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95 Cards in this Set

  • Front
  • Back
Initial drug therapy for hypertension
Beta blockers and diuretics unless compelling indications or comorbid conditions

For patients >20/10mmHg above goal, need 2-drug combo
Thiazide and thiazide-like diuretics - MOA
Direct arteriole dilation
Reduction of total fluid volume through inhibition of sodium reabsorption in distal tubules
Increases excretion of sodium, water, potassium, and hydrogen
Decreased efficacy in renal failure, SCr >2mg/dL or GFR <30mL/min
Thiazide and thiazide-like diuretics - AE's
Short-term increased cholesterol and glucose
Decreased potassium, sodium, and magnesium
Increased uric acid and calcium
Rare blood dyscrasias, photosensitivy, pancreatitis, hyponatremia, sulfonamide-type immune reactions
Impotence, fatigue, HA, rash, vertigo
Thiazide-like have less or hypocholesterolemia and decreased microalbuminuria in diabetes
Thiazide and thiazide-like diuretics - Patient education
Take with food or milk, early in day to avoid nocturia
May increase blood glucose in diabetics
Report problems with muscle cramps that may indicate decreased potassium level
Thiazide and thiazide-like diuretics - Drug-drug & drug-disease interactions
Steroids - salt retention & antagonize thiazide action
NSAIDs - blunt thiazide response
Class IA or III antiarrhythmics (prolong QT interval) may cause torsades de pointes with diuretic-induced hypokalemia
Probenecid & lithium - block thiazide effects by interefering with thiazide excretion into the urine
Lithium - thiazides decrease lithium renal clearance & increase risk of lithium toxicity
Thiazide and thiazide-like diuretics - Monitoring parameters
Blood pressure, weight, serum electrolytes, uric acid, BUN, SCr, cholesterol levels
Loop diuretics - MOA
Reduce total fluid volume through inhibition of sodium & chloride reabsorption in ascending loop of Henle
Increases excretion of water, sodium, chloride, magnesium, & calcium
Are more effective than thiazides in patients with renal failure (SCr >2mg/dL or GFR <30mL/min)
Loop diuretics - AE's
Ototoxicity at high doses
Short duration, no hypercalcemia
Loop diuretics - Patient education
Take with food or milk, early in day to avoid nocturia
may increase blood glucose in diabetics
Report problems with muscle cramps that may indicate decreased potassium level
Rise slowly from a lying or sitting posistion
Loop diuretics - Drug-drug & drug-disease interactions
Aminoglycosides - combined with loops can precipitate ototoxicity
NSAIDs - blunt diuretic response
Class IA or III antiarrhythmics (prolong QT interval) may cause torsades de pointes with diuretic-induced hypokalemia
Probenecid - blocks loop effects by interfering with excretion into the urine
Loop diuretics - Monitoring parameters
Weight, serum electrolytes, BUN & SCr, uric acid, hearing (in high doses)
Potassium-sparing diuretics - MOA
Interferes with potassium/ sodium exchange in the distal tubule
Decreases calcium excretion, increases magnesium loss
Potassium-sparing diuretics - AE's
Avoid with history of kidney stones or hepatic disease
Potassium-sparing diuretics - Patient education
Take after a meal, early in day to avoid nocturia
Avoid excess ingestion of foods high in potassium and use of salt substitues
May increase blood glucose in diabetics
Report problems with muscle cramps that may indicate decreased potassium levels
Sexual dysfunction
Potassium-sparing diuretics - Drug-drug & drug-disease interactions
ACE-I - may increase risk of hyperkalemia
Indomethacin - combo with triamterene can cause decrease in renal function
Cimetidine - increases bioavailability and decreases clearance of triamterene
Potassium-sparing diuretics - Monitoring parameters
Weight, serum electrolytes (especially potassium), BUN & SCr
Adrenergic Inhibitors - MOA
Alpha-2 agonist, inhibit neurotransmitter release from peripheral neurons
Adrenergic Inhibitors - AE's
Postural hypotension, diarrhea, nasal congestion, sedation, depression, activation of peptic ulcer, dizziness, lethargy, memory impairment, sleep disturbances, weight gain
Adrenergic Inhibitors - Patient education
Report symptoms of dizziness or hypotension
Don't take OTC cold productions
Rise slowly from lying or sitting position
Report new fluid retention
Sexual dysfunction
Adrenergic Inhibitors - Drug-drug & drug-disease interactions
OTC sympathomimetics - may potentiate an acute hypertensive effect
TCAs & chlorpromazine - antagoinize therapeutic effects of guanethidine
Pheochromocytoma is a contraindication to this class
Avoid in patients with CHF, angina, & cerebrovascular disease
Adrenergic Inhibitors - Monitoring parameters
History of depression with reserpine (Serpasil)
Sleep disturbances, drowsiness, lethargy (reserpine)
Symptoms of peptic ulcer (reserpine)
Centrally Active Alpha Agonists - MOA
Agonistic activity on central alpha-2 receptors, decreases sympathetic outflow to cardiovascular system
Centrally Active Alpha Agonists - AE's
Sedation, dry mouth, bradycardia, withdrawal hypetension, orthostatic hypotension, depression, impotence, sleep disturbences
Centrally Active Alpha Agonists - Patient education
Report symptoms of dizziness or hypotension
Sedation precautions
Fever & flu-like symptoms may represent hepatic dysfunction (methyldopa)
Report new fluid retention
Sexual dysfunction
Centrally Active Alpha Agonists - Drug-drug & drug-disease interactions
Use cautiously with other sedating medications
Use cautiously in patients with angina, recent MI, CVA, & hepatic or renal disease (guanabenz & guanfacine)
Centrally Active Alpha Agonists - Monitoring parameters
CBC, positive Coomb's test in 25%, less than 1% develop hemolytic anemia (methyldopa)
Sleep disturbances, drowsiness, dry mouth
Symptoms of depression
Pulse, rebound hypertension
Peripherally Acting Alpha Antagonists - MOA
Alpha-1 antagonists, cause vasodilation of both arteries and veins (indirect vasodilators)
Causes less reflex tachycardia than direct vasodilators (hydralazine/ minoxidil)
Peripherally Acting Alpha Antagonists - AE's
Postural hypotension, syncopal episode with first dose, diarrhea, weight gain, peripheral edema, dry mouth, urinary urgency, constipation, pripism, nausea, dizziness, headache, palpitations, sweating, no effects on glucose or cholesterol
Peripherally Acting Alpha Antagonists - Patient education
Take first dose of no more than 1mg of any agent and take at bedtime
Rise slowly from lying or sitting position
May cause dizziness
Peripherally Acting Alpha Antagonists - Drug-drug & drug-disease interactions
NSAIDs - decrease antihypertensive effects
Increased antihypertensive effects with diuretics and beta blockers
Peripherally Acting Alpha Antagonists - Monitoring parameters
Blood pressure and pulse
Peripheral edema
Beta Blockers - MOA
Competitively blocks response to beta stimulation
Blocks secretion of renin
Decreases cardiac contractility, which decreases cardiac output
Decreases central sympathetic output
Decreases heart rate, which decreases cardiac output
Beta Blockers - AE's
Bronchospasm, bradycardia, herat failure, may mask insulin-induced hypoglycemia, less serious impaired peripheral circulation, insomnia, fatigue, decreased exercise tolerance, hypertriglycideremia (except ISA agents)
Beta Blockers - Patient education
Report symptoms of dizziness or hypotension
Sedation precautions (with lipid-soluble compounds)
Abrupt withdrawal of drug should be avoided
Sexual dysfunction
Beta Blockers - Drug-drug & drug-disease interactions
Use with caution in patients with diabetes, Raynaud's phenomenon or peripheral vascular disease
Sulfonylureas - beta blockers may decrease effectiveness
Non-DHP - may increase effect/ toxicity of beta blockers
Beta Blockers - Monitoring parameters
ECG, rebound hypertension, cholesterol levels, pulse (apical & radial), glucose levels
Direct Vasodilators - MOA
Direct relaxation of peripheral arterial smooth muscle
Decrease peripheral resistance
Direct Vasodilators - AE's
Headaches, fluid retention, tachycardia, peripheral neruopathy, postural hypotension
Lupus syndrome (hydralazine)
Hirsutism (minoxidil)
Direct Vasodilators - Patient education
Report symptoms of dizziness or hypotension
Hirsutism (minoxidil)
Report any new symptoms of fatigue, malaise, low-grade fever, & joint aches
Report rapid weight gain (>5 lb), unusual swelling & pulse increase >20 BPM
Rise slowly from lying or sitting position
Direct Vasodilators - Drug-drug & drug-disease interactions
Use with caution in patients with pulmonary hypertension & significant renal failure, CHF, CAD, or recent MI
Direct Vasodilators - Monitoring parameters
Weight (fluid status), blood pressure & pulse, CBC with ANA (hydralazine - Lupus syndrome)
Calcium Channel Blockers - MOA
Inhibit influx of calcium in vascular smooth muscle, causes relaxation of both coronary & peripheral arteries
Sinoatrial (SA) & atrioventricular (AV) nodal depression & decrease in myocardial contractility (non-DHPs)
Calcium Channel Blockers - AE's
Conduction defects, worsening of systolic dysfunction, gingival hyperplasia

- Nausea, headache, constipation

- Edema of ankle, flushing, headache, gingival hyperplasia
Calcium Channel Blockers - Patient education
Report symptoms of dizziness or hypotension
Constipation (verapamil)
Report any new symptoms of shortness of breath, fatigue, or increased swelling of the extremities
Rise slowly from lying or sitting position
Calcium Channel Blockers - Drug-drug & drug-disease interactions
Use with caution in patients on beta blockers (non-DHPs) - may increase CHF & bradycardia - this combo can also cause conduction abnormalities to AV node
Grapefruit juice may increase levels of some DHPs
Calcium Channel Blockers - Monitoring parameters
ECG, peripheral edema, blood pressure & pulse
Bowel habits
Symptoms of conduction disturbances
ACE-I's & ARBs - MOA
Inhibit conversion of angiotensin I to angiotensin II (potent vasoconstrictor)

- Indirectly inhibit fluid volume incrases by inhibiting ANG II-stimulated release of aldosterone

- Inhibit binding of ANG II to receptor, inhibiting vasoconstriction and stimulation of aldosterone release
Currently considered as alternative therapy in patients not able to tolerate ACEI's due to cough
ACE-I's & ARBs - AE's
- Cough, angioedema, hyperkalemia, rash, loss of taste, leukopenia
- Vertigo, headache, fatigue, first-dose hypotension, minor disturbances, acute renal insufficiency in patiens with predisposing factors such as renal stenosis and coadministration with thiazide diuretics, proteinuria (esp. in patients with history of renal disease)

- Angioedema, hyperkalemia
ACE-I's & ARBs - Patient education
Report symptoms of dizziness or hypotension
Symptoms of swelling of the lips, mouth, or face should be considered an emergency, and should immediately report to doctor's office or ED
Report new rashes, esp. with captopril
Do not use salt substitues containing potassium, and do not take OTC potassium supplements
Rise slowly from lying or sitting position
ACE-I's & ARBs - Drug-drug & drug-disease interactions
NSAIDs will decrease effectiveness
Potassium-sparing diuretics, potassium supplements, & salt substitues will increase risk of hyperkalemia
Avoid in patients with bilateral renal artery stenosis or stenosis in single kidney
Contraindicated in 2nd and 3rd trimesters of pregnancy
ACE-I's & ARBs - Monitoring parameters
Serum electrolytes, esp. SCr & potassium
Symptoms of angioedema
Blood pressure, symptoms of hypotension
CBC, esp. with captopril & enalapril, for neutropenia - more common in preexisting renal impairment
Urinary proteins
Hypertensive Urgencies & Emergencies
Determined by presence or absence of target organ damage, not by blood pressure

Relative rise and rate of increase in blood pressure is more important than actual blood pressure
Hypertensive Emergencies - Classification
Acute elevations of BP >180/120 with presence of acute or ongoing target organ damage
Requires immediate lowering of BP to prevent or minimize target organ damage
Hypertensive Emergencies - Treatment
- Reduce MAP by no more than 25% within minutes to hours, reach 160/100 within 2-6hrs
Measure BP every 5-10min until goal MAP reached and life-threatening TOD resolves
Maintain goal BP for 1-2 days, and further reduce BP toward normal over several weeks
Excessive falls in BP may ppt renal, cerebral, or coronary ischemia
Hypertensive Urgencies - Classification
Accelerated, malignant, or perioperative elevations in BP in absence of new or progressive TOD; therefore immediate lowering of BP is not required
IV dosing is preferred
Hypertensive Urgencies - Treatment
No agent of choice - meds chosen based on patient characteristics
Oral therapy preferred
Onset of action should be 15-30min, and peak effects seen in 2-3hrs
Check BP every 15-30min to ensure response
Use of IR nifedipine is NOT appropriate to lower BP in patients with hypertensive urgencies
What are the non-dihydropyridine calcium channel blockers?
Diltiazem, verapamil
What are the dihydropyridine calcium channel blockers?
Amlodipine, felodipine, isradipine, nicardipine, nifedipine, nisoldipine
Name the thiazide diuretics
Naturetin (bendroflumethiazide)
Aquatag, Exna (benzthiazide)
Diuril (chlorothiazide)
Hydroton, Hylidone (chlorthalidone)
Hydrodiuril, Microzide (hydrochlorothiazide)
Saluron, Diucardin (hydroflumethiazide)
Renese (polythiazide)
Metahydrin, Naqua (trichlormethiazide)
Name the thiazide-like diuretics
Mykrox, Zaroxolyn (metolazone)
Lozol (indapamide)
Name the loop diuretics
Bumex (bumetanide)
Lasix (furosemide)
Demedex (torsemide)
Name the potassium-sparing diuretics
Midamor (amiloride)
Dyrenium (triamterene)
Name the aldosterone antagonist diuretic
Aldactone (spironolactone)
Name the combination ACEI's and CCBs
Lotrel (amlodipine + benazepril)
Lexxel (enalapril + felodipine)
Tarka (trandalopril + verapamil)
Name the ACEI's and diuretic combination drugs
Lotensin HCT (benazepril, HCTZ)
Capozide (captopril, HCTZ)
Vaseretic (enalapril, HCTZ)
Prinzide (lisinopril, HCTZ)
Uniretic (moexipril, HCTZ)
Accuretic (quinapril, HCTZ)
Name the ARBs and diuretic combinations
Atacand HCT (irbesartan, HCTZ)
Teveten/HCT (eprosartan, HCTZ)
Avalide (irbesartan, HCTZ)
Hyzaar (losartan, HCTZ)
Micardis/HCT (telmisartan, HCTZ)
Diovan/HCT (valsartan, HCTZ)
Name the beta blocker and diuretic combinations
Tenoretic (atenolol/chlorthalidone)
Ziac (bisoprol,HCTZ)
Inderide (propranolol, HCTZ)
Lopressor HCT (metoprolol, HCTZ)
Corzide (nadolol, bendrofluthiazide)
Timolide (timolol, HCTZ)
Name the diuretic combinations
Aldoril (amiloride, HCTZ)
Aldactone HCT (spironolactone, HCTZ)
Dyazide, Maxzide (triamterene/HCTZ)
Name the peripheral alpha-2 agonists
Hylorel (guanadrel)
Ismelin (guanethidine)
Serpasil (reserpine)- also acts centraly
Name the central alpha-2 agonists
Catapres (clonidine)
Wytensin (guanabenz)
Tenex (guanfacine)
Aldomet (methyldopa)
Serpasil (reserpine) - also acts peripherally
Name the peripheral alpha-1 antagonists
Cardura (doxazosin)
Minipress (prazosin)
Hytrin (terazosin)
Name the cardioselective beta blockers
Sectral (acebutolol)
Tenormin (atenolol)
Kerlone (betaxolol)
Zebeta (bisoprolol)
Lopressor (metoprolol tartrate)
Toprol-XL (metoprolol succinate)
Name the beta blockers with intrinsic sympathomimetic activity
Sectral (acebutolol0
Cartrol (carteolol)
Levatol (penbutolol)
Name the non-cardioselective, non-ISA beta blockers
Corgard (nadolol)
Inderal, Inderal LA (propranolol)
Blocadren (timolol)
Name the combined alpha and beta blockers
Coreg (carvedilol)
Normodyne, Trandate (labetalol)
Name the direct vasodilators
Apresoline (hydrazoline)
Loniten (minoxidil)
Name the non-dihydropyridine calcium channel blockers (brand and generic)
Cardizem SR, Cardizem CD, Dilacor XR, Tiazac (diltiazem)
Calan, Isoptin (verapamil IR)
Calan SR, Isoptin SR (verapamil LA)
Covera HS, Verelan PM (verapamil-Coer)

Also are Class IV antiarrhythmics - more selective for cardiac tissue
Name the dihydropyridine calcium channel blockers (brand and generic)
Norvasc (amlodipine)
Plendil (felodipine)
DynaCirc, DynaCirc CR (isradipine)
Cardene SR (nicardipine)
Procardia XL, Adalat CC (nifedipine)
Sular (nisoldipine)
Name the ACE-I's
Lotensin (benazepril)
Capoten (captopril)
Vasotec (enalapril)
Monopril (fosinopril)
Prinivil, Zelstril (lisinopril)
Univasc (moexipril)
Aceon (perindopril)
Accupril (quinapril)
Altace (ramipril)
Mavik (trandolapril)
Name the ARB's
Atacand (candesartan)
Teveten (eprosartan)
Avapro (irbesartan)
Cozaar (losartan)
Benicar (olmesartan)
Micardis (telmisartan)
Diovan (valsartan)
What parenteral drugs are used for the treatment of hypertensive emergencies?
- sodium nitroprusside, nicardipine, fendolopam, nitroglycerin, enalaprilat, hydralazine, diazoxide
Adrenergic inhibitors:
- labetalol, esmolol, phentolamine
What agents are used to treat hypertensive urgencies?
Captopril, clonidine, labetalol
Toprol XL
metoprolol succinate
amlodipine + benazepril
Diovan, Diovan HCT
valasartan +/- hydrochlorothiazide
losartan + HCTZ
Benicar, Benicar HCT
olmesartan +/- HCTZ
irbesartan + HCTZ
Inderal LA
Catapres TTS