Clinical Guidelines Quick Review for NAPLEX
First-Line & Second-Line Drug Therapy Summaries for Major Conditions
Hypertension (HTN)
First-Line Therapy: ACE inhibitors (e.g., lisinopril), ARBs (e.g., losartan), thiazide
diuretics (e.g., hydrochlorothiazide), CCBs (e.g., amlodipine).
Second-Line Therapy: Beta-blockers (e.g., metoprolol), aldosterone antagonists (e.g.,
spironolactone), direct renin inhibitors.
Clinical Notes: Use ACEi/ARBs in diabetes with proteinuria. Avoid
ACEi + ARB combination. Black patients: prefer thiazides/CCBs.
Type 2 Diabetes Mellitus (T2DM)
First-Line Therapy: Metformin unless contraindicated.
Second-Line Therapy: GLP-1 receptor agonists (e.g., liraglutide), SGLT2 inhibitors (e.g.,
empagliflozin), DPP-4 inhibitors, sulfonylureas.
Clinical Notes: SGLT2 inhibitors preferred in ASCVD, HF, or CKD.
Avoid sulfonylureas in elderly due to hypoglycemia risk.
Heart Failure (HFrEF)
First-Line Therapy: ACE inhibitors or ARBs, beta-blockers (carvedilol, metoprolol
succinate, bisoprolol), loop diuretics for symptom control.
Second-Line Therapy: Aldosterone antagonists, ARNI (sacubitril/valsartan),
hydralazine/isosorbide (esp. in Black patients).
Clinical Notes: Avoid non-DHP CCBs. Monitor K+ and renal function
with ACEi/ARBs.
Hyperlipidemia
First-Line Therapy: High-intensity statins (e.g., atorvastatin 40–80 mg, rosuvastatin 20–
40 mg) for patients with ASCVD.
First-Line & Second-Line Drug Therapy Summaries for Major Conditions
Hypertension (HTN)
First-Line Therapy: ACE inhibitors (e.g., lisinopril), ARBs (e.g., losartan), thiazide
diuretics (e.g., hydrochlorothiazide), CCBs (e.g., amlodipine).
Second-Line Therapy: Beta-blockers (e.g., metoprolol), aldosterone antagonists (e.g.,
spironolactone), direct renin inhibitors.
Clinical Notes: Use ACEi/ARBs in diabetes with proteinuria. Avoid
ACEi + ARB combination. Black patients: prefer thiazides/CCBs.
Type 2 Diabetes Mellitus (T2DM)
First-Line Therapy: Metformin unless contraindicated.
Second-Line Therapy: GLP-1 receptor agonists (e.g., liraglutide), SGLT2 inhibitors (e.g.,
empagliflozin), DPP-4 inhibitors, sulfonylureas.
Clinical Notes: SGLT2 inhibitors preferred in ASCVD, HF, or CKD.
Avoid sulfonylureas in elderly due to hypoglycemia risk.
Heart Failure (HFrEF)
First-Line Therapy: ACE inhibitors or ARBs, beta-blockers (carvedilol, metoprolol
succinate, bisoprolol), loop diuretics for symptom control.
Second-Line Therapy: Aldosterone antagonists, ARNI (sacubitril/valsartan),
hydralazine/isosorbide (esp. in Black patients).
Clinical Notes: Avoid non-DHP CCBs. Monitor K+ and renal function
with ACEi/ARBs.
Hyperlipidemia
First-Line Therapy: High-intensity statins (e.g., atorvastatin 40–80 mg, rosuvastatin 20–
40 mg) for patients with ASCVD.
