
Class: Diuretic, Potassium-Sparing, selective Aldosterone Blocker
Dose:  25-50 mg/day up to 100 mg/day
MOA: Competes with aldosterone for receptor sites in the distal renal tubules, increasing sodium chloride and water excretion while conserving potassium and hydrogen ion: may block the effects of aldosterone and arteriolar smooth muscle as well
Side Effects : Edema, headache, fatigue,  mental confusion, drug fever, nausea, vomiting, diarrhea,gynecomastia.

Combination

Methyldopa

Class: Antihypertensive Combination
Dose: No more than methyldopa 3g/day and /or hydrochlorothiazide 50 mg/day.
Methyldopa 250 mg and hydrochlorothizide 15 mg: 2-3 times/day
Methyldopa 250 mg and hydrochlorothizide 25 mg: twice daily
Methyldopa 250 mg and hydrochlorothizide 30 mg: once daily

Losartan & Hydrochlorothiazide

Brand Name : Hyzaar
Class: : Angiotensin II receptor Blocker & Diuretic Thiazide
Dose: Dose is individualized

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