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60 Cards in this Set
- Front
- Back
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Treatment goals
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-reduce BP to <140/90
-<130/80 in diabetic and renal pts |
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Diuretics
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1. Thiazide: most commonly used for mild-mod HTN
2. Loop type- for edema 3. K+sparing diuretics |
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Thiazides
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-work in distal tubule and block Na channels and decrease reabsorption of Na and water
-first line for mild-mod HTN -Hydrochlorothizide (HCTZ)* -Chlorthalidone -Metolazone -Indapamide |
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Thiazides AE and DI
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AE: hypokalemia, hyponatremia, hypoMg, hypercalcemia
-muscle cramps, dizzy, sexual dysfunction, hyperlipidemia and hyperuricemia DI: NSAIDs, quinidine and digitals (potentiated by a pts low K level) -not useful in renal failure pts |
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Loop diuretics
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-block NaCl reabsorption in the thick ascending loop
-indicated for edema and volume overload assoc with heart failure -Furosemide (Lasix)* (IV and PO) -Bumetamide (Bumex) -Ethacrynic acid (Edecin) -Torsemide (Demadex) |
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Loop diuretics and AE, DI
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AE:
-hyocalcemia -hypomagnesemia -ototoxicity (IV) -rash, photosensitive, bone marrow depression DI: -aminoglycosides -anticoags -digitalis |
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K+ sparing diuretics
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-used in conjunction with loop or thiazide diuretics to minimize risk of hypokalemia
-for edema and hepatic cirrhosis; primary hyperaldosteronism -Amiloride (Midamor) -Triamterene (Dyrenium) -Spironolactone (Aldactone) -Eplerenone (Inspra) |
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K+sparing diuretics MOA
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-effect K channels in the later part of the nephron
-block Na/K+ exchange mechanism in distal nephron & -aldosterone inhibitors |
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K+ sparing diuretics AE and DI
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AE: -Spironolactone may cause gynecomastia, decreased libido, impotence and menstrual irregularities, also diarrhea and dyspepsia
-Hyperkalemia is C/I to taking K+ sparing diureticscan lead to arrhythmias -CNS effects DI: ACE inhibitors and angiotensin II receptor blockers can inc K+ |
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ACE inhibitors
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-MOA: inhibits ACE which blocks conversion to ANG II
-reduces preload and afterload in HTN -decreased left ventricular remodeling caused by chronic HTN and MI |
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ACEI -indications
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-HTN
-all pts post MI and heart failure -diabetic and non diabetic proteinuria (reduce progression to clinical nephropathy) -Enalapril -Ramipril -Captopril |
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ACEI AE
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1. rash
2. cough* 3. Hyperkalemia 4. Acute renal failure and elevated serum creatinine 5. Hypotension 6. Angioedema 7. Dysgeusia |
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ACEI C/I and DI
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CI:
-pregnancy -angioedema -bilateral renal artery stenosis -hyperkalemia DI: NSAIDs, Dig and lithium levels can be increased |
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ANG II receptor blockers (ARBs)
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MOA: block the ANG II receptor (AT) so action of ANG II is inhibited
-no effects on bradykinin metabolism -Losartan -Valsartan -Candesartan -Irbesartan -Telmisartan |
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ARBs AE
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1. less cough
2. less angioedema 3. good for pts who cannot tolerate ACEI 4. may reduce progression of type 2 diabetic nephropathy 5. same preg C/I |
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Calcium channel blockers
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-inhibit the influx of Ca++ across cell membranes
-Causes peripheral artery dilation and coronary arteries dilate -Also slows conduction through AV node, reduces contractility of myocardial muscle, slows rate of sinus node |
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Types of CCBs
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1. Verapamil- most cardiac effects
-Slows conduction through AV node 2. Diltiazem - cardiac and peripheral blood vessel effects |
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Diphydropyridines
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-CCB
-more peripheral arteriolarvascular smooth muscle vasodilation -Nifedipine -Amlodipine |
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CCBs indications
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-HTN
-Angina -SVT |
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CCBs DI and CI
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CI: metabolized by P450
-verapamil is CYP 3A4 inhibitor CI: use caution when you combine CCBs with beta blockers -severe CHF and high degree heart blocks |
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ACEI -indications
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-HTN
-all pts post MI and heart failure -diabetic and non diabetic proteinuria (reduce progression to clinical nephropathy) -Enalapril -Ramipril -Captopril |
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ACEI AE
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1. rash
2. cough* 3. Hyperkalemia 4. Acute renal failure and elevated serum creatinine 5. Hypotension 6. Angioedema 7. Dysgeusia |
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ACEI C/I and DI
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CI:
-pregnancy -angioedema -bilateral renal artery stenosis -hyperkalemia DI: NSAIDs, Dig and lithium levels can be increased |
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ANG II receptor blockers (ARBs)
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MOA: block the ANG II receptor (AT) so action of ANG II is inhibited
-no effects on bradykinin metabolism -Losartan -Valsartan -Candesartan -Irbesartan -Telmisartan |
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ARBs AE
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1. less cough
2. less angioedema 3. good for pts who cannot tolerate ACEI 4. may reduce progression of type 2 diabetic nephropathy 5. same preg C/I |
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Calcium channel blockers
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-inhibit the influx of Ca++ across cell membranes
-Causes peripheral artery dilation and coronary arteries dilate -Also slows conduction through AV node, reduces contractility of myocardial muscle, slows rate of sinus node |
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Types of CCBs
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1. Verapamil- most cardiac effects
-Slows conduction through AV node 2. Diltiazem - cardiac and peripheral blood vessel effects |
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Diphydropyridines
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-CCB
-more peripheral arteriolarvascular smooth muscle vasodilation -Nifedipine -Amlodipine |
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CCBs indications
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-HTN
-Angina -SVT |
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CCBs DI and CI
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CI: metabolized by P450
-verapamil is CYP 3A4 inhibitor CI: use caution when you combine CCBs with beta blockers -severe CHF and high degree heart blocks |
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CCBs and AE
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1. dizzy, flushing, HA (vasodilation)
2. Worsening angina 3. peripheral edema 4. Constipation, GI complaints 5. Heart conduction abnormalities are possible with verapamil and diltiazem |
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Beta blockers
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-MOA: slow heart rate, reduce contractility and reduce CO, block release of renin for JGA
-Beta 1 selectivity |
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Indications for beta blockers
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Stable angina
Stable heart failure Post Myocardial infarction Migraine HA Situational panic Symptoms related to hyperthyroidism |
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non selective beta antagonists
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-block B1 and B2 receptors
1. Propanolol 2. Nadolol 3. Labetolol- alpha 1 blocker also 4. Carvedilol- alpha 1 blocker also |
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Cardio-selective Beta antagonists
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-greater affinity for B1 receptors
-safer for asthma 1. Metoprolol (Lopressor) 2. Atenolol 3. Esmolol (IV) 4. Acebutolol |
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Beta blockers AE
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1. bradycardia, hypotension, conduction abnormalities
2. increase in airway resistance 3. fatigue, dizzy 4. impotence 5. cold extremities 6. depression 7. nightmares 8. lower HDL, higher TG |
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beta blockers- C/I and DI
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-do not abruptly withdraw
-caution with with CCBS -caution with DM and bronchospastic diseases CI: cardiogenic shock, heart blocks, bradycardia DI: beta blockers may be less effective if given with potent CYP 450 inducers; Ca channel blockers |
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peripheral alpha1-blockers
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-MOA: selective alpha1 blockers --> vasodilation --> decreased PVR
-Prazosin -Doxazocin -Terazocin -dosed at night b/c they cause orthostatic hypotension (first dose syncope) -can also be used to tx BPH |
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AE of alpha1 blockers
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-1st dose phenomenon
-HA -Dizzy -weakness -palpitations -dry mouth |
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central alpha2 receptor agonists
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-Clonidine*- PO, weekly patch
-Methyldopa- for mod-severe cases, used for HTN in preg -Guanfacine -Guanabenz -reduction in sympathetic outflow from the vasomotor center in the brain--> more vagal tone--> reduces PVR/BP -adjunctive therapy |
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AE of alpha 2 agonists
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1. sedation and dry mouth most common!
2. dizzy 3. depression 4. orthostasis uncommon 5. Na and H2O retention (use w/diuretic) 6. Rebound HTN if you stop without tapering!! 7. Bradycardia 8. Methyldopa --> hepatitis or immune hemolytic anemia |
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Vasodilators
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-Hydralazine- IV/PO (rarely used alone)
-Minoxidil -for severe, resistant ases of HTN in combo with diuretics, Bblockers -MOA: direct arteriolar smooth m. relaxation -problem- reflex tachycardia |
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AE of vasodilators
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-minoxidil- Na, H2O retention, inc HR, contractility, hypertrichosis (excessive hair growth)
-hydralazine- reflex sympathetic CV effects, drug induced lupus, serum sickness |
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Tekturna
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-oral direct renin inhibitor
-monotherapy or combination -AE/CI: edema of face, neck and hands, renal dysfunction, diarrhea, cough |
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HTN emergencies
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-immediate BP reduction to limit new or progressing target organ damage
-parenteral therapy to lower BP toward 160/100 in 1-6hrs -Nitroprusside given as continuous IV infusion; inc release of NO causing immediate vasodilation AE: excessive and rapid hypotension, must use special pump, toxic accumulation of cyanide |
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other drugs for HTN emergencies
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1. Labetolol IV
2. Nitroglycerin IV- dilates arterioles and venules as well as coronary vessels |
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HTN urgencies
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-elevated BP without new or progressive target organ damage
-Captopril PO -Amlodipine PO |
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peripheral alpha1-blockers
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-MOA: selective alpha1 blockers --> vasodilation --> decreased PVR
-Prazosin -Doxazocin -Terazocin -dosed at night b/c they cause orthostatic hypotension (first dose syncope) -can also be used to tx BPH |
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AE of alpha1 blockers
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-1st dose phenomenon
-HA -Dizzy -weakness -palpitations -dry mouth |
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central alpha2 receptor agonists
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-Clonidine*- PO, weekly patch
-Methyldopa- for mod-severe cases, used for HTN in preg -Guanfacine -Guanabenz -reduction in sympathetic outflow from the vasomotor center in the brain--> more vagal tone--> reduces PVR/BP -adjunctive therapy |
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AE of alpha 2 agonists
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1. sedation and dry mouth most common!
2. dizzy 3. depression 4. orthostasis uncommon 5. Na and H2O retention (use w/diuretic) 6. Rebound HTN if you stop without tapering!! 7. Bradycardia 8. Methyldopa --> hepatitis or immune hemolytic anemia |
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Vasodilators
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-Hydralazine- IV/PO (rarely used alone)
-Minoxidil -for severe, resistant ases of HTN in combo with diuretics, Bblockers -MOA: direct arteriolar smooth m. relaxation -problem- reflex tachycardia |
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AE of vasodilators
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-minoxidil- Na, H2O retention, inc HR, contractility, hypertrichosis (excessive hair growth)
-hydralazine- reflex sympathetic CV effects, drug induced lupus, serum sickness |
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Tekturna
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-oral direct renin inhibitor
-monotherapy or combination -AE/CI: edema of face, neck and hands, renal dysfunction, diarrhea, cough |
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HTN emergencies
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-immediate BP reduction to limit new or progressing target organ damage
-parenteral therapy to lower BP toward 160/100 in 1-6hrs -Nitroprusside given as continuous IV infusion; inc release of NO causing immediate vasodilation AE: excessive and rapid hypotension, must use special pump, toxic accumulation of cyanide |
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other drugs for HTN emergencies
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1. Labetolol IV
2. Nitroglycerin IV- dilates arterioles and venules as well as coronary vessels |
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HTN urgencies
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-elevated BP without new or progressive target organ damage
-Captopril PO -Amlodipine PO |
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When to use which drugs
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-first line should be a thiazide diuretic alone or in combo with another agent if BP > 160/100
-when BP is 20/10 above goal consider starting with 2 drugs either as separate prescriptions or in combo |
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when to use which drugs- compelling indications
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1. Ischemic heart disease- beta blockers and/or ACEI
2. Heart failure- ACEI and B-Blockers 3. Post MI- ACEI and B Blockers 4. Diabetes – ACEI/ARBs plus thiazides 5. Cerebrovascular disease: ACEI-thiazide combinations 6. Chronic kidney disease: ARBs and ACEI |
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pregnancy and HTN
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-wait and watch unless pt has severe HTN or BP reaches 150-160/100
-Methlydopa first line -Labetolol also first line |
