What are the essential medications for an intern to know in general practice for diseases like hypertension, diabetes, asthma, and infections?

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Essential Medications for Interns in General Practice

The most essential medications for interns to memorize in general practice include ACE inhibitors (lisinopril), ARBs (losartan), calcium channel blockers (amlodipine), thiazide diuretics (hydrochlorothiazide), metformin, statins (atorvastatin), and inhaled corticosteroids (budesonide) as these medications directly impact morbidity and mortality across common chronic diseases. 1

Hypertension Medications

First-Line Agents

  • ACE Inhibitors

    • Lisinopril (10-40mg daily) - Reduces mortality in hypertension, heart failure, and post-MI 2
    • Ramipril (2.5-10mg daily)
    • Enalapril (5-40mg daily)
    • Side effects: Dry cough (5-10%), hyperkalemia, angioedema
    • Contraindications: Pregnancy, history of angioedema, bilateral renal artery stenosis 3

  • ARBs (Alternative when ACE inhibitors cause cough)

    • Losartan (25-100mg daily)
    • Valsartan (80-320mg daily)
    • Candesartan (8-32mg daily)
    • Side effects: Hyperkalemia
    • Contraindications: Pregnancy, history of angioedema with ARBs 3

  • Calcium Channel Blockers

    • Amlodipine (2.5-10mg daily) - Most commonly prescribed globally
    • Nifedipine (30-90mg daily, extended-release)
    • Side effects: Peripheral edema (more common in women) 3
    • Caution: Avoid in heart failure with reduced ejection fraction (except amlodipine/felodipine) 3

  • Thiazide/Thiazide-like Diuretics

    • Hydrochlorothiazide (12.5-25mg daily)
    • Chlorthalidone (12.5-25mg daily) - Longer acting than HCTZ
    • Side effects: Hypokalemia, hyperuricemia, hyperglycemia
    • Monitoring: Electrolytes, uric acid, glucose 1

Second-Line/Add-On Agents

  • Beta Blockers

    • Metoprolol succinate (50-200mg daily) - Preferred in heart failure
    • Carvedilol (12.5-50mg twice daily) - Combined alpha/beta effects
    • Caution: Avoid abrupt discontinuation, use with caution in asthmatics 3

  • Aldosterone Antagonists

    • Spironolactone (25-100mg daily) - For resistant hypertension
    • Eplerenone (50-100mg daily) - Less sexual side effects
    • Side effects: Hyperkalemia, gynecomastia (spironolactone)
    • Contraindications: Significant renal dysfunction, concurrent K+ supplements 3

Diabetes Medications

First-Line

  • Metformin
    • Dosing: 500-2000mg daily in divided doses
    • Benefits: Weight neutral/loss, cardiovascular benefits
    • Side effects: GI upset, vitamin B12 deficiency
    • Contraindications: eGFR <30 mL/min, acute illness 4

Second-Line

  • SGLT-2 Inhibitors

    • Empagliflozin (10-25mg daily)
    • Dapagliflozin (5-10mg daily)
    • Benefits: Cardiovascular and renal protection
    • Side effects: Genital mycotic infections, volume depletion 1

  • GLP-1 Receptor Agonists

    • Semaglutide (0.25-1mg weekly SC or 3-14mg daily oral)
    • Dulaglutide (0.75-4.5mg weekly SC)
    • Benefits: Weight loss, cardiovascular benefits
    • Side effects: Nausea, vomiting (usually transient) 1

  • DPP-4 Inhibitors

    • Sitagliptin (100mg daily)
    • Benefits: Weight neutral, low hypoglycemia risk
    • Caution: Potential heart failure risk with saxagliptin 3

  • Sulfonylureas

    • Glipizide (5-20mg daily)
    • Glimepiride (1-8mg daily)
    • Side effects: Hypoglycemia, weight gain 1

Asthma Medications

Controller Medications

  • Inhaled Corticosteroids (ICS)

    • Budesonide (180-720mcg twice daily)
    • Fluticasone (88-440mcg twice daily)
    • Note: Low-moderate doses don't significantly affect glycemic control in diabetics 5

  • Long-Acting Beta Agonists (LABA) - Always with ICS

    • Salmeterol
    • Formoterol

  • Combination ICS/LABA

    • Fluticasone/Salmeterol
    • Budesonide/Formoterol

Rescue Medications

  • Short-Acting Beta Agonists

    • Albuterol (90mcg 2 puffs as needed)
    • Levalbuterol

  • Short-Acting Anticholinergics

    • Ipratropium bromide

Infection Management

Antibiotics

  • Penicillins

    • Amoxicillin (500mg three times daily)
    • Amoxicillin-clavulanate (875/125mg twice daily)

  • Cephalosporins

    • Cephalexin (500mg four times daily)
    • Cefuroxime (500mg twice daily)

  • Macrolides

    • Azithromycin (500mg day 1, then 250mg daily for 4 days)
    • Clarithromycin (500mg twice daily)

  • Fluoroquinolones

    • Ciprofloxacin (500mg twice daily)
    • Levofloxacin (500-750mg daily)
    • Caution: Tendon rupture risk, QT prolongation

Lipid Management

  • Statins
    • Atorvastatin (10-80mg daily)
    • Rosuvastatin (5-40mg daily)
    • Side effects: Myalgias, elevated liver enzymes
    • Monitoring: Baseline LFTs, symptoms of myopathy 1

Key Medication Interactions to Remember

  1. NSAIDs reduce effectiveness of ACE inhibitors, ARBs, and diuretics
  2. Potassium supplements increase hyperkalemia risk with ACE inhibitors, ARBs, and aldosterone antagonists
  3. Beta blockers with non-dihydropyridine CCBs increase bradycardia risk
  4. Metformin with contrast dye requires temporary discontinuation

Monitoring Requirements

  • ACE inhibitors/ARBs: Check renal function and potassium 1-2 weeks after initiation
  • Diuretics: Monitor electrolytes, especially potassium
  • Metformin: Periodic B12 levels, renal function
  • Statins: Baseline LFTs, monitor for muscle symptoms

Special Populations

  • Elderly: Start at lower doses, especially with antihypertensives
  • CKD: Prefer ACE inhibitors/ARBs, adjust metformin dose based on GFR
  • Heart Failure: Use ACE inhibitors, beta blockers (metoprolol succinate, carvedilol), spironolactone
  • Diabetic Hypertension: ACE inhibitors/ARBs as first-line, target BP <130/80 mmHg 3

Remember that medication management should follow a structured approach based on evidence-based guidelines, with careful attention to contraindications, drug interactions, and appropriate monitoring to minimize adverse effects while maximizing benefits for morbidity and mortality outcomes.

References

1
Guideline

Medication Management in General Practice

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

3
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

5
Research

Is there a relationship between asthma and diabetes?

The Journal of asthma : official journal of the Association for the Care of Asthma, 2020

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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