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38 Cards in this Set
- Front
- Back
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Goals of treatment in regards to hypertension.
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Reduce blood pressure to acceptable levels (140/90 or 120/80 in diabetics or those with renal disease.
Reduce incidence of end organ damage. Avoid adverse drug effects. Use least expensive agent possible. |
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Blood Pressure=
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Heart Rate X Volume X Total Peripheral Resistance
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Potent Vasoconstrictor
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Angiotensin II
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Released by kidneys
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Renin
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Causes sodium and water retention
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Aldosterone
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Prevents the formation of Angiotensin II
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ACE Inhibitors
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Mechanism of Action for Diuretics
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Reduce extracellular volume and total peripheral resistance
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Special considerations for Diuretics
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Very Inexpensive
Very Effective in the black population Use with caution in patients with diabetes or those with elevated cholesterol or triglycerides. Monitor electrolyte , glucose and lipoprotein concentrations. |
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CNS Mediated effects of Beta Blockers
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Depression
Sleep disturbances Fatigue Hallucinations |
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Peripherally Mediated Effects of Beta Blockers
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Bradycardia
Slow AV conduction Muscle fatigue Bronchospasm Increased LDL and triglyerides Decreased HDLs Cold extremities |
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Special Considerations for Beta Blockers
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Very Inexpensive
Work well in white population Should be considered in patients with angina, migraines, or those with history of MI. Avoid in patients with pulmonary disease, CHF, diabetes and/or peripheral vascular diseases. |
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Alpha 1 Antagonists: Mechanism of Action
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Block postsynaptic alpha 1 receptors thus reducing total peripheral resistance.
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Side effects of Alpha 1 Antagonists
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Orthostatic hypotension
Headache Palpitations Weakness "First Dose Effect" |
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Special Considerations for Alpha 1 Antagonists
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Work well in all age and racial groups.
Reduce total cholesterol and triglycerides while increasing HDL Prazosin inexpensive |
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Thiazide-Type Diuretics
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Chlorothiazide (Diuril)
Chlorthalidone (Hygroton) Hydrochlorothiazide (Esidrix) Indapamide (Lozol) Metolazone (Zaroxolyn) |
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Examples of Loop Diuretcs
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Bumetanide (Bumex)
Furosemide (Lasix) Torsemide (Demadex) |
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Examples of Potassium Sparing Diuretics
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Amiloride (Midamor)
Spironolactone (Aldactone) Triamterene (Dyrenium) |
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Examples of Beta Blockers
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Acebutolol (Sectral)
Atenolol (Tenormin) Betaxolol (Kerlon) Bisoprolol (Zebeta) Metoprolol (Lopressor) Metoprolol (Toprol XL) Nadolol (Corgard) Pindolol (Visken) Propranolol (Inderal) Propranolol (Inderal-LA) |
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Examples of Alpha 1 Antagonists
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Doxazosin (Cardura)
Prazosin (Minipress) Terazosin (Hytrin) |
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Mechanism of Action for ACE Inhibitors
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Reduces total peripheral resistance by inhibiting the conversion of angiotensin I to angiotensin II
Reduces both preload and afterload in CHF |
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Side Effects of ACE Inhibitors
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Cough
rash Angioedema Hyperkalemia Hypotension Dysgeusia Renal Insfficiency Neutropenia (rare) |
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Special Considerations for ACE Inhibitors
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Good choice in treating patients with CHF. diabetic neuropathy, and following a MI.
Do not affect lipid levels. |
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Examples of ACE Inhibitors
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Benazepril (Lotensin)
Captopril (Capoten) Enalapril (Vasotec) Fosinopril (Monopril) Lisinopril (Zestril) Moexipril (Univasc) Perindopril (Aceon) Quibapril (Accupril) Ramipril (Altace) Trandolapril (Mavik) |
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Mechanism of Action for Angiotensin Receptor Antagonists
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Blocks Angiotensin II at the receptor level thus reducing total peripheral resistance and volume.
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Side Effects of Angiotensin Receptor Antagonist
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Same as ACE Inhibitors but with less incidence of cough and angiedema
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Special considerations for Angiotensin Receptor Antagonists
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Useful alternative in patients who cannot tolerate ACE Inhibitors because of cough.
Expensive |
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Examples of Angiotensin Receptor Antagonists
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Candesartan (Atecand)
Eprosartan (Tevetan) Irbesartan (Avapro) Losartan (Cozzar) Olmesartan (Benicar) Telmisartan (Micardis) Valsartan (Diovan) |
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Direct Renin Inhibitor Example
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Aliskiren (Tekturna)
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Mechanism of Action for Direct Renin Inhibitor
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Blocks the action of renin thus inhibiting activation of the renin-angiotensin-aldosterone cascade.
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Side effects of direct renin inhibitors
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Diarrhea (at higher doses)
Cough and angioedema (less common than with ACE-I). |
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Special considerations for direct renin inhibitors
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Use second line if ACE-I not tolerated
Only indicated for HTN Contraidicated in pregnancy |
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Mechanism of Action for Calcium Channel Blockers
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Decrease total peripheral resistance by blocking calcium which is needed for smooth muscle contraction
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Side effects of calcium channel blockers
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Headache
Dizziness Peripheral edema Gingival hyperplasia Tachycardia - Dihydropyridines only Bradycardia- Verapamil, Diltiazem only Constipation- Verapamil only |
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Special Considerations for calcium channel blockers
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Work well in black population
Consider in patients with hyperlipidemias Useful in patients with angina and supraventricular arrhythmias (Verapamil and Diltiazem) |
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Examples of Calcium Channel Blockers
Nondihydropyridines |
Diltiazem (Cardizem)
Diltiazem (Cardizem CD) Mibefradil (Posicor) Verapamil (Calan) Verapamil (Calan SR) |
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Examples of Calcium Channel Blockers
Dihydropyrodones |
Amlodipine (Norvasc)
Felodipine (Plendil) Nicardipine (Cardene SR) Nifedipine (Procardia XL) Nisoldipine (Sular) Isradipine (DynaCirc) |
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Treatment for Stage I HTN
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No compelling indications: Thiazide diuretics
Compelling Indications: BB, ACE-I, ARB's, or CCB. If no response, add a second agent (second should be thiazide if not already taking) |
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Treatment for Stage II HTN
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Begin therapy with 2 drugs : thiazide diuretic plus BB, ACE-I, ARB, or CCB.
Add aditional drugs if optimal blood pressure control not achieved. |
