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92 Cards in this Set
- Front
- Back
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what is goal BP for pts
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<140/90
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whats is BP goal for diabetic patients
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<130/80
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stages of HTN
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normal <120 / <80
pre HTN 120-139/80-89 stage 1 140-159.90-99 stage 2 >160/>100 |
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stage 1 tx without complicating conditions
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thiazides
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stage 2 tx without complicating conditiosn
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2 drug combo: thiazides and ACEI/ ARB/BB/CCCB
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CHF patients with HTN
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beta blockers, ACEI/ARB, loop diuretics, aldo antagonist
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Post-MI HTN
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BETA BLOCKERS (increased survival rates post MI), ACE-I, aldo antagonist
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high CAD risk HTN
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BB, ACEI, CCB, thiazide
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HTN in diabetics
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ACI/ARB - protect kidneys
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chronic kidney disease
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ACEI/ARB
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recurrent stroke prevention
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ACEI/thiazides
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CI thiazides
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gout
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CI BB
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asthma, significant bradycardia or heart block
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which drug should be avoided for pts who are pregnant or have a history of angioedema
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ACEI/ARB
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CI with aldosterone antagonist
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CRI/hyperkalmeia -
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what is the first line tx for HTN
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diuretics especially thiazides
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what drug is best for low rening or volume expanded HTN
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diuretics
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what drug is good 1st line for AA
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diuretics
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adverse effect of diuretics
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increase serum lipids and decrease insulin insensility (caution with DM may worsen condition)
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which HTN drug reduces CO and reduces PVR
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CCB
Reduce CO - dilate peripheral arteries reduce PVS - cause release of NO in endothelial cells |
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which class of CCB have most affect on arteriolar SM
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dihydrophyridine (amlodipine, Nifedipine)
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what is the most common drug used in AA and elderly patients
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CCB
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which class of drugs has more affect on nodal conduction?
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non dihydropyines
diltizem verapamil |
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MOA dilitazem
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decrease AV nodal conduction and HR, wker than verapamil
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MOA verapamil
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direct negative ionotropy (nodal tissue)
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SE CCB
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cardiac deprresion (D, V) so don't use with BBB
hypotension, vasodilation (edema - nifepidine), tachycardia (N) gingival hyperplasia (A, N) |
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what combination is good for decreasing CV events in HTN patients
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amiodipine and ACE I
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what drug is effective in patients with high renin activity - young patients
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propranolol - BB
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SE propranolol
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lipid soluble - cross BBB - nightmares, induce glucose intolerance, acute withdrawl symoms
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MOA of BB
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decrease heart contractility, increase TPR but eventially decrease TPR because of renin-ang system
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which BB is useful in asthmatic HTN patients
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metroprolol
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CI propranolol
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asthma, peripheral vascular diseae, AV block
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atenolol
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B1 antagonist, once daily, less lipid soluble
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nadolol
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non selective B antagonist
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used for mild-moderate HTN, in pts taking vasodilators to rpevent SNS reflex tachycaria
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BB (metroprolol, atenolol, nadolol
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what drug is used to control BP in patients with underlying heart disease and can also be used for high renin patients
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BB - metroprolol, atenolol, nadolol
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function of ACE I
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promotes vasodilation, reduce fluid retention, slow progression of diabetic neuropathy and renal diseae in diabetics
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ACE I used to tx HTN patients
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enalapril
ramipril lisinopril captorpil |
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which ACEI contains sulfhydryl
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captorpil - cause taste changes
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which ACEI does should be reduced in pts with renal insufficiency
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enalapril
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what is the first choice drug for HTN in patients with CHF, renal disease, DM
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ACE-I then ARBs (if problems with ACEI)
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ACEI SE
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severe hypotension in hypovolumic patients
hyperkalemia exacerbated by K sparing dieurects angiodema may not be effective in AA population |
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CI ACE I
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pregnant - suppress cell proliferation in 2nd and 3rd trimester
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what is first line tx for HTN in patients with CHF, renal disease and DM who have dry cough/angiodema
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ARBs
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peripheral selective alpha1 antagonists
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-zosin
prazosin terazosin doxazosin |
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MOA peripheral alpha 1 antagonists
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block alpha 1 from binding NE from nerve terminal, decrease vascular tone, PVR and BP
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SE prazosin
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postural dizziness, first dose tolerance to rxn
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which drugs are used for benign prostate hypertrophy as well as HTN
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doxazosin, terazosin
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adrenergic neuron blocking agents MOA
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deplete NE from presynaptic, postganglionic sympathetic nerve terminals so there is less NE to respond to SNS stimualation leading to decreased CO and TPR
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adrenergic neuron blocking agents types?
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guanethidine
reserpine |
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what drug acts as a False NT to deplete NE stores
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guanethidine
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what type of drugs are used as last resort for refractory HTN
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adrenergic neuron blocking agents (guanethidine, reserpine)
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reserpine MOA
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blocks transport of DA into storage vessicles - depletes body's store of catecholamines and serotonin - decresae sympathetic tone, TPR and CO
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SE adrenergic neuron blocking agents
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orthostatic HTN -> bradycardia, salt and water retention -> bloating impotence and diarrhea (guanethidine)
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drug interactions adrenergic neuron blocking agents
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drugs that alter amine pump function can block site of uptake - TCA, MOAI, ephedrine, amphetamines, phenothiazines
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central alpha 2 adrenergic receptor agonists?
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methyldopa, clonidine
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MOA alpha 2 adrenergic agonists
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cross BBB to stimulate alpha 2 receptors on BS vasomotor center -> inhibits sympathetic outflow -> decrease vasoconstriction, HR, contractility but increases parasympathetic outflow to periphery - decredase HR, CO, TPR, plasma renin and baroreceptor function
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what drug is approved for tx of HTN in pregnant women?
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methyldopa
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what drug is useful in dx of pheochromocytomia in HTN pts
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clonidine (decrease NE to <500, if tumor free)
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MOA clonidine
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direct alpha 2 agonist
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SE clonidine
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dry mouth, drowsiness, NA reteention
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drug interactions clonidine/methydolpa
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TCA can reverse antiHTN effects (increase CYP450)
barbituates may reduce efficacy MAOI may produce HTN and CNS stimulation |
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which central alpha adrenergic receptor agonists is a prodrug
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methyldopa
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vasodilators?
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hydralazine, minoxidil, sodium nitroprusside, diazoxide, labetalol and carvedilol
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vasodilators MOA
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relax vascular SM, vasodilate arterioles decrse PVR and BP
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vasodilator site of action
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SMC
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hydralazine
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increase cAMP = SM relaxtion, reduce afterload, TPR
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hyralazine SE
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reflex tachycardia - can precipitate MI in elderly patients/CAD
can block reflex by addition of propranolol lupus syndrome |
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hydralazine CI
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angina/CAD
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MOA minoxidil
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activates ATP sensitive K channels leading ot hyperpolarizaitohn/relaxation of SMS, vasodilation of arterioles and ultimately decrease in TPR
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what vasodilator is reserved for severe resistant HTN
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minoxidil
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what drug SE is hypertrichosis
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minoxidil - accentuated hair gtrowth
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sodium nitroprusside MOA
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liberates NO which dilates vascular SMS - decrease TPR
only given IV - light sensitive and unstable in aq solutions |
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SE sodium nitroprusside
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toxic accumulation of cyanide can lead to lactic acidosis, rebound HTN, tolerance
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MOA diazoxide
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activate ATP sens K channel on arterial SMC - dilates arterila SM - decrease TPR
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SE diazoxide
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tachycardia angina
hyperglycemia |
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what vasodilators are used for HTN crisis
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sodium nitroprusside
diazoxide labetalol and carvedilol |
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labetalol and carvedilol
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mixture of alpha 1 and non seletive B receptor antagonist so it is able to reduce TPR without reflex tachycardia
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what drug is used to treat HTN due to pheochromocytoma
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labetalol
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HTN urgency
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BP >180/120 w/out evidence of end organ manifestations
tx - admit and gradually lower BP |
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HTN emergency
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severly elevated BP with acute evidence of end organ disease
tx - admit to ICU and aggressively lower BP |
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HTN damage to heart
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LVH - S4 gallop
CHF - systolic dysfunction - fibrosis CAD |
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causes of resistant HTN
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improper BP measurement (cuff to large, non compliance, excess NA intake, herbal, illicit drug use, excessive ETOH
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what drugs to avoid during pregnancy
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ACEI, ARB, BB (if early)
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drgus to avoid in arrhythmatic patients
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diuretics
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drugs to use post MI
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BB
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drugs to avoid post MI
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diruetic, diazoxide
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drugs to avoid in AV block pts
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BB
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drugs to use in pts with renal disease
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ACEI, ARBs
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CI for indiv taking antidepressents
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central acting alpha agonists, adrenergic neuron blocking agnets
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CHF and HTN
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ACE/ARB
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angina and HTN
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BB and CCB
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