Beta blocker

Metoprolol Bisoprolol Carvedilol

Initial 50 mg/ 12 hours 5 mg/day • CHF: 3,125 mg/ 12hrs

• Hypertension: 6,25 mg/ 12hrs

Maintenance 100mg/ 12 hours 5-10mg/day
• CHF: up to 25 mg/ 12 hrs

But 2,5 mg in liver/ renal ( max. 80mg)

damage • Hypertension: 12,5 mg/ 12hrs

(max.50 mg)

Calcium channel blocker

Amlodipine Diltiazem Verapamil

Starting dose 5 mg/ day • Angina: 30 mg/ 6 hours

• Angina: 80-120 mg/ 8 hours

• Hypertension: 120-240mg/ • Hypertension: 80mg/8 hrs

day
• SVT Arrhythmia: 5-10 mg
• Arrhythmia: 0,25 mg/kg in 2 over 2 min
min

Maintenance dose 5-10 mg/ day • Angina: 180-360 mg ( max. • Angina: 240-480mg/
360)
divided in 3-4 doses

• Hypertension: 240-360mg/ • Hypertension: 80-320 mg /

day( max.540)
in 2 divided doses

• Arrhythmia: 5-15 mg/ day • SVT Arrhythmia: up to 20

mg/ day

Felodipine Initial: 5 mg/day Maintenance: 2,5-10mg/day

Anticoagulants
1) Anticoagulants

Warfarin Acenocoum Apixaban Heparin Enoxaparin

arol

Starting dose 2-5 mg/day 5 mg /day 5000 units IV

Maintenance 2-10 mg/ day

1-10 mg/day 2,5 mg/12hrs if
20,000- 1 mg/kg/ 12hrs
dose INR should be 2-3 • Age > 80
40,000 units SC
• Weight < 60
per 24 hours
• Creatinine >1,5 IV infusion

2) Antiplatelet

• Aspirin: 75-100 mg /day

• Clopidogrel:

A. Initial: 300 mg/ day

B. Maintenance: 75 mg/ day

• Tirofiban
A. Initial: 25 mcg/kg IV within 5 minutes

B. Maintenance: 0.15 mcg/kg/min IV infusion for up to 18 hours