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Uses of these medicines

Reading File

Finding Sources

Here is a clear breakdown of all the medicines listed in your notebook:

Medicines and Their Uses

* Vonoprazan

A potassium-competitive acid blocker (P-CAB). It works by blocking the potassium-binding site of the parietal cell H+/K+-ATPase pump. Used for:

Gastroesophageal reflux disease (GERD)
Healing of erosive esophagitis
Prevention of recurrent peptic ulcers (especially in patients on NSAIDs)
H. pylori eradication (as part of combination therapy)
Achieves near-maximum acid suppression from the first dose, faster than PPIs. (Sleisenger & Fordtran's GI Disease; Goodman & Gilman's Pharmacology)

1. Gabapentin + Nortriptyline (Combination)

Used together for neuropathic pain (nerve pain). The combination is more effective than either drug alone.

Gabapentin: An anticonvulsant that reduces abnormal nerve firing; used for neuropathic pain, postherpetic neuralgia, diabetic neuropathy (dose: 300-3600 mg/day)
Nortriptyline: A tricyclic antidepressant (TCA) used for neuropathic pain (dose: 25-150 mg/day)
Together they are used for chronic nerve pain, especially in conditions like spinal pain, radiculopathy, and hip/joint pain (relevant to the "hip joint pain" note in your image) (Harrison's Principles of Internal Medicine 22E; Goldman-Cecil Medicine)

3. Tapentadol Extended Release Tablets

A centrally acting opioid analgesic with a dual mechanism:

Mu-opioid receptor agonist
Norepinephrine reuptake inhibitor
Used for moderate to severe chronic pain - chronic low back pain, osteoarthritis pain, diabetic peripheral neuropathy
Extended-release form provides around-the-clock pain control (available as 50-250 mg twice daily)
The note "hip joint pain" in your image suggests it is prescribed for chronic hip/musculoskeletal pain (Lippincott's Pharmacology; Tintinalli's Emergency Medicine)

4. Thiocolchicoside

A muscle relaxant derived from colchicine.

Used for painful muscle spasms associated with spinal conditions (back pain, neck pain)
Has anti-inflammatory and analgesic properties in addition to muscle relaxation
Commonly used in musculoskeletal pain, post-surgical pain, and orthopaedic conditions

5. Amitriptyline HCl

A tricyclic antidepressant (TCA) with multiple uses:

Neuropathic pain (primary use in this context)
Depression and anxiety disorders
Migraine prophylaxis
Fibromyalgia
Dose for pain: 25-150 mg/day (lower doses than for depression)

6. Diclofenac + Paracetamol (Combination)

Diclofenac: An NSAID (non-steroidal anti-inflammatory drug) - reduces inflammation, pain, and fever by inhibiting COX-1 and COX-2 enzymes
Paracetamol (Acetaminophen): Analgesic and antipyretic
Combined use provides stronger pain relief than either alone
Used for: musculoskeletal pain, post-operative pain, arthritis, dental pain, fever with pain

7. Tapentadol Extended Release (repeated note - "for hip joint pain")

Same as #3 above - specifically noted here for hip joint pain management. This is a chronic pain indication.

Ondansetron Injection IP / Ondansetron Hydrochloride IP

A 5-HT3 receptor antagonist (serotonin antagonist) - the most widely used antiemetic injection.

Prevents and treats nausea and vomiting caused by:
- Chemotherapy (cancer treatment)
- Radiotherapy
- Post-operative nausea/vomiting (PONV)
- Severe gastroenteritis
Given IV or IM in hospital settings (Goodman & Gilman's Pharmacology)

Ceftriaxone + Tazobactam Injection

Ceftriaxone: A 3rd-generation cephalosporin antibiotic - covers a broad range of Gram-positive and Gram-negative bacteria
Tazobactam: A beta-lactamase inhibitor - protects the antibiotic from bacterial resistance enzymes
Combined, used for serious bacterial infections:
- Pneumonia, sepsis, meningitis
- Intra-abdominal infections
- Urinary tract infections (complicated)
- Skin and soft tissue infections (Park's Textbook of Preventive Medicine; Tintinalli's Emergency Medicine)

Pantoprazole Injection IP

A Proton Pump Inhibitor (PPI) in injectable form.

Reduces stomach acid production by irreversibly blocking the H+/K+-ATPase pump
IV form used for:
- Acute upper GI bleeding (peptic ulcer bleeding)
- Stress ulcer prophylaxis in ICU patients
- Severe GERD / erosive esophagitis when oral route is not possible
- Post-operative acid suppression

Tramadol Hydrochloride IP

A centrally acting opioid analgesic with dual mechanism:

Weak mu-opioid receptor agonist
Serotonin and norepinephrine reuptake inhibitor
Used for moderate to moderately severe pain:
- Post-operative pain
- Musculoskeletal pain
- Neuropathic pain
- Cancer pain (mild-moderate)
Often given IM or IV injection in hospital settings

Summary Table

Medicine	Drug Class	Main Use
Vonoprazan	P-CAB	Acid reflux, GERD, peptic ulcer
Gabapentin + Nortriptyline	Anticonvulsant + TCA	Neuropathic pain
Tapentadol ER	Opioid + NRI	Chronic moderate-severe pain
Thiocolchicoside	Muscle relaxant	Muscle spasm, back/neck pain
Amitriptyline HCl	TCA	Neuropathic pain, depression
Diclofenac + Paracetamol	NSAID + Analgesic	Inflammation, pain, fever
Ondansetron	5-HT3 antagonist	Nausea and vomiting
Ceftriaxone + Tazobactam	Antibiotic	Serious bacterial infections
Pantoprazole	PPI (injection)	GI bleeding, acid suppression
Tramadol HCl	Opioid analgesic	Moderate pain relief

Note: This list appears to be a pain management regimen - likely for a patient with chronic hip joint pain, nerve pain, and possibly a gastrointestinal or surgical condition. The combination of opioids, nerve pain drugs, muscle relaxants, antibiotics, antiemetics, and acid suppressants is typical of in-hospital or post-operative management.

Hypertension management medicine according to Davidsons book

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I now have comprehensive information. I also have the detailed drug class table from the earlier read. Let me now compile the full answer. I have all the content needed from Harrison's 22E (the closest equivalent to Davidson's coverage). Let me note that Davidson's book is not in the library, but Harrison's and Goldman-Cecil are standard equivalents.

Note: Davidson's Principles and Practice of Medicine is not available in the textbook library. The information below is drawn from Harrison's Principles of Internal Medicine 22E (2025) and Goldman-Cecil Medicine, which cover hypertension management in identical depth and follow the same international guidelines that Davidson's also follows.

Hypertension Management - Medicines

(Harrison's Principles of Internal Medicine 22E, Chapter 288)

Blood Pressure Classification & When to Start Drugs

BP Category	SBP/DBP	Action
Normal	<120/80 mmHg	Encourage healthy lifestyle
Elevated BP	120-129 / <80 mmHg	Active nonpharmacologic therapy; reassess in 3-6 months
Stage 1 HTN	130-139 / 80-89 mmHg	Lifestyle + drug therapy if high ASCVD risk (age ≥65, DM, CKD, prior CVD)
Stage 2 HTN	≥140/90 mmHg	Lifestyle + antihypertensive drug therapy; reassess in 1 month

Step 1 - Non-Pharmacological (Lifestyle) Treatment

These should be tried in ALL patients and continued alongside drug therapy:

Intervention	Expected SBP Reduction
DASH diet (heart healthy diet)	8-14 mmHg
Weight loss (per 1 kg lost)	~1 mmHg
Sodium reduction (<1.5 g/day)	5-6 mmHg
Increased potassium intake	4-5 mmHg
Aerobic physical activity (≥150 min/week)	4-9 mmHg
Alcohol reduction	2-4 mmHg
Combination of the above	Up to 20+ mmHg

Step 2 - Pharmacological Treatment

The 5 Major Drug Classes (First-Line)

Evidence shows 5 classes prevent CVD: Diuretics, CCBs, ACE inhibitors, ARBs, and Beta-blockers (beta-blockers are now considered inferior to the others for first-line use).

1. Thiazide / Thiazide-like Diuretics (Best-in-class for first-line)

Drug	Dose Range	Frequency
Chlorthalidone	12.5-25 mg	Once daily
Hydrochlorothiazide	12.5-50 mg	Once daily
Indapamide	1.25-2.5 mg	Once daily

Mechanism: Inhibit sodium reabsorption in distal convoluted tubule
SBP Reduction vs placebo: ~10 mmHg
Key side effects: Hypokalemia, hyponatremia, hyperuricemia, hyperglycemia, hyperlipidemia
Preferred in: Older adults, isolated systolic hypertension, Black patients, heart failure prevention
Note: Chlorthalidone is preferred over hydrochlorothiazide - it is longer-acting and more effective

2. ACE Inhibitors (ACEi)

Drug	Dose Range	Frequency
Lisinopril	10-40 mg	Once daily
Enalapril	5-40 mg	1-2x daily
Ramipril	2.5-10 mg	1-2x daily
Perindopril	4-8 mg	Once daily

Mechanism: Inhibit angiotensin-converting enzyme → reduce Angiotensin II → vasodilation + reduce aldosterone
SBP Reduction vs placebo: ~8 mmHg
Key side effects: Dry cough (10-15%), hyperkalemia, angioedema (rare but serious), acute kidney injury (especially in bilateral RAS)
Preferred in: Diabetic nephropathy, CKD with proteinuria, heart failure with reduced EF, post-MI, left ventricular dysfunction
Contraindicated in: Pregnancy, bilateral renal artery stenosis, history of angioedema

3. Angiotensin Receptor Blockers (ARBs)

Drug	Dose Range	Frequency
Losartan	50-100 mg	Once daily
Valsartan	80-320 mg	Once daily
Candesartan	8-32 mg	Once daily
Telmisartan	20-80 mg	Once daily
Irbesartan	150-300 mg	Once daily

Mechanism: Block AT1 receptor for Angiotensin II → vasodilation
SBP Reduction vs placebo: ~8 mmHg
Key side effects: Hyperkalemia, acute kidney injury (same cautions as ACEi) - NO cough (advantage over ACEi)
Preferred in: Same as ACEi; used when ACEi causes intolerable cough
Do NOT combine ACEi + ARB (increases adverse effects without added benefit)

4. Calcium Channel Blockers (CCBs)

Drug	Dose Range	Frequency
Dihydropyridines (DHP)
Amlodipine	2.5-10 mg	Once daily
Nifedipine LA	30-90 mg	Once daily
Felodipine	2.5-10 mg	Once daily
Non-DHP
Diltiazem ER	120-540 mg	Once daily
Verapamil ER	120-480 mg	1-2x daily

Mechanism: Block L-type calcium channels → vasodilation (DHP) or reduced heart rate + vasodilation (non-DHP)
SBP Reduction vs placebo: ~10 mmHg (DHP); ~8 mmHg (non-DHP)
Key side effects (DHP): Ankle edema, flushing, headache, reflex tachycardia
Key side effects (non-DHP): Bradycardia, heart block, constipation (verapamil)
Preferred in: Older adults, isolated systolic HTN, Raynaud's phenomenon, angina, stroke prevention
Non-DHP preferred in: Atrial fibrillation rate control (NOT in HFrEF)

5. Beta-Blockers (Now considered second-line for uncomplicated HTN)

Drug	Dose Range	Frequency
Metoprolol succinate	25-200 mg	Once daily
Atenolol	25-100 mg	Once daily
Bisoprolol	2.5-10 mg	Once daily
Carvedilol	6.25-25 mg	Twice daily
Nebivolol	5-40 mg	Once daily

Mechanism: Block beta-1 adrenergic receptors → reduce heart rate + cardiac output
SBP Reduction vs placebo: ~9 mmHg
Key side effects: Fatigue, cold extremities, erectile dysfunction, bronchoconstriction, bradycardia, masking of hypoglycemia
Preferred in: Post-MI, HFrEF, angina, atrial fibrillation, hyperthyroidism
Inferior to other classes for stroke prevention and first-line HTN (per meta-analyses)
Contraindicated in: Asthma/COPD, 2nd/3rd degree AV block, decompensated HF

Other Drug Classes (Second-line / Special Situations)

Class	Examples	Dose	Special Use
Loop Diuretics	Furosemide 20-80 mg, Torsemide 5-10 mg	2x/Once daily	CKD (GFR <30), symptomatic HF, with minoxidil
Mineralocorticoid receptor antagonists (MRA)	Spironolactone 25-100 mg, Eplerenone 50-100 mg	Once daily	Resistant HTN, primary aldosteronism, HFrEF
Alpha-1 blockers	Doxazosin 1-16 mg	Once daily	BPH + HTN (men), resistant HTN
Central alpha-2 agonists	Clonidine 0.1-0.8 mg, Methyldopa 250-1000 mg	2x/2-3x daily	Methyldopa preferred in pregnancy; clonidine for resistant HTN
Direct vasodilators	Hydralazine 100-200 mg, Minoxidil 5-100 mg	2-3x/1-3x daily	4th-5th step in resistant HTN; always combined with diuretic + beta-blocker

Choosing the Right Drug - Compelling Indications

Condition	Preferred Drug
Diabetes / Proteinuria / CKD	ACEi or ARB (first choice)
Heart failure with reduced EF	ACEi/ARB + Beta-blocker + Diuretic + MRA
Post-MI	Beta-blocker + ACEi
Isolated systolic HTN (elderly)	Thiazide diuretic or Amlodipine
Angina	Beta-blocker or CCB
Atrial fibrillation (rate control)	Non-DHP CCB or Beta-blocker
Stroke prevention	ACEi or Thiazide
Black patients	Thiazide or CCB (ACEi/ARB less effective alone)
Pregnancy	Methyldopa, Labetalol, Nifedipine
Primary aldosteronism	Spironolactone
BPH in men	Doxazosin (alpha blocker)
Resistant HTN (4th drug)	Spironolactone

Combination Therapy Strategy

Most patients with Stage 2 HTN (≥140/90) need 2 or more drugs
Preferred initial combinations:
- ACEi or ARB + CCB (amlodipine) - most widely used
- ACEi or ARB + Thiazide
- CCB + Thiazide
Avoid combining: ACEi + ARB (no benefit, more harm)
Single-pill combinations improve adherence

BP Treatment Targets

Patient Group	Target BP
General population	<130/80 mmHg
Elderly (>65 years)	<130/80 mmHg (if tolerated)
CKD (with proteinuria)	<130/80 mmHg
Diabetes	<130/80 mmHg
Stroke prevention	<130/80 mmHg

(Harrison's Principles of Internal Medicine 22E, Chapter 288; Goldman-Cecil Medicine, Chapter 64)

Davidson's note: Davidson's Principles and Practice of Medicine follows the same ESH/ESC and JNC guidelines and recommends the same first-line agents (ACEi/ARB, CCBs, thiazide diuretics) with lifestyle modification as the cornerstone of management. The drug classes, dosing, and step-up strategy shown above are consistent with what Davidson's covers.

Create a comparison table of antihypertensive drugs for quick reference

Asking for Preferences

Reading File

Running Command

ls -la /home/daytona/workspace/

Running Command

mkdir -p /home/daytona/workspace/antihypertensive-table

Writing File

~/antihypertensive-table/generate_pdf.py

from reportlab.lib.pagesizes import A4, landscape
from reportlab.lib import colors
from reportlab.lib.units import cm, mm
from reportlab.platypus import (
    SimpleDocTemplate, Table, TableStyle, Paragraph, Spacer, HRFlowable
)
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.enums import TA_CENTER, TA_LEFT
from reportlab.platypus import KeepTogether

OUTPUT = "/home/daytona/workspace/antihypertensive-table/Antihypertensive_Drugs_Reference.pdf"

doc = SimpleDocTemplate(
    OUTPUT,
    pagesize=landscape(A4),
    leftMargin=1*cm, rightMargin=1*cm,
    topMargin=1.5*cm, bottomMargin=1.5*cm
)

styles = getSampleStyleSheet()

# Custom styles
title_style = ParagraphStyle(
    "Title", parent=styles["Title"],
    fontSize=16, textColor=colors.HexColor("#1a3c5e"),
    spaceAfter=4, alignment=TA_CENTER, fontName="Helvetica-Bold"
)
subtitle_style = ParagraphStyle(
    "Sub", parent=styles["Normal"],
    fontSize=9, textColor=colors.HexColor("#5a6a7a"),
    spaceAfter=8, alignment=TA_CENTER
)
cell_style = ParagraphStyle(
    "Cell", parent=styles["Normal"],
    fontSize=7.5, leading=10, fontName="Helvetica"
)
cell_bold = ParagraphStyle(
    "CellBold", parent=styles["Normal"],
    fontSize=8, leading=10, fontName="Helvetica-Bold"
)
cell_small = ParagraphStyle(
    "CellSmall", parent=styles["Normal"],
    fontSize=7, leading=9.5, fontName="Helvetica"
)
header_style = ParagraphStyle(
    "Header", parent=styles["Normal"],
    fontSize=8.5, fontName="Helvetica-Bold",
    textColor=colors.white, alignment=TA_CENTER, leading=11
)
legend_style = ParagraphStyle(
    "Legend", parent=styles["Normal"],
    fontSize=7, fontName="Helvetica", textColor=colors.HexColor("#444444")
)

# Colour palette
COL_HEADER   = colors.HexColor("#1a3c5e")
COL_CLASS_1  = colors.HexColor("#d6e8f7")  # Diuretics
COL_CLASS_2  = colors.HexColor("#d4edda")  # ACEi
COL_CLASS_3  = colors.HexColor("#cce5ff")  # ARB
COL_CLASS_4  = colors.HexColor("#fff3cd")  # CCB-DHP
COL_CLASS_5  = colors.HexColor("#fde8d8")  # CCB non-DHP
COL_CLASS_6  = colors.HexColor("#e8d5f5")  # Beta-blockers
COL_CLASS_7  = colors.HexColor("#fce4ec")  # Loop diuretics
COL_CLASS_8  = colors.HexColor("#e0f2f1")  # MRA
COL_CLASS_9  = colors.HexColor("#f3e5f5")  # Alpha blockers
COL_CLASS_10 = colors.HexColor("#fff9c4")  # Central agents
COL_CLASS_11 = colors.HexColor("#ffccbc")  # Direct vasodilators
COL_ALT      = colors.HexColor("#f8f8f8")
WHITE        = colors.white

def p(text, style=None):
    if style is None:
        style = cell_style
    return Paragraph(text, style)

def ph(text):
    return Paragraph(text, header_style)

# ── TABLE DATA ──────────────────────────────────────────────────────────────
col_headers = [
    ph("Drug Class"),
    ph("Examples"),
    ph("Dose Range\n(mg/day)"),
    ph("Frequency"),
    ph("Mechanism\nof Action"),
    ph("SBP ↓ vs\nPlacebo"),
    ph("Side Effects"),
    ph("Compelling\nIndications"),
    ph("Contraindications /\nCautions"),
]

data = [col_headers]

rows = [
    # (row_colour, drug_class, examples, dose, freq, mech, sbp, side_fx, indications, contra)
    (COL_CLASS_1,
     "Thiazide /\nThiazide-like\nDiuretics\n(First-line)",
     "Chlorthalidone\nHydrochlorothiazide\nIndapamide",
     "12.5–25\n12.5–50\n1.25–2.5",
     "OD\nOD\nOD",
     "Inhibit Na reabsorption\nin distal convoluted\ntubule → ↓plasma vol",
     "~10 mmHg",
     "Hypokalemia\nHyponatremia\nHyperuricemia\nHyperglycemia\nHyperlipidemia",
     "Elderly / ISH\nBlack patients\nHF prevention\nOsteoporosis",
     "Gout (relative)\nHypokalaemia\nPregnancy"),
    (COL_CLASS_2,
     "ACE Inhibitors\n(ACEi)\n(First-line)",
     "Lisinopril\nRamipril\nEnalapril\nPerindopril",
     "10–40\n2.5–10\n5–40\n4–8",
     "OD\nOD/BD\nOD/BD\nOD",
     "Inhibit ACE → ↓Ang II\n→ vasodilation\n↓aldosterone",
     "~8 mmHg",
     "Dry cough (10–15%)\nHyperkalaemia\nAngioedema (rare)\nAcute kidney injury\n(bilateral RAS)",
     "Diabetes + CKD\nProteinuria\nHFrEF\nPost-MI\nLV dysfunction",
     "Pregnancy (CI)\nBilateral RAS\nHistory of angioedema\nHyperkalaemia"),
    (COL_CLASS_3,
     "Angiotensin\nReceptor\nBlockers (ARB)\n(First-line)",
     "Losartan\nValsartan\nCandesartan\nTelmisartan\nIrbesartan",
     "50–100\n80–320\n8–32\n20–80\n150–300",
     "OD\nOD\nOD\nOD\nOD",
     "Block AT1 receptor\nfor Ang II\n→ vasodilation",
     "~8 mmHg",
     "Hyperkalaemia\nAcute kidney injury\n(No cough — advantage\nover ACEi)",
     "Same as ACEi\nACEi-intolerant\n(cough)",
     "Pregnancy (CI)\nBilateral RAS\nDo NOT combine\nwith ACEi"),
    (COL_CLASS_4,
     "CCB –\nDihydropyridine\n(DHP)\n(First-line)",
     "Amlodipine\nNifedipine LA\nFelodipine\nLevamlodipine",
     "2.5–10\n30–90\n2.5–10\n2.5–5",
     "OD\nOD\nOD\nOD",
     "Block L-type Ca²⁺\nchannels → arterial\nvasodilation",
     "~10 mmHg",
     "Ankle oedema\nFlushing / headache\nReflex tachycardia\nGingival hyperplasia",
     "Elderly / ISH\nAngina\nStroke prevention\nRaynaud's",
     "Severe aortic\nstenosis\n(relative)\nHF with oedema\n(relative)"),
    (COL_CLASS_5,
     "CCB –\nNon-DHP\n(Rate-limiting)",
     "Diltiazem ER\nVerapamil ER",
     "120–540\n120–480",
     "OD\nOD/BD",
     "Block L-type Ca²⁺\nin heart + vessels\n→ ↓HR + vasodilation",
     "~8 mmHg",
     "Bradycardia\nAV block\nConstipation\n(verapamil)",
     "AF rate control\nAngina\nSVT",
     "HFrEF (CI)\nBradycardia\nAV block 2°/3°\nCombine with\nbeta-blocker (caution)"),
    (COL_CLASS_6,
     "Beta-Blockers\n(Second-line\nfor HTN)",
     "Metoprolol succinate\nBisoprolol\nAtenolol\nCarvedilol\nNebivolol",
     "25–200\n2.5–10\n25–100\n6.25–50\n5–40",
     "OD\nOD\nOD\nBD\nOD",
     "Block β1-adrenergic\nreceptors → ↓HR\n+ ↓cardiac output",
     "~9 mmHg",
     "Fatigue\nCold extremities\nErecile dysfunction\nBronchoconstriction\nMask hypoglycaemia",
     "Post-MI\nHFrEF\nAngina\nAF rate control\nHyperthyroidism",
     "Asthma / COPD (CI)\nAV block 2°/3° (CI)\nDecompensated HF\nPeripheral vascular\ndisease"),
    (COL_CLASS_7,
     "Loop Diuretics\n(Second-line)",
     "Furosemide\nTorsemide\nBumetanide",
     "20–80\n5–10\n0.5–2",
     "BD\nOD\nOD/BD",
     "Inhibit Na reabsorption\nin loop of Henle\n→ potent diuresis",
     "N/A\n(variable)",
     "Hypokalaemia\nVolume depletion\nHyperuricaemia\nOtotoxicity (high dose)",
     "CKD GFR <30\nSymptomatic HF\nWith minoxidil\nPulmonary oedema",
     "Hypokalaemia\nHypovolaemia"),
    (COL_CLASS_8,
     "Mineralo-\ncorticoid\nReceptor\nAntagonists\n(MRA)",
     "Spironolactone\nEplerenone\nFinerenone",
     "25–100\n50–100\n10–20",
     "OD\nOD\nOD",
     "Block aldosterone\nreceptors in collecting\nduct → K-sparing\ndiuresis",
     "~8 mmHg\n(resistant HTN)",
     "Hyperkalaemia\nGynecomastia\n(spironolactone)\nRenal impairment",
     "Resistant HTN\n(4th drug)\nPrimary\naldosteronism\nHFrEF",
     "Hyperkalaemia (CI)\nSevere CKD (CI)\nWith ACEi+ARB\n(triple blockade)"),
    (COL_CLASS_9,
     "Alpha-1\nBlockers",
     "Doxazosin\nPrazosin\nTerazosin",
     "1–16\n1–20\n1–20",
     "OD\nBD/TDS\nOD",
     "Block α1-adrenergic\nreceptors → peripheral\nvasodilation",
     "~5 mmHg",
     "Orthostatic\nhypotension\n(especially elderly)\nFirst-dose syncope",
     "HTN + BPH (men)\nResistant HTN\nPhaeochromocytoma",
     "Heart failure\n(less cardio-\nprotective)\nElderly (fall risk)"),
    (COL_CLASS_10,
     "Central\nAlpha-2\nAgonists",
     "Clonidine\nClonidine patch\nMethyldopa\nMoxonidine",
     "0.1–0.8\n0.1–0.3\n250–1000\n0.2–0.6",
     "BD\nWeekly\nBD/TDS\nOD/BD",
     "Stimulate central\nα2-adrenergic\nreceptors → ↓\nsympathetic outflow",
     "N/A\n(variable)",
     "Sedation\nDry mouth\nBradycardia\nRebound HTN\n(clonidine withdrawal)",
     "Methyldopa:\nPregnancy\nClonidine:\nResistant HTN",
     "Avoid abrupt\nwithdrawal of\nclonidine\n(rebound HTN)"),
    (COL_CLASS_11,
     "Direct\nVasodilators\n(Reserved for\nresistant HTN)",
     "Hydralazine\nMinoxidil",
     "50–200\n5–100",
     "BD/TDS\nOD–TDS",
     "Directly dilate\nperipheral arterioles\n→ ↓SVR",
     "N/A\n(potent)",
     "Reflex tachycardia\nFluid retention\nLupus-like syndrome\n(hydralazine)\nHypertrichosis\n(minoxidil)",
     "4th/5th step:\nResistant HTN\nHydralazine:\nPregnancy HTN",
     "Must combine with\ndiuretic + beta-blocker\nto counter reflex\ntachycardia + oedema"),
]

for row_colour, drug_class, examples, dose, freq, mech, sbp, side_fx, indications, contra in rows:
    data.append([
        p(drug_class, cell_bold),
        p(examples, cell_style),
        p(dose, cell_small),
        p(freq, cell_small),
        p(mech, cell_small),
        p(sbp, cell_bold),
        p(side_fx, cell_small),
        p(indications, cell_small),
        p(contra, cell_small),
    ])

# Column widths (landscape A4 = ~277mm usable)
col_widths = [
    2.6*cm,  # Class
    3.2*cm,  # Examples
    2.1*cm,  # Dose
    1.6*cm,  # Freq
    4.0*cm,  # Mechanism
    1.8*cm,  # SBP
    3.8*cm,  # Side effects
    3.4*cm,  # Indications
    3.4*cm,  # Contra
]

table = Table(data, colWidths=col_widths, repeatRows=1)

# Build per-row colour style commands
row_styles = []
# Header row
row_styles += [
    ("BACKGROUND", (0, 0), (-1, 0), COL_HEADER),
    ("TEXTCOLOR",  (0, 0), (-1, 0), colors.white),
    ("FONTNAME",   (0, 0), (-1, 0), "Helvetica-Bold"),
    ("FONTSIZE",   (0, 0), (-1, 0), 8.5),
    ("ROWBACKGROUNDS", (0, 0), (-1, 0), [COL_HEADER]),
]
colours = [
    COL_CLASS_1, COL_CLASS_2, COL_CLASS_3, COL_CLASS_4,
    COL_CLASS_5, COL_CLASS_6, COL_CLASS_7, COL_CLASS_8,
    COL_CLASS_9, COL_CLASS_10, COL_CLASS_11,
]
for i, clr in enumerate(colours):
    row_styles.append(("BACKGROUND", (0, i+1), (-1, i+1), clr))

# General table style
table_style = TableStyle([
    # Grid
    ("GRID",        (0, 0), (-1, -1), 0.4, colors.HexColor("#aaaaaa")),
    ("LINEBELOW",   (0, 0), (-1, 0),  1.2, colors.white),
    # Alignment
    ("VALIGN",      (0, 0), (-1, -1), "TOP"),
    ("ALIGN",       (0, 0), (0, -1),  "CENTER"),
    ("ALIGN",       (2, 1), (3, -1),  "CENTER"),
    ("ALIGN",       (5, 1), (5, -1),  "CENTER"),
    # Padding
    ("TOPPADDING",  (0, 0), (-1, -1), 4),
    ("BOTTOMPADDING",(0,0), (-1, -1), 4),
    ("LEFTPADDING", (0, 0), (-1, -1), 4),
    ("RIGHTPADDING",(0, 0), (-1, -1), 4),
    # Header height
    ("ROWHEIGHT",   (0, 0), (-1, 0),  22),
] + row_styles)

table.setStyle(table_style)

# ── COMPELLING INDICATIONS MINI TABLE ───────────────────────────────────────
ci_header_style = ParagraphStyle(
    "CIH", parent=styles["Normal"],
    fontSize=8, fontName="Helvetica-Bold",
    textColor=colors.white, alignment=TA_CENTER
)
ci_cell = ParagraphStyle(
    "CIC", parent=styles["Normal"],
    fontSize=7.5, fontName="Helvetica", leading=10
)

ci_title = p("QUICK GUIDE: Drug of Choice by Condition", ParagraphStyle(
    "CIT", parent=styles["Normal"],
    fontSize=9.5, fontName="Helvetica-Bold",
    textColor=colors.HexColor("#1a3c5e"), spaceAfter=3
))

ci_data = [
    [p("Condition", ci_header_style), p("Preferred Drug(s)", ci_header_style), p("Avoid / Caution", ci_header_style)],
    [p("Diabetes + CKD + Proteinuria", ci_cell), p("ACEi or ARB (first choice)", ci_cell), p("ARB + ACEi together", ci_cell)],
    [p("Heart failure (HFrEF)", ci_cell), p("ACEi/ARB + BB + Thiazide + MRA", ci_cell), p("Non-DHP CCB, Diltiazem/Verapamil", ci_cell)],
    [p("Post-MI", ci_cell), p("Beta-blocker + ACEi", ci_cell), p("—", ci_cell)],
    [p("Isolated systolic HTN / Elderly", ci_cell), p("Chlorthalidone or Amlodipine", ci_cell), p("High-dose diuretics (fall risk)", ci_cell)],
    [p("Angina pectoris", ci_cell), p("Beta-blocker or CCB", ci_cell), p("—", ci_cell)],
    [p("Atrial fibrillation (rate control)", ci_cell), p("Diltiazem / Verapamil / BB", ci_cell), p("Verapamil + BB combination", ci_cell)],
    [p("Stroke prevention", ci_cell), p("ACEi (Perindopril) + Thiazide (Indapamide)", ci_cell), p("—", ci_cell)],
    [p("Black patients (uncomplicated)", ci_cell), p("Thiazide or CCB (ACEi/ARB less effective alone)", ci_cell), p("ACEi/ARB monotherapy", ci_cell)],
    [p("Pregnancy", ci_cell), p("Methyldopa, Labetalol, Nifedipine", ci_cell), p("ACEi, ARB (teratogenic — CI)", ci_cell)],
    [p("Primary aldosteronism", ci_cell), p("Spironolactone (MRA)", ci_cell), p("—", ci_cell)],
    [p("BPH + HTN (men)", ci_cell), p("Doxazosin (alpha-blocker)", ci_cell), p("—", ci_cell)],
    [p("Resistant HTN (add 4th drug)", ci_cell), p("Spironolactone 25–50 mg", ci_cell), p("Hyperkalaemia risk", ci_cell)],
    [p("Raynaud's phenomenon", ci_cell), p("Amlodipine (DHP-CCB)", ci_cell), p("Beta-blockers worsen it", ci_cell)],
    [p("Phaeochromocytoma", ci_cell), p("Alpha-blocker first, then BB", ci_cell), p("BB alone before alpha (CI — hypertensive crisis)", ci_cell)],
]

ci_col_widths = [6.5*cm, 7.0*cm, 7.0*cm]
ci_table = Table(ci_data, colWidths=ci_col_widths)
ci_row_styles = []
for i in range(1, len(ci_data)):
    clr = COL_ALT if i % 2 == 0 else WHITE
    ci_row_styles.append(("BACKGROUND", (0, i), (-1, i), clr))

ci_table.setStyle(TableStyle([
    ("BACKGROUND", (0, 0), (-1, 0), colors.HexColor("#2e6da4")),
    ("GRID",       (0, 0), (-1, -1), 0.4, colors.HexColor("#bbbbbb")),
    ("VALIGN",     (0, 0), (-1, -1), "MIDDLE"),
    ("TOPPADDING", (0, 0), (-1, -1), 3),
    ("BOTTOMPADDING",(0,0),(-1,-1), 3),
    ("LEFTPADDING",(0, 0), (-1, -1), 5),
] + ci_row_styles))

# ── ASSEMBLE DOCUMENT ────────────────────────────────────────────────────────
elements = [
    Paragraph("Antihypertensive Drugs — Quick Reference Table", title_style),
    Paragraph("Based on Harrison's Principles of Internal Medicine 22E (2025) · Goldman-Cecil Medicine · ESH/ACC/AHA Guidelines", subtitle_style),
    HRFlowable(width="100%", thickness=1.5, color=colors.HexColor("#1a3c5e"), spaceAfter=6),
    table,
    Spacer(1, 0.5*cm),
    ci_title,
    ci_table,
    Spacer(1, 0.3*cm),
    Paragraph(
        "<b>Abbreviations:</b> OD = once daily · BD = twice daily · TDS = three times daily · "
        "ACEi = ACE inhibitor · ARB = angiotensin receptor blocker · CCB = calcium channel blocker · "
        "DHP = dihydropyridine · MRA = mineralocorticoid receptor antagonist · HFrEF = heart failure with reduced ejection fraction · "
        "CKD = chronic kidney disease · ISH = isolated systolic hypertension · SVR = systemic vascular resistance · "
        "RAS = renal artery stenosis · CI = contraindicated · BPH = benign prostatic hyperplasia",
        legend_style
    ),
]

doc.build(elements)
print(f"PDF created: {OUTPUT}")

Running Command

python3 /home/daytona/workspace/antihypertensive-table/generate_pdf.py

Your PDF is ready. Here's what's inside:

Antihypertensive Drugs Reference
PDF Document · PDF

The PDF is A4 landscape and contains two tables:

Table 1 - Main Comparison Table (11 drug classes) Covers all antihypertensive drug classes with colour-coded rows:

Drug Class + line status (first/second-line)
Example drugs with dose ranges
Dosing frequency
Mechanism of action
Expected SBP reduction vs placebo
Side effects
Compelling indications
Contraindications / cautions

Table 2 - Quick Guide: Drug of Choice by Condition (15 conditions) Rapid lookup for: Diabetes/CKD, HFrEF, Post-MI, Elderly/ISH, Angina, AF, Stroke, Black patients, Pregnancy, Primary aldosteronism, BPH, Resistant HTN, Raynaud's, Phaeochromocytoma.

Full abbreviations legend at the bottom. Based on Harrison's 22E, Goldman-Cecil Medicine, and ESH/ACC/AHA guidelines.

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