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56 Cards in this Set
- Front
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Thiazide diuretics
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Chlorothiazide
Chlorthalidone Hydrochlorothiazide Polythiazide Indipamide Metolazone |
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Loop Diuretics
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Bumetanide
Furosemide Torsemide |
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K Sparing Diuretics
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Amiloride
Triamterene |
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Aldosterone receptor Blockers
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Eplerenone
Spironolactone |
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Beta blockers
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Atenolol
Betaxolol Bisoprolol Metoprolol Nadolol Propranolol Timolol |
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Beta Blockers with sympathomimetic activity
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Acebutolol
Penbutolol Pindolol |
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Combined alpha and Beta blockers
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carvedilol
Labetalol |
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Ace Inhibitors
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Benazepril
Captopril Fosinopril Moexipril Perindopril Quinapril Ramipril Trandolapril |
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Angiotensin II receptor blocker
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Candesartan
Eprosartan Irbesartan Losartan Olmesartan Telmisartan Valsartan |
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Calcium Channel blockers Nondihydropyridines
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Diltiazem
Verapamil |
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Calcium Channel blockers Dihydropyridines
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Amlodipine
Felodipine Isradipine Nicardipine Nifedipiine Nisoldipine |
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Alpha 1 Blockers
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Doxazosin
Prazosin Terazosin |
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Central Alpha 2 Agonists and other centrally Acting drugs
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Clonidine
Methyldopa Reserpine Guanfacine |
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direct vasodilators
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Hydralazine
Minoxidil |
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Contraindicated in:
Broncospastic disease Peripheral Vascular disease |
Beta blockers
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Contraindicated in:
Depression |
Beta Blockers
Central Alpha agonists Reserpine |
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Contraindicated in:
Diabetes Mellitus Dyslipidemias |
Beta-Blockers
High Dose Diuretics |
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Gout
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Diuretics
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Contraindicated in:
2nd or 3rd degree heart block Heart Failure |
Beta Blockers
Calcium Channel blocker |
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Contraindicated in:
Liver disease |
Labetalol Hydrochloride
Methyldopa |
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Contraindicated in:
Pregnancy Renovascular disease |
ACE Inhibitors
Angiotensin II Receptor Blockers |
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Contraindicated in:
Renal Insufficiency |
Potassuim- Sparing agents
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Methyldopa
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Vasodilator
1st Line for Preggers Can cause hematologic immunotoxicity and hemolytic anemia in some patients. |
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Labetalol
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Increasingly preferred to Methyldopa apparently…
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Sodium Nitroprusside
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Vasodilator
Action involves release of nitric oxide Onset of Action: Immediate Used in: Most Hypertensive Emergencies Caution in: high Intracranial pressure or azotemia Adverse Effects: Thiocynate and cyanide intoxication |
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Nicardipine Hydrochloride
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Vasodilator
Onset of Action: 5-10 min Used in: Most Hypertensive Emergencies except Acute Heart Failure Caution in: Coronary Ischemia Adverse Effects: Local Phlebitis |
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Fenoldopam Mesylate
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Vasodilator
Onset of Action: <5min Used in: Most Hypertensive Emergencies Caution in: Glaucoma |
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Nitroglycerin
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Vasodilator
Onset of Action: 2-5min Used in: Coronary Ischemia Adverse Effects: Methemoglobinemia, Tolerance with prolonged use |
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Enalaprilat
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Vasodilator
Onset of Action: 15-30 min Used in: Acute left ventricular failure Avoid in: Acute Myocardial Infarction Adverse Effects: Precipitous fall in pression in high renin states, variable response |
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Hydralazine Hydrochloride
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Vasodilator
Onset of Action: 10-30 mins Used in: Eclampsia Adverse Effects: Aggravation of Angina |
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Labetalol Hydrochloride
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Adrenergic Inhibitors
Onset of Action: 5-10 mins Used in: Most Hypertensive Emergencies Except Acute heart Failure Adverse Effects: Vomiting, Scalp Tingling, Bronchoconstriction, Dizziness, nausea, Heart Block, Orthostatic Hypertension |
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Esmolol Hydrochloride
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Adrenergic Inhibitor
Onset of Action: 1-2 min Used in: Aortic Dissection, preoperative Adverse Effects: Hypotension, Nausea, Asthma, 1st degree Heart Bloc, Heart Failure |
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Phentolamine
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Adrenergic Inhibitor
Onset of Action: 1-2 min Used in: Catecholamine Excess |
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Diuretics Properties
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Thiazides and Loop Diuretics
Lowers Blood Pressure by reduction of Blood Volume and a direct vascular effect that is not fully understood. Compensatory responses are minimal. Recommended as single therapy or combine with other agents For most Stage 1 hypertension and as part of drug combinations in Stage 2. •Adverse effects: hypokalemia, hyperlipidemia, hyperuricemia, and hyperglycemia. |
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Thiazides properties
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Diuretic
Adequate for mild hypertension |
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Loop Diuretics Properties
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Used in moderate to severe hypotension.
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CNS Activive Agents
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Alpha Selective agonists (Clonidine/Methyldopa) decrease in sympathetic outflow.
Readily enters CNS and reduce blood pressure by reducing cardiac output and/or vascular r esistance. |
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Clonidine
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Centrally Acting agent (Alpha 2 receptor Agonist)
Adverse Effects: Salt retention, sedation, and rebound hypertension |
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Ganglion Blocking Drugs
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Hexamethonium and trimethaphan
Are extremely powerful blood pressure lowering drugs however, severe adverse effects made their use obsolete. Toxicities reflects parasympathetic blockade (blurred vision, constipation, urinary hesitance, sexual dysfunction) and sympathetic blockade (sexual dysfunction, orthostatic hypotension). |
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Nerve Terminal blockers
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Reserpine
Guanetidine |
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Reserpine
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Deplete adrenergic nerve terminals of norepinephrine stores enters CNS and can cause behavioral depression.
Is still currently used in low doses as adjunct of other agents while guanetidine is now rarely used. |
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Guanetidine
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Deplete and block release of norepinephrine stores
do not enter CNS but can cause orthostatic hypotension and sexual dysfunction. |
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Adrenoreceptor Blockers
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Alpha and Beta blockers
Alpha 1-blockers (Prazosin) reduce vascular resistance and receptors in arterioles and venous return by blocking α1 receptors in venules. Non-selective agents (Phentolamine and phenoxybenzamine) are of no value in treatment of chronic hypertension (compensatory response like tachycardia). Beta-Blockers reduce cardiac output initially and vascular resistance after a few days. Among the most heavily used antihypertensive drugs. Slight increase in LDL and triglyceride. |
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Older Vasodilators
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Hydralazine and Minoxidil:
Orally active, used in chronic treatment and have more effect on arterioles than veins. |
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Hydralazine
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Rarely used at high doses: tachycardia, salt and water retention, and Lupus (uncommon at doses below 200 mg/d).
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Minoxidil
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Reserved for severe hypertension,
a potassium channel opener that hyperpolarizes and relaxes vascular smooth muscle, severe compensatory responses hisurtism and pericardial abnormalities. |
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Vasodilators: Calcium Channel Blockers
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Prototypes: Nifedipine, Verapamil, and Diltiazem.
Effective vasodilators, suitable for chronic use in hypertension. Mechanism of action and toxicities will be discussed in detail in a subsequent lecture. |
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Diazoxide
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Parenteral Vasodilator
Opens potassium Channels Adverse Effects: Hypotension, hyperglycemia, and salt and water Retention. |
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ACE Inhibitors Properties
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Reduce levels of angiotensin II and aldosterone (and probably increase
in Bradykinin). Adverse effects: cough (30%), renal damage in some patients and fetus. |
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Angiotensin Receptor Blockers
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Competitively inhibit angiotensin II at its AT receptor
As effective as ACE inhibitors. Low incident of cough but can also cause fetal renal toxicity. Reduce aldosterone levels and can cause potassium retention. |
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Steps for Stepped Care of Hypertensive Patients
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1. Lifestyle measures
2. Diuretics 3, Sympathoplegics 4. Vasodilators 5. ACE inhibitors |
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Pregnancy considerations
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No ACE Inhibitors and Angiotensin II receptor Blockers
Methyldopa Widely used Beta-blockers not recommended if early |
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African American considerations
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Diuretics 1st choice
Ca blockers and Alpha/beta blockers effective Do not respond well to ACE or Beta blocker alone |
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Elderly patients Considerations
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Smaller Doses Slower Incremental increases in dosing
Close monitoring for side effects |
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Diabetes
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ACE inhibitors, alpha-antagonists, and calcium antagonists can be effective, and
have few adverse effects on carbohydrate metabolism. |
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Hyperlipidemic
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Low dose diuretics have little effect on cholesterol and triglycerides.
Alpha-Blockers decrease LDL/HDL ratio. Calcium-channel blockers, ACE inhibitors,angiotensin II receptor blockers have little effect on lipid profile. |