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Drug

Enalapril

Losartan

Monitoring parameters

Contraindication

1. potassium level

1. Pregnancy

2. Scr ( >3mg/dl 30-35% baseline)

2. Angioneurotic edema

3. sign of persistent dry cough (ADR)

3. Hyperkalemia (>5.5 )

4. eGFR 30% 4

4. Bilateral renal artery stenosis

1. potassium level

1. Pregnancy

2. Scr ( >3mg/dl 30-35% baseline)

2. Hyperkalemia

3. cough ( ACEI)

3. Bilateral renal artery stenosis

Alternative drugs if has ADR/CI


Cough - ARB losartan

Cough -

4. eGFR 30% 4
Amlodipine

1. sign of edema

1. Tachyarrhythmia

HF - CCB alpha blocker

2. CYP3A4 substrate ( D/I CYP3A4 inhibitor)

2. Heart failure

CYP3A4 - simvastatin 20mg


metabolic AE CCB, RAAS

3. Headache, tachycardia, flushing, ankle edema (ADR)


Atenolol

HCTZ

Doxazosin

1. Heart rate = bradycardia HR 60

1. Asthma/COPD

2. Blood sugar ()

2. AV block (Grade 2 or 3)

3. lipid profile ( TG HDL)

3. Peripheral artery disease

1. Electrolytes, uric acid

1. Gout

loop diuretics furosemide

2. Lipid, glucose

2. Metabolic syndrome

CrCl <30 ml/min

3. Crcl <30 ml/min

3. Pregnancy

Hypokalemia- moduretic

4. Hypercalcemia, Hypokalemia

Moduretic (HCTZ+Amiloride)

1. Heart failure

HF - CCB alpha blocker

1. Serum creatinine

1. Scr >=1.5 >=1.4

SU, TZD, DPP-4 inhibitor

2. lactic acidosis (muscle pain, weakness, dizzy, tired)

2. Hepatic impair lactate

3. N/V, diarrhea (ADR)

3. CHF

1. orthostatic hypotension
2. syncope, dizziness, palpitation (ADR)

Metformin

4. lactic acidosis
hypoxia
Glibenclamide 1. Blood sugar
2. weight gain, hypoglycemia

1. allergy to sulfa
2. Pregnancy
3. GFR < 30ml/min

Pioglitazone

1. volume overload/edema/ weight gain

1. CHF class 3 and 4

2. liver function ALT

2. ALT >3 times of UNL

3. increase risk of fracture and osteoporosis


Insulin

1. Blood sugar

1. Allergy to insulin (rare)

glipizide (GFR < 30ml/min)