What are the most commonly used medications and treatments for prevalent medical conditions?

Most Commonly Used Medications and Treatments for Prevalent Medical Conditions

The most commonly used medications for prevalent medical conditions include ACE inhibitors, angiotensin receptor blockers, calcium channel blockers, and thiazide diuretics for hypertension; statins for hyperlipidemia; and GLP-1 receptor agonists, SGLT2 inhibitors, and metformin for diabetes mellitus. 1, 2

Cardiovascular Medications

Hypertension Management

Hypertension is one of the most common medical conditions requiring pharmacological treatment. The primary medication classes include:

1. ACE Inhibitors (ACEIs)

   • First-line therapy for patients with diabetes, coronary artery disease, or kidney disease
   • Benefits: Reduce albuminuria, slow CKD progression, cardioprotective
   • Side effects: Dry cough (5-10%), hyperkalemia
   • Examples: lisinopril, enalapril 1, 2

2. Angiotensin Receptor Blockers (ARBs)

   • Alternative to ACEIs when cough develops
   • Benefits: Similar to ACEIs but without cough side effect
   • Side effects: Hyperkalemia
   • Examples: valsartan, losartan 1

3. Calcium Channel Blockers (CCBs)

   • Dihydropyridine CCBs (amlodipine) - common first-line agent
   • Side effects: Peripheral edema, especially in women
   • Non-dihydropyridine CCBs should not be combined with beta-blockers due to risk of bradycardia 1

4. Thiazide and Thiazide-like Diuretics

   • First-line agents for hypertension
   • Long-acting agents (chlorthalidone, indapamide) preferred
   • Side effects: Hyponatremia, hypokalemia, hyperuricemia
   • Monitor: Electrolytes, uric acid, calcium 1

5. Beta-Blockers

   • Benefits in ischemic heart disease, heart failure with reduced ejection fraction
   • Must be tapered rather than stopped abruptly
   • Examples: metoprolol, carvedilol 1

6. Mineralocorticoid Receptor Antagonists (MRAs)

   • Used for resistant hypertension
   • Examples: spironolactone, eplerenone
   • Side effects: Hyperkalemia; spironolactone may cause sexual dysfunction 1

Hyperlipidemia Treatment

1. Statins

   • First-line therapy for hyperlipidemia
   • Reduces risk of heart attack, stroke, and cardiovascular death
   • Examples: atorvastatin, rosuvastatin
   • Side effects: Muscle pain/weakness, liver enzyme elevations 3

2. Other Lipid-Lowering Agents

   • Ezetimibe, PCSK9 inhibitors, fibrates, bile acid sequestrants
   • Used as add-on therapy or in statin-intolerant patients

Diabetes Medications

1. Metformin

   • First-line therapy for type 2 diabetes
   • Benefits: Weight neutral or modest weight loss, no hypoglycemia risk
   • Contraindicated if eGFR <30 mL/min/1.73 m² due to lactic acidosis risk 1

2. GLP-1 Receptor Agonists

   • Significant weight reduction and cardiovascular benefits
   • Examples: semaglutide, liraglutide, tirzepatide (dual GIP/GLP-1)
   • Side effects: Primarily gastrointestinal, usually transient 1

3. SGLT2 Inhibitors

   • Cardiovascular and kidney benefits
   • Side effects: Genital mycotic infections
   • Contraindicated in dialysis patients 1

4. DPP-4 Inhibitors

   • Weight neutral, low hypoglycemia risk
   • Requires dose adjustment in kidney disease (except linagliptin)
   • Possible increased heart failure hospitalization risk with saxagliptin and alogliptin 1

5. Insulin

   • Multiple formulations (basal, bolus, premixed)
   • Risk of hypoglycemia and weight gain 1

Antibiotic Treatments

1. Amoxicillin/Clavulanate

   • Broad-spectrum antibiotic for respiratory, skin, and urinary tract infections
   • Dosing: 875/125 mg every 12 hours as effective as 500/125 mg every 8 hours 4
   • Side effects: Diarrhea, less common with 12-hour dosing 4

2. Amoxicillin

   • First-line for streptococcal pharyngitis
   • Once-daily dosing effective and improves compliance 5
   • Low cost compared to newer antibiotics 5

3. Ceftriaxone

   • Third-generation cephalosporin with once-daily dosing
   • Broad spectrum against gram-positive and gram-negative bacteria
   • Effective for complicated infections including meningitis 6

Anti-inflammatory and Immunosuppressive Medications

1. Corticosteroids (Glucocorticoids)

   • Used for inflammatory conditions, autoimmune disorders
   • Dosing ranges from low-medium (0.1-0.5 mg/kg/day) to high-dose pulse therapy (1-10 mg/kg)
   • Side effects: Electrolyte imbalance, metabolic effects, increased infection risk 1

2. Disease-Modifying Antirheumatic Drugs (DMARDs)

   • Conventional DMARDs:

     • Methotrexate: Used for rheumatoid arthritis, psoriasis
     • Azathioprine: Used for autoimmune conditions, organ transplant
     • Side effects: Myelosuppression, hepatotoxicity, pneumonitis 1

   • Biological DMARDs:

     • Rituximab: Anti-CD20 monoclonal antibody for B-cell depletion
     • Used for severe autoimmune conditions, B-cell lymphoproliferative disorders
     • Improves various manifestations in 75-90% of cases 1

Important Clinical Considerations

1. Drug Combinations to Avoid:

   • ACE inhibitors with ARBs (increased hyperkalemia risk) 1
   • Beta-blockers with non-dihydropyridine CCBs (bradycardia risk) 1

2. Monitoring Requirements:

   • ACE inhibitors/ARBs/diuretics: Monitor serum creatinine and potassium within 7-14 days of initiation and at least annually 1
   • Statins: Monitor liver enzymes and assess for muscle symptoms 3
   • Metformin: Monitor kidney function 1

3. Special Populations:

   • Elderly: Higher plasma concentrations of many drugs (e.g., statins ~40% higher) 3
   • Renal Impairment: Dose adjustments needed for many medications
   • Hepatic Impairment: Markedly increased drug concentrations (e.g., statins 4-16 fold higher in Child-Pugh A/B) 3

4. Drug Interactions:

   • Statins with certain antibiotics (clarithromycin) or antifungals (itraconazole) significantly increase statin levels 3
   • Grapefruit juice can increase levels of many medications including statins 3

Remember that medication selection should always consider individual patient factors including comorbidities, potential drug interactions, and risk factors for adverse effects.