Common Medication Classes and Examples for Key Conditions
Hypertension
For hypertension, initiate treatment with ACE inhibitors, ARBs, thiazide-like diuretics, or dihydropyridine calcium channel blockers—these are the four first-line drug classes proven to reduce cardiovascular events 1, 2, 3.
First-Line Agents:
- ACE Inhibitors: Lisinopril, enalapril, ramipril
- ARBs (Angiotensin Receptor Blockers): Losartan, valsartan, irbesartan
- Thiazide-like Diuretics: Chlorthalidone, indapamide (preferred over hydrochlorothiazide for cardiovascular event reduction) 4, 3
- Dihydropyridine Calcium Channel Blockers: Amlodipine, nifedipine (long-acting only)
Treatment Algorithm:
- Blood pressure 130-150/80-90 mmHg: Start with single agent 3
- Blood pressure ≥150/90 mmHg or ≥160/100 mmHg: Initiate two drugs simultaneously 4, 3
- Combination therapy: Use (ACE inhibitor or ARB) + (calcium channel blocker or thiazide diuretic) 1, 5
- Resistant hypertension (not controlled on 3 drugs including diuretic): Add mineralocorticoid receptor antagonist (spironolactone) 4
Special Populations:
- With diabetes and albuminuria (≥30 mg/g): ACE inhibitor or ARB mandatory 6, 2, 3
- With coronary artery disease: ACE inhibitor or ARB preferred 7, 4, 3
- Post-myocardial infarction: Beta-blocker + ACE inhibitor 7
- Older patients (≥60 years): Beta-blockers NOT first-line for uncomplicated hypertension 7
Type 2 Diabetes
Metformin is the foundational first-line agent for type 2 diabetes, with additional agents selected based on cardiovascular and renal comorbidities 8.
Medication Classes:
- Biguanides: Metformin (first-line)
- Sulfonylureas: Glipizide, glyburide, glimepiride (risk of hypoglycemia) 9
- SGLT2 Inhibitors: Empagliflozin, dapagliflozin, canagliflozin (cardiovascular and renal benefits) 2
- GLP-1 Receptor Agonists: Semaglutide, liraglutide, dulaglutide (cardiovascular benefits, weight loss) 2
- DPP-4 Inhibitors: Sitagliptin, linagliptin, saxagliptin
- Thiazolidinediones: Pioglitazone (avoid rosiglitazone)
- Insulin: Multiple formulations (rapid, short, intermediate, long-acting)
Key Considerations:
- With cardiovascular disease or high risk: Add SGLT2 inhibitor or GLP-1 receptor agonist 2
- With chronic kidney disease: SGLT2 inhibitor preferred for renal protection 2
- Hypoglycemia risk: Highest with sulfonylureas and insulin 9
Hyperlipidemia
Statins are the preferred first-line lipid-lowering drugs, with LDL-cholesterol as the primary target 6, 8, 6.
Medication Classes:
- Statins (HMG-CoA Reductase Inhibitors): Atorvastatin, rosuvastatin, simvastatin, pravastatin 6, 8, 6
- Ezetimibe: Cholesterol absorption inhibitor (add-on therapy)
- PCSK9 Inhibitors: Evolocumab, alirocumab (for very high-risk patients or statin intolerance)
- Fibrates: Fenofibrate, gemfibrozil (for severe hypertriglyceridemia ≥5.7 mmol/L) 8
- Omega-3 Fatty Acids: Icosapent ethyl (for elevated triglycerides with cardiovascular disease)
Treatment Targets:
- Very high cardiovascular risk: LDL-C <1.8 mmol/L (70 mg/dL) 8
- High cardiovascular risk: LDL-C <2.6 mmol/L (100 mg/dL) 8
- Alternative target: ≥50% LDL-C reduction from baseline 8
- Severe hypertriglyceridemia (≥5.7 mmol/L): Prioritize triglyceride-lowering drugs first to prevent pancreatitis 8
Diabetes-Specific Considerations:
Patients with type 2 diabetes are treated as secondary prevention candidates—statins are indicated regardless of baseline LDL-cholesterol if total cholesterol ≥3.5 mmol/L 10. The lipid abnormality pattern in diabetes typically shows elevated triglycerides, low HDL-cholesterol, and small dense LDL particles that are more atherogenic 6.
Pain Management
Acute Pain:
- Non-opioid analgesics: Acetaminophen (paracetamol)
- NSAIDs: Ibuprofen, naproxen, ketorolac, diclofenac
- Opioids: Morphine, oxycodone, hydrocodone, tramadol (use cautiously, short-term only)
Chronic Pain:
- Neuropathic pain agents: Gabapentin, pregabalin, duloxetine, amitriptyline
- Topical agents: Lidocaine patches, capsaicin cream
- Muscle relaxants: Cyclobenzaprine, tizanidine
Critical Caveats:
- NSAIDs in diabetes/hypertension: Use cautiously—can worsen blood pressure control and kidney function
- Opioids: Reserve for severe pain; high addiction potential
- Diabetic neuropathy: Gabapentin, pregabalin, or duloxetine are preferred over opioids
Bacterial Infections
Common Antibiotic Classes:
- Penicillins: Amoxicillin, amoxicillin-clavulanate, ampicillin
- Cephalosporins: Cephalexin (1st gen), cefuroxime (2nd gen), ceftriaxone (3rd gen)
- Macrolides: Azithromycin, clarithromycin, erythromycin
- Fluoroquinolones: Ciprofloxacin, levofloxacin, moxifloxacin
- Tetracyclines: Doxycycline, minocycline
- Sulfonamides: Trimethoprim-sulfamethoxazole
- Carbapenems: Meropenem, imipenem (reserved for severe/resistant infections)
- Glycopeptides: Vancomycin (for MRSA)
Diabetes-Specific Considerations:
Patients with type 2 diabetes have increased susceptibility to infections, particularly urinary tract infections 11, 12. Fluoroquinolones can cause dysglycemia (both hyper- and hypoglycemia). Monitor blood glucose closely when initiating antibiotics 11.
Important Drug-Drug Interactions
Polypharmacy is common when treating these conditions simultaneously—the most frequent drug-related problems involve antidiabetics, antihypertensives, and antibiotics 11.
Key Monitoring Parameters:
- ACE inhibitors/ARBs + diuretics: Monitor serum creatinine and potassium within 7-14 days of initiation or dose change 4, 3
- Statins: Monitor liver function and assess for myopathy symptoms 9
- Metformin: Contraindicated if eGFR <30 mL/min/1.73 m²; risk of lactic acidosis 9
- Sulfonylureas + multiple drugs: Increased hypoglycemia risk 11, 9
Contraindications in Pregnancy:
ACE inhibitors, ARBs, mineralocorticoid receptor antagonists, and direct renin inhibitors are absolutely contraindicated in pregnancy—avoid in sexually active individuals of childbearing potential not using reliable contraception 3.