Medications · Reference
Inpatient medications
A quick-reference table of the drug classes interns prescribe most often on the ward — doses, brand names, renal adjustments, and bedside tips.
Updated May 2026
Antihypertensives
| Class | Medication (Brand) | Dose |
|---|---|---|
| ACE inhibitor | Lisinopril (Zestril) | 5–20 mg OD |
| Ramipril (Tritace) | 1.25–10 mg OD | |
| Perindopril (Coversyl) | 2–8 mg OD | |
| Captopril (Capoten) | 12.5–50 mg BD or TDS | |
| ARB | Valsartan (Diovan) | 80–160 mg OD |
| Telmisartan (Micardis) | 20–80 mg OD | |
| Candesartan (Atacand) | 8–32 mg OD | |
| CCB (DHP) | Amlodipine (Norvasc, Istin) | 5–10 mg OD |
| Nifedipine LA (Adalat LA) | 30–60 mg OD | |
| Lercanidipine (Lercadip) | 5–20 mg OD | |
| Thiazide-like diuretic | Indapamide (Natrilix) | 1.25–2.5 mg OD |
| Loop diuretic | Furosemide (Lasix) | 20–80 mg PO / IV |
| Aldosterone antagonist | Spironolactone (Aldactone) | 25–100 mg OD |
| Beta blockers (not first-line) | Bisoprolol (Concor) | 2.5–5 mg OD |
| Metoprolol (Lopressor) | 50–100 mg BD | |
| Carvedilol (Dilatrend) | 6.25–25 mg BD | |
| Atenolol (Tenormin) | 25 mg–10 mg/day in 1 or 2 doses | |
| Labetalol (Trandate) | 100–400 mg BD | |
| Central acting agent | Methyldopa (Aldomet) | 250–500 mg BD / TDS |
| Direct vasodilator | Hydralazine (Apresoline) | 100–200 mg/day in 3 to 4 divided doses |
| Combination | Amlodipine + Valsartan (Exforge) | 5/160, 10/160 mg OD |
| Combination | Exforge HCT (+ Hydrochlorothiazide) | 5/160/12.5, 10/160/12.5 mg OD |
| Combination | Amlodipine + Telmisartan (Twynsta) | 40/5, 80/5, 80/10 mg OD |
| Combination | Amlodipine + Perindopril (Coveram) | 5/5, 5/10, 10/10 mg OD |
| Combination | Telmisartan + HCTZ (Micardis Plus) | 80/12.5 mg OD |
| Combination | Valsartan + HCTZ (Co-Diovan) | 80/12.5, 160/25 mg OD |
MOC meds tips
- Start treatment with one of → thiazide-like diuretic, ACEi, ARB, or CCB (beta blockers only if other indications like IHD, tachyarrhythmias)
- Always review K⁺ and renal function before starting combinations with ACEi / ARBs or thiazides
- If BP not controlled, combine → ACEi/ARB + CCB → or CCB + thiazide → avoid ACEi + ARB combo
- Monitor renal function & potassium, especially when using → ACEi, ARBs, spironolactone, methyldopa
- In elderly / CKD / HF:
- Prefer agents with renal dosing clarity
- Avoid excessive diuresis with loop diuretics unless fluid overload
- Beta blockers: not first-line for uncomplicated hypertension per WHO, but valuable in specific conditions (post-MI, HF with reduced EF)
Insulin
| Type | Generic | Brand | Typical use | Onset | Peak | Duration |
|---|---|---|---|---|---|---|
| Rapid-acting | Insulin aspart | NovoRapid | Pre-meal bolus | 10–20 min | 1–3 h | 3–5 h |
| Rapid-acting | Insulin lispro | Humalog | Pre-meal bolus | 15–30 min | 1–2 h | 4–5 h |
| Short-acting | Regular insulin | Actrapid | Correction / pre-meal / IV drip | 30 min | 2–4 h | 6–8 h |
| Intermediate | NPH insulin | Insulatard / Humulin N / Novolin N | BID basal | 60–90 min | 4–6 h | 12–18 h |
| Basal | Insulin glargine | Lantus | OD basal | 60–120 min | No peak | ~24 h |
| Basal (ultra-long) | Insulin glargine U300 | Toujeo | Long-acting basal | 60–120 min | No peak | > 24 h |
| Basal (ultra-long) | Insulin degludec | Tresiba | Ultra-long basal | ~1 h | No peak | ~42 h |
| IV insulin | Regular insulin (IV) | Humulin R | DKA, ICU insulin drip | Immediate | Varies | Short (per infusion) |
| Premixed | Biphasic insulin aspart | NovoMix 30 | Premixed (basal + bolus) | 10–20 min | 1–4 h | Up to 24 h |
MOC meds tips
- Preferred: basal-bolus regimen (long-acting basal + prandial insulin ± correction insulin)
- Type 1 DM: always requires basal insulin, even if NPO
- Target glucose: 7.8–10 mmol/L
- Start insulin if glucose ≥ 10 mmol/L
Oral & non-insulin diabetes medications
| Medication | Inpatient use | Notes |
|---|---|---|
| Metformin | Stop | Risk of lactic acidosis |
| Sulfonylureas | Avoid | High hypoglycemia risk |
| DPP-4 inhibitors | Continue if stable | Low risk, safe in eating patients |
| GLP-1 RAs | Avoid | Nausea, limited benefit inpatient |
| SGLT2 inhibitors | Avoid | Risk of DKA, dehydration |
| Thiazolidinediones | Avoid | Risk of edema, HF |
| Alpha-glucosidase inhibitors | Not used | Ineffective if NPO, limited availability |
Proton pump inhibitors
| Generic | Brand | Route | Dose (PO) | Dose (IV) | Renal adjust |
|---|---|---|---|---|---|
| Omeprazole | Losec, Minisec | PO / IV | 20–40 mg OD | 40 mg IV OD | No |
| Pantoprazole | Proton | PO / IV | 40 mg OD | 40 mg IV OD | No |
| Esomeprazole | Nexium | PO / IV | 20–40 mg OD | 40 mg IV OD | No |
| Dexlansoprazole | Dexilant | PO only | 30–60 mg OD | — | No |
MOC meds tips
- NPO or IV needed: pantoprazole or omeprazole — both available IV; pantoprazole preferred for fewer interactions
- GI bleeding: esomeprazole or pantoprazole IV — both supported in bleeding protocols
- Critically ill (ICU): pantoprazole IV — preferred for stress ulcer prophylaxis
- Clopidogrel / polypharmacy: pantoprazole — minimal CYP450 interaction
- Once-daily, potent oral PPI: esomeprazole or Dexilant — excellent oral absorption; Dexilant has dual-release action
Avoid unnecessary PPI use in low-risk inpatients. IV PPI is not needed if the patient is tolerating PO. Dexilant is PO-only and usually reserved for outpatient or resistant reflux cases.
Lipid-lowering medications
| Class | Generic | Brand | Common dose | Renal adjust |
|---|---|---|---|---|
| Statin | Atorvastatin | Lipitor | 10–80 mg daily | No |
| Statin | Simvastatin | Zocor | 10–40 mg at night | Yes — caution if eGFR < 30 |
| Statin | Rosuvastatin | Crestor | 10–40 mg daily | Yes — start at 5 mg if eGFR < 30 |
| PCSK9 inhibitor | Evolocumab | Repatha | 140 mg SC every 2 weeks | No |
| Cholesterol absorption inhibitor | Ezetimibe | Ezetrol | 10 mg daily | No |
| Combination | Atorvastatin + ezetimibe | Atozet | e.g., 40/10 mg daily | No |
MOC meds tips
- Post-ACS or CVA? Start a high-intensity statin: atorvastatin 80 mg or rosuvastatin 20–40 mg unless contraindicated
- Check LFTs at baseline before starting or escalating statin therapy
- Renal dosing matters most with rosuvastatin (start low if eGFR < 30)
- Simvastatin has more drug interactions (avoid high doses with amlodipine or amiodarone)
- Muscle aches? Ask about symptoms, check CK only if concerned for myopathy
- If LDL goals not met with statin, consider adding ezetimibe before escalating to more costly agents
- Repatha (evolocumab) is not typically initiated inpatient — flag for outpatient lipid clinic follow-up
- Always document: indication, target LDL (if available), and plan for follow-up
Anticoagulants & antiplatelets
| Class | Generic | Brand | Common dose | Renal adjust |
|---|---|---|---|---|
| LMWH | Enoxaparin | Clexane | 40 mg SC daily (prophylaxis) or 1 mg/kg SC BID (treatment) | Yes — adjust if eGFR < 30 |
| UFH | Heparin | Heparin | IV infusion (weight-based) or 5,000 units SC BID / TID (prophylaxis) | No |
| Factor Xa inhibitor | Fondaparinux | Arixtra | 2.5 mg SC daily (prophylaxis); treatment dose weight-based | Yes — contraindicated if eGFR < 30 |
| DOAC | Apixaban | Eliquis | 5 mg BID (2.5 mg BID if ≥ 2 of: age ≥ 80, wt ≤ 60 kg, Cr ≥ 1.5) | Yes — dose adjust |
| DOAC | Rivaroxaban | Xarelto | 10–20 mg daily (e.g., 15 mg BID × 3 weeks then 20 mg daily for DVT) | Yes — avoid if eGFR < 15 |
| Antiplatelet | Aspirin | Aspirin | 81–325 mg daily | No |
| Antiplatelet | Clopidogrel | Plavix | 75 mg daily (or 300 mg loading) | No |
MOC meds tips
- Always confirm the indication → treatment vs prophylaxis matters
- Check renal function + weight → especially before Clexane or DOACs
- Write clear orders → avoid “Clexane therapeutic” → write full dose (e.g., 1 mg/kg SC BID)
- DOACs aren’t for everyone → avoid if NPO, vomiting, or severe renal impairment
- Adjust Eliquis if: age ≥ 80, weight ≤ 60 kg, Cr ≥ 1.5
- Avoid unnecessary overlap → don’t mix antiplatelets + anticoagulants unless clearly indicated
- Document the plan → dose, indication, and discharge instructions
Last reviewed · May 2026