A. Commonly used antihypertensive drugs
1.Diuretic drugs
(1) thiazide diuretics: including hydrochlorothiazide, chlorothiazide
Contraindications: gout, hyponatremia is prohibited; pregnancy women should not be used.
(2) Tab diuretics: including furosemide, torasemide, bumetanide, pirotonide.
(3) Aldosterone receptor antagonists: spironolactone
Contraindications: renal failure, hyperkalemia.
(4) Potassium-preserving diuretics Aminoglutethimide, Amiloride
(5) Others Metolazone, indapamide, trapamide
Adverse effects: Acid-base and water-electrolyte disorders, abnormal glucose tolerance, dyslipidemia, gastrointestinal reactions, elevated uric acid, upright hypotension may occur with diuretics. Electrolyte changes must be monitored during drug administration.
2.β-blockers
Propranolol Metoprolol, Atenolol, Betaxolol Bisoprolol, Carveolol Labetalol
Contraindications: Contraindicated in acute heart failure, bronchial asthma, sick sinus node syndrome, 2nd-3rd degree AV block, peripheral vascular disease.
Adverse effects: Bradycardia, weakness, chills in the extremities. Long-term drug users are not easy to suddenly stop the drug easy to 1-2 weeks to gradually reduce the amount of drug discontinuation, food can be less drug absorption easy to take the drug before meals.
Betalactam.
Adverse reactions.
(1) Cardiovascular system: slowed heart rate, conduction block, reduced blood pressure, increased heart failure, cold extremities or impalpable pulse due to peripheral vasospasm, Raynaud’s phenomenon
(2) Because of the lipid solubility and easier penetration into the central nervous system, there are more adverse reactions in this system. Fatigue and vertigo account for 10%, depression accounts for 5%, other headache, dreaminess, insomnia, etc.. Hallucinations are occasionally seen.
(3) Digestive system: nausea, stomach pain, constipation 1%, diarrhea accounted for 5%, but not serious, rarely affect the use of drugs.
(4) Other: shortness of breath, arthralgia, pruritus, retroperitoneal fibrosis, deafness, eye pain, etc.
3.Calcium channel blockers (CCB, calcium antagonists)
Nifedipine , nifedipine controlled-release tablets, nicardipine, nifedipine, felodipine extended-release, amlodipine, lacidipine, lercanidipine, verapamil extended-release, diltiazem extended-release
Contraindications: Contraindicated in severe congestive heart failure, 2nd-3rd degree AV block.
Adverse reactions.
Causes increased heart rate, facial flushing, headache,, vertigo, lower extremity edema. Non-dihydropyridine is contraindicated in heart failure, sinus node hypofunction, and heart block.
(1) Amlodipine besylate tablets: adverse reactions: headache and edema.
(2) Felodipine extended-release tablets: Adverse reactions: facial flushing, palpitations, dizziness and fatigue, ankle edema, mild gingival enlargement, rash and pruritus may result after administration in patients with gingivitis or periodontitis.
(3) Byxin Tong: Adverse reactions: headache, facial and skin flushing, dryness, tachycardia, palpitations, dizziness and lethargy. Hypotension. Swelling of the lower legs. Gastrointestinal disorders such as nausea, diarrhea in rare cases. Skin reactions such as pruritus, urticaria, rash. Gynecomastia in men is seen in elderly men with long-term use. Gum enlargement may also occur with prolonged use of the drug. May impair the ability to drive and operate machinery.
(4) Nimodipine tablets: adverse reactions: about 11.2% of patients treated with nimodipine for subarachnoid space hemorrhage experienced adverse reactions. The most common adverse reactions include: decrease in blood pressure, the degree of which is related to the drug dose, hepatitis, skin tingling, gastrointestinal bleeding, and thrombocytopenia. Occasionally, transient dizziness, headache, facial flushing, vomiting, gastrointestinal discomfort, etc.
4.Angiotensin converting enzyme inhibitors (ACEI)
Captopril, enalapril, benazepril, lenopril, ramipril, cilazepril, perindopril
Contraindications: Hyperkalemia, pregnancy and bilateral renal artery stenosis, angioedema are contraindicated. Use with caution in blood creatinine above 3 mg.
Adverse effects: dry cough, hypotension, angioneurotic edema, rash, fatigue, headache, abnormal taste, leukopenia, renal impairment, hyperkalemia, hyponatremia may occur. Food can reduce drug absorption easy to take the drug before meals.
(1) Benadryl hydrochloride tablets: adverse reactions: palpitations, erect intolerance symptoms, non-specific gastrointestinal disorders, diarrhea, constipation, nausea, vomiting, abdominal pain, rash, flushing, itching, photosensitivity, hepatitis (mainly cholestatic hepatitis), cholestatic jaundice, dysuria, cough, respiratory syndrome, headache, dizziness, fatigue, etc.
(2) Perindopril tablets: adverse reactions: a, headache, fatigue, vertigo, mood or sleep disturbance, painful cramps; b, postural or non-postural hypotension; c, rash in a few cases; d, stomach pain, anorexia, nausea, abdominal pain, taste disturbance; e, dry cough; f, rarely: angioneurotic edema.
5, Angiotensin II receptor blockers (ARB)
Colesartan, valsartan (Dextran), irbesartan, telmisartan
Contraindications: Hyperkalemia, pregnancy and bilateral renal artery stenosis are contraindicated.
Adverse reactions: less frequent, with elevated blood potassium, headache, dizziness, malaise, and gastrointestinal discomfort.
(1) Valsartan: adverse reactions: headache, dizziness, fatigue, cough
(2) Coxsartan: adverse reactions: allergic reactions: angioedema (including swelling of the larynx and voice box leading to airway obstruction, and/or swelling of the face, lips, pharynx, and/or tongue. Gastrointestinal reactions: hepatitis, abnormal liver function. Hematologic system: anemia. Musculoskeletal system: myalgia. Nervous/psychiatric system: migraine. Respiratory system: cough. Skin: urticaria, itching.
II. Anti-arrhythmic drugs
Anti-arrhythmic drugs are divided into four categories according to the electrophysiological characteristics of drug action.
Class I With membrane stabilizing effect, sodium channel blocking drugs
Class II β-blockers, drugs including propranolol, atenolol, metoprolol, etc.
Class III Prolonged action potential duration drugs, drugs including amiodarone, sotalol, bromelain, ibutilide and dofetilide, etc.
Class IV Calcium channel blocking drugs, including verapamil and diltiazem, etc.
(A) sodium channel blocking drugs
1.Mexilate
Contraindications: severe heart failure, cardiogenic shock, slow arrhythmias and intraventricular block.
Adverse reactions: few and mild. Gastrointestinal reactions, neurological reactions such as vertigo and ataxia may occur at high doses. Intravenous administration may occasionally produce hypotension, bradycardia, conduction block, etc.
2.Propafenone
Contraindications: pregnancy and lactating women, pathological sinus node syndrome, heart failure, atrioventricular block. This drug should not be used in combination with other antiarrhythmic drugs to avoid cardiac depression.
Adverse reactions: gastrointestinal reactions, bradycardia and AV block in a small number of users, may also cause upright hypotension, and QT interval prolongation should be reduced or discontinued.
(B) β-blocking drugs
1.Propranolol
Adverse effects: This drug can cause sinus bradycardia, atrioventricular block, and may induce heart failure and asthma, hypotension, etc. Long-term application has adverse effects on lipid metabolism and glucose metabolism, so it should be used with caution in patients with hyperlipidemia and diabetes. Sudden discontinuation of the drug may produce rebound phenomenon.
2. Amiodarone: prolonging the action potential time course drug.
Contraindications: sinus bradycardia and sinus block; high degree of conduction block; abnormal thyroid function; iodine allergy; pregnancy and lactation.
Adverse reactions: Adverse reactions are dose-related. Common cardiovascular reactions include sinus bradycardia, atrioventricular block and prolonged Q-T interval. Long-term application of this product can be seen in the corneal brown particles deposition, usually asymptomatic; a small number of patients occur hyper- or hypothyroidism and hepatic necrosis; individual patients develop interstitial pneumonia or pulmonary fibrosis.
(C) calcium channel blocking drugs
1.Verapamil
Contraindications: 2-3 degree AV block, cardiac insufficiency, cardiogenic shock patients, etc.
Adverse reactions: dry mouth, nausea, abdominal distension, diarrhea, headache, dizziness, etc. are common. Blood pressure may drop and bradycardia may occur if injected too quickly, and cardiac arrest may occur in severe cases.
III. Anti-heart failure drugs
Cardiac glycosides
Digoxin (digitalis preparation)
Adverse reactions.
1, the most serious and dangerous is the cardiac reactions, about 50% of cases occur in various types of arrhythmias. The most common and earliest is ventricular premature beats, but also duplex and triplex rhythms and tachycardia, and even ventricular fibrillation can occur.
2. Gastrointestinal reactions are the most common early symptoms of cardiac glycosides poisoning: anorexia, nausea, vomiting.
3. Neuropsychiatric symptoms, visual abnormalities are usually the precursors of cardiac glycoside poisoning and can be used as indications for drug discontinuation, lethargy and confusion. 4. Hypokalemia, hypomagnesemia and hypothyroidism are likely to induce digitalis poisoning.
IV. Anti-anginal drugs
(A) nitrate class
1.Nitroglycerin.
(1) in the angina attack sublingual effect within 3 minutes, 5 minutes after the repetition of containing, the maximum dose of 3 times / 15 minutes.
(2) Intravenous drip: the starting dose is 5~10μg/minute, gradually increase according to the condition, the maximum dose can be more than 100μg/minute.
Contraindications: glaucoma, intracranial hemorrhage, cranial hypertension, shock.
Adverse reactions: possible facial and neck skin flushing, throbbing headache, dizziness, bradycardia, dry mouth, nausea, vomiting, postural hypotension (should be administered in sitting or lying position, should immediately adopt a foot-high, head-low lying position to facilitate venous return to increase blood supply). Long-term continuous use of drugs can produce drug resistance.
2.Isosorbide nitrate.
(1) sublingual cardiac pain: 5-10mg each time, repeatable in 5-10 minutes, maximum dose 3 times / 15-30 minutes.
(2) oral: 10-20mg each time, there are affected by diet.
(3) Sustained release: the maximum efficacy is 2-5 hours after taking the drug, and the duration of action can last for more than 8 hours.
(4) Intravenous drip: Aibe, Isoxurugi, Xinkang commonly used intravenous drip dose of 2-7mg/h, average 3.3mg/h. (5) Isosorbide mononitrate: Imodium glutamate commonly used oral dose of 20mg or 40mg, every 8 or 12 hours. Long-acting isoradine (controlled-release agent): commonly used oral dose of 50mg, 1~2 times a day.
Adverse effects: the same as nitroglycerin.
(II) β-blocking drugs
Propranolol.
Adverse reactions: vertigo, confusion (especially in the elderly), depression, unresponsiveness and other central nervous system adverse reactions; dizziness (due to hypotension); slow heart rate (<50 beats/minute); less common are bronchospasm and dyspnea, congestive heart failure.
(iii) Calcium antagonists
Nifedipine.
Adverse effects: headache, facial and skin flushing, dryness, tachycardia, palpitations, dizziness, lethargy. Hypotension. Calf swelling, ankle edema. Gastrointestinal disturbances such as nausea and diarrhea in rare cases. Skin reactions such as pruritus, urticaria, rash. Gynecomastia may be seen in elderly male patients with prolonged use. Gum enlargement may also occur with long-term use. May impair the ability to drive and operate machinery. Excessive doses can cause bradycardia and hypotension. Individuals have numbness of the tongue, dry mouth, sweating, headache, nausea, loss of appetite, etc.
(iv) Other
Quick-acting Heart Relief Pill Indications: Promoting blood circulation, removing blood stasis and relieving pain, increasing coronary blood flow and relieving angina pectoris. It is used for coronary heart disease and angina pectoris of Qi stagnation and blood stasis.
Adverse reactions: minor adverse reactions. There is a clinical report of a case of angina pectoris patients taking 2 capsules of quick-acting heart pills within a short period of time and induced glaucoma attack, considered to be related to the use of dose and time, should be paid attention to.
V. Anti-platelet aggregation drugs, anticoagulants
1.Aspirin
Adverse reactions.
(1) Allergic reactions: skin rash.
(2) Epigastric discomfort, nausea, poor appetite.
(3) Upper gastrointestinal bleeding.
(4) Skin bleeding spots.
(5) Effects on surgery: Aspirin must be discontinued for more than one week for insurance purposes.
2.Clopidogrel
Indications: Patients who have had a recent episode of stroke, myocardial infarction and confirmed peripheral arterial disease. The drug may reduce the occurrence of atherosclerotic events (such as myocardial infarction, stroke and vascular death.)
Adverse reactions: bleeding, leukopenia, thrombocytopenia, abdominal pain, dyspepsia, gastritis, and constipation. The incidence of adverse reactions (effects on liver enzymes and on the number of granulocytes and platelets) is significantly lower than that of ticlopidine hydrochloride.
3, warfarin: coumarin class oral anticoagulant
It is used for the prevention of thromboembolic disease and also reduces the incidence of stroke in patients with atrial fibrillation. INR is stable at 2.0-3.0.
Six, lipid-lowering drugs
1.Simvastatin
Indications: It can inhibit the synthesis of endogenous cholesterol and is a blood ester regulator. Clinically used to treat hypercholesterolemia and coronary heart disease.
Adverse reactions: abdominal pain, constipation, gastrointestinal distension, rarely fatigue and weakness, headache. Rarely, there are allergic reaction syndrome: such as angioneurotic edema, lupus-like syndrome, rheumatic polymyalgia, vasculitis, thrombocytopenia, arthralgia, paresthesia, fever, dyspnea and other symptoms.
2.Fluvastatin
Indications: Primary hypercholesterolemia and primary mixed dyslipidemia not completely controlled by dietary therapy.
3.Atorvastatin
Indications: Patients with primary hypercholesterolemia, including familial hypercholesterolemia (heterozygous) or mixed hyperlipidemia (equivalent to Fredrickson’s classification type IIa and IIb), whose total cholesterol elevation, LDL cholesterol elevation, Apo B elevation and Triglyceride elevation.
Adverse effects: constipation, flatulence, dyspepsia, abdominal pain, anorexia, vomiting, thrombocytopenia, allergic reactions, alopecia, hyperglycemia, hypoglycemia, pancreatitis, headache, dizziness, sensory abnormalities, etc.