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Classification			Drug	Dose			Mechanism of Action	Side Effects
				Adult	Pediatric	Renal Dose Adjustment
Antihypertensives	Medications that affect the renin-angiotensin-aldosterone system (RAAS)	ACE Inhibitors (Angiotensin-Converting Enzyme Inhibitors)					ACE inhibitors, or angiotensin-converting enzyme inhibitors, work by blocking the activity of the enzyme angiotensin-converting enzyme (ACE): Inhibition of Angiotensin II Formation: ACE converts angiotensin I to angiotensin II, a potent vasoconstrictor that narrows blood vessels and increases blood pressure. By inhibiting ACE, these drugs reduce the formation of angiotensin II, leading to vasodilation and lower blood pressure. Increase in Bradykinin Levels: ACE also breaks down bradykinin, a peptide that promotes vasodilation. By inhibiting ACE, the levels of bradykinin increase, contributing further to the vasodilatory effect. Reduction of Aldosterone Secretion: Angiotensin II stimulates the adrenal glands to release aldosterone, which promotes sodium and water retention, increasing blood volume and pressure. By reducing angiotensin II levels, ACE inhibitors decrease aldosterone secretion, promoting diuresis (increased urine production) and further lowering blood pressure. Decreased Sympathetic Nervous System Activity: Angiotensin II enhances the release of norepinephrine, a neurotransmitter that increases heart rate and blood pressure. ACE inhibitors reduce this effect, leading to decreased sympathetic activity and further lowering blood pressure. Overall, ACE inhibitors help relax blood vessels, reduce blood volume, and decrease the workload on the heart, making them effective in treating high blood pressure, heart failure, and certain kidney conditions	Common Side Effects: Dry cough: A persistent, dry cough is one of the most well-known side effects. Low blood pressure: This can cause dizziness or lightheadedness. Dizziness: Feeling faint or lightheaded. Headache: Some people may experience headaches. Increased potassium levels: This can lead to muscle weakness or irregular heartbeats. Loss of taste: Some people report a change in their sense of taste. Serious Side Effects: Swelling of the face, lips, tongue, or throat (angioedema): This can be life-threatening and requires immediate medical attention. Kidney problems: ACE inhibitors can sometimes worsen kidney function. Severe dizziness or fainting: This can occur if blood pressure drops too low. Short-term worsening of kidney function: Rarely, ACE inhibitors can cause a temporary decline in kidney function
				Angiotensin II Receptor Blockers (ARBs)	Candesartan	Hypertension: The usual starting dose is 16 mg once daily. May adjust the dose to 8 to 32 mg once daily based on your response and any side effects. Heart Failure: The starting dose is 4 mg once daily. This dose is usually doubled every two weeks, as tolerated, up to a target dose of 32 mg once daily	Children 1 to Less Than 6 Years Old: Initial Dose: 0.2 mg/kg/day orally in 1 to 2 divided doses Maintenance Dose: 0.05 to 0.4 mg/kg/day orally in 1 to 2 divided doses Children 6 to Less Than 17 Years Old: Less than 50 kg: Initial Dose: 4 to 8 mg/day orally in 1 to 2 divided doses Maintenance Dose: 2 to 16 mg/day orally in 1 to 2 divided doses Greater than 50 kg: Initial Dose: 8 to 16 mg/day orally in 1 to 2 divided doses Maintenance Dose: 4 to 32 mg/day orally in 1 to 2 divided doses	Mild Renal Impairment: No dose adjustment is usually necessary Moderate Renal Impairment: It's recommended to initiate therapy at a lower dose Severe Renal Impairment: Candesartan is generally not recommended	Block the action of angiotensin II on its receptors, preventing vasoconstriction and aldosterone release	Common Side Effects: Dizziness: This can occur, especially when standing up quickly Headache: Some people may experience headaches Fatigue: Feeling unusually tired is another common side effect. Stomach issues: Nausea, vomiting, or diarrhea can occur High potassium levels: This can lead to muscle weakness or irregular heartbeats. Swelling: Fluid retention can cause swelling in the legs or other parts of the body. Serious Side Effects: Kidney problems: ARBs can sometimes worsen kidney function. Swelling of the face, lips, tongue, or throat (angioedema): This can be life-threatening and requires immediate medical attention. Severe dizziness or fainting: This can occur if blood pressure drops too low Pregnancy: ARBs are unsafe to take during pregnancy as they can harm the developing baby
				Renin Inhibitors					Directly inhibit renin, preventing the conversion of angiotensinogen to angiotensin I
				Aldosterone Antagonists (aldosterone receptor antagonists or mineralocorticoid receptor antagonists (MRAs)	Eplerenone (Inspra)				Block the action of aldosterone, reducing sodium and water retention	Common Side Effects High potassium levels (hyperkalemia): This can cause symptoms like muscle weakness, fatigue, and irregular heartbeats. Increased creatinine levels: This may indicate kidney function issues. Nausea, vomiting, and diarrhea. Headache and dizziness. Cough and respiratory issues. Serious Side Effects Severe allergic reactions: Symptoms include difficulty breathing, swelling of the face, lips, or throat, and hives. Chest pain or discomfort: This could indicate heart-related issues. Severe dizziness or fainting: This may be a sign of low blood pressure or other serious conditions. Hyperkalemia: Very high potassium levels can be life-threatening and may cause heart rhythm problems
						Finerenone (Kerendia)
						Spironolactone (Aldactone)
			Beta Blockers
			Calcium Channel Blockers
	Antiarrhythmics	Class I: Sodium channel blockers
			Class II: Beta-blockers
			Class III: Potassium channel blockers
			Class IV: Calcium channel blockers


Antihypertensives	Medications that affect the renin-angiotensin-aldosterone system (RAAS)	ACE Inhibitors (Angiotensin-Converting Enzyme Inhibitors)
				Angiotensin II Receptor Blockers (ARBs)
				Renin Inhibitors
				Aldosterone Antagonists (aldosterone receptor antagonists or mineralocorticoid receptor antagonists (MRAs)


			Beta Blockers
			Calcium Channel Blockers
	Antiarrhythmics	Class I: Sodium channel blockers
			Class II: Beta-blockers
			Class III: Potassium channel blockers
			Class IV: Calcium channel blockers

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Important Notes

Antiarrhythmics: Only cardiac Arrhythmia
ACE-Is: Acute coronary syndrome, post-myocardial infarction, heart failure, hypertension.
Antiplatelet agents: Prevention of systemic embolism, Coronary artery diseases, Intermittent claudication, prevention and treatment of ischemic stroke, prophylaxis of venous thromboembolism.
Anticoagulants:
- Oral: Prevention of systemic embolism (A.fib), Coronary artery diseases, prevention of ischemic stroke, prevention and treatment of venous thromboembolism.
- Parenteral: Acute coronary syndrome, prevention, and treatment of venous thromboembolism.
B₁ adrenergic antagonists: Cardiac arrhythmia, coronary artery diseases, heart failure, hypertension
Calcium channel blockers:
- DHP: Acute coronary syndrome, stable angina, hypertension, Raynaud phenomenon
- NDHP: control of heart rate (A.fib), Acute coronary syndrome, stable angina, heart failure, hypertension, Raynaud phenomenon
Diuretics: Heart failure, hypertension
MRAs: Acute coronary syndrome, post-myocardial infarction, heart failure, and hypertension.
Nitrates: Acute Coronary syndrome, Stable angina
Thrombolytics: Acute coronary syndrome, Treatment of ischemic stroke, treatment of venous thromboembolism.

Post category:Cardiovascular Disorders / Cardiovascular Pharmacology / Drug Treatment Of ...
Post published:July 23, 2021
Post comments:0 Comments
Post last modified:February 11, 2025

Tags: ACE Inhibitors, ACE-Is, Beta Blockers, Calcium Channel Blockers, CCB, Clinical Pharmacology, Clinical Pharmacy, Diuretics, Drug Treatment of Cardiovascular Disorders

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