Drug
|
Principal Site of
Action
|
Initial Dose
|
Target Dose
|
Adverse effects
|
Drug Interactions
|
| Direct
Vasodilators Hydralazine
|
Arteriolar
vasodilator, afterload reduction |
10-25
mg tid |
75 mg
tid |
headache,
palpitations, postural hypotension, nausea,
vomiting, increase in heart rate, myocardial
ischemia, fluid retention |
other
vasodilators (increase risk of hypotension) |
| Nitrates Isosorbide dinitrate
(Isordil)
|
venous
vasodilator, preload reduction |
10 mg
tid |
40 mg
tid |
headache,
dizziness, flushing, postural hypotension |
other
vasodilators (increase risk of hypotension) |
| Ace
Inhibitors Captopril
(Capoten)
|
mixed vasodilators, afterload and
preload reduction |
6.25-12.5
mg q 8 hr |
50 mg
q 8 hr |
hypotension, dizziness, hyperkalemia,
cough, increased serum Cr, maculopapular rash,
leukopenia, proteinuria |
K+ sparing diuretics, K+ supplements,
lithium, digoxin, aspirin/NSAIDs, other
vasodilators |
| Enalapril
(Vasotec) |
2.5
mg q 12 hr |
10 mg
q 12 hr |
| Lisinopril
(Prinivil, Zestril) |
5 mg
q 24 hr |
20 mg
q 24 hr |
| Quinapril
(Accupril) |
5 mg
q 12 hr |
20 mg
q 12 hr |
| Ramipril
(Altace) |
1.25-2.5
mg q 12 hr |
5-10
mg q 12 hr |
| Digitalis
Glycosides Digoxin
(Lanoxin)
|
Na+/K+
ATPase positive inotropic effect |
0.125-0.25
mg qd loading doses vary |
0.125-0.5
mg qd |
cardiac
arrhythmias, altered mental status, visual
disturbances, anorexia, nausea, vomiting,
diarrhea |
cholestyramine,
antacids, erythromycin, tetracycline, quinidine,
verapamil, amiodarone |
| Thiazides Hydrochlorothiazide
|
distal
convoluted tubules |
12.5
mg q 24 hr |
as
needed |
hypokalemia,
hyponatremia, metabolic acidosis, dehydration,
hypomagnesemia, azotemia, hyperlipoproteinema,
hyperglycemia |
NSAIDs,
loop diuretics, lithium |
| Loop
Diuretics Furosemide
(Lasix)
|
thick ascending limb of Henle, distal
convoluted tubules |
20-40
mg q 24 hr |
as
needed |
same as thiazides, with hypocalcemia and
deafness |
thiazides or metolazone, digoxin,
NSAIDs, lithium |
| Bumtanide
(Bumex) |
0.5-1.0
mg q 12-24 hr |
as
needed |
| K+
Sparing Diuretics Spironolactone
(Aldactone)
|
distal
convoluted tubule, aldosterone-dependent Na+/K+
exchange sites |
25 mg
q 24 hr |
as
needed |
hyperkalemia,
gynecomastia |
ACE
inhibitors, K+ supplements, digoxin |
| Triamterene |
distal convoluted tubule, Na+/K+/H+
exchange site, non-aldosterone dependent |
50 mg
q 24 hr |
as
needed |
hyperkalemia, azotemia |
ACE inhibitors, K+ supplements |
| Amiloride |
5 mg
q 24 hr |
as
needed |
| Alpha-Beta
Blockers Carvedilol
(Coreg)
|
alpha/beta-adrenergic
receptors |
3.12
mg bid X 2 weeks |
25-50
mg bid as tolerated |
hypotension,
bradycardia, syncope arrhythmia, altered mental
status |
Antidiabetic
agent, Ca channel blockers, clonidine, digoxin,
cimetidine |
| Angiotension
II Antagonists Losartan
(Cozaar)
|
angiotensin
II receptors |
25-50
mg qd |
50 mg
qd |
hypotension,
tachycardia, bradycardia, dizziness, ataxia |
cimetidine,
phenobarbitol |