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56 Cards in this Set

  • Front
  • Back
Thiazide diuretics
Chlorothiazide
Chlorthalidone
Hydrochlorothiazide
Polythiazide
Indipamide
Metolazone

Loop Diuretics
Bumetanide
Furosemide
Torsemide
K Sparing Diuretics
Amiloride
Triamterene
Aldosterone receptor Blockers
Eplerenone
Spironolactone
Beta blockers
Atenolol
Betaxolol
Bisoprolol
Metoprolol
Nadolol
Propranolol
Timolol
Beta Blockers with sympathomimetic activity
Acebutolol
Penbutolol
Pindolol
Combined alpha and Beta blockers
carvedilol
Labetalol
Ace Inhibitors
Benazepril
Captopril
Fosinopril
Moexipril
Perindopril
Quinapril
Ramipril
Trandolapril
Angiotensin II receptor blocker
Candesartan
Eprosartan
Irbesartan
Losartan
Olmesartan
Telmisartan
Valsartan
Calcium Channel blockers Nondihydropyridines
Diltiazem
Verapamil
Calcium Channel blockers Dihydropyridines
Amlodipine
Felodipine
Isradipine
Nicardipine
Nifedipiine
Nisoldipine
Alpha 1 Blockers
Doxazosin
Prazosin
Terazosin
Central Alpha 2 Agonists and other centrally Acting drugs
Clonidine
Methyldopa
Reserpine
Guanfacine
direct vasodilators
Hydralazine
Minoxidil
Contraindicated in:
Broncospastic disease
Peripheral Vascular disease
Beta blockers
Contraindicated in:
Depression
Beta Blockers
Central Alpha agonists
Reserpine
Contraindicated in:
Diabetes Mellitus
Dyslipidemias
Beta-Blockers
High Dose Diuretics
Gout
Diuretics
Contraindicated in:
2nd or 3rd degree heart block
Heart Failure
Beta Blockers
Calcium Channel blocker
Contraindicated in:
Liver disease
Labetalol Hydrochloride
Methyldopa
Contraindicated in:
Pregnancy
Renovascular disease
ACE Inhibitors
Angiotensin II Receptor Blockers
Contraindicated in:
Renal Insufficiency
Potassuim- Sparing agents
Methyldopa
Vasodilator
1st Line for Preggers
Can cause hematologic immunotoxicity and hemolytic anemia in some patients.

Labetalol
Increasingly preferred to Methyldopa apparently…
Sodium Nitroprusside
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


Nicardipine Hydrochloride
Vasodilator
Onset of Action: 5-10 min
Used in: Most Hypertensive Emergencies except Acute Heart Failure
Caution in: Coronary Ischemia
Adverse Effects: Local Phlebitis
Fenoldopam Mesylate
Vasodilator
Onset of Action: <5min
Used in: Most Hypertensive Emergencies
Caution in: Glaucoma
Nitroglycerin
Vasodilator
Onset of Action: 2-5min
Used in: Coronary Ischemia
Adverse Effects: Methemoglobinemia, Tolerance with prolonged use
Enalaprilat
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
Hydralazine Hydrochloride
Vasodilator
Onset of Action: 10-30 mins
Used in: Eclampsia
Adverse Effects: Aggravation of Angina
Labetalol Hydrochloride
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
Esmolol Hydrochloride
Adrenergic Inhibitor
Onset of Action: 1-2 min
Used in: Aortic Dissection, preoperative
Adverse Effects:
Hypotension, Nausea, Asthma, 1st degree Heart Bloc, Heart Failure
Phentolamine
Adrenergic Inhibitor
Onset of Action: 1-2 min
Used in: Catecholamine Excess
Diuretics Properties
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.
Thiazides properties
Diuretic
Adequate for mild hypertension
Loop Diuretics Properties
Used in moderate to severe hypotension.
CNS Activive Agents
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.
Clonidine
Centrally Acting agent (Alpha 2 receptor Agonist)
Adverse Effects: Salt retention, sedation, and rebound hypertension
Ganglion Blocking Drugs
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).

Nerve Terminal blockers
Reserpine
Guanetidine
Reserpine
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.
Guanetidine
Deplete and block release of norepinephrine stores
do not enter CNS but can cause orthostatic hypotension and sexual dysfunction.
Adrenoreceptor Blockers
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.
Older Vasodilators
Hydralazine and Minoxidil:
Orally active, used in chronic treatment and have more effect
on arterioles than veins.
Hydralazine
Rarely used at high doses: tachycardia, salt and water retention, and Lupus (uncommon at doses below 200 mg/d).
Minoxidil
Reserved for severe hypertension,
a potassium channel opener that hyperpolarizes and relaxes vascular smooth muscle, severe compensatory responses
hisurtism and pericardial abnormalities.

Vasodilators: Calcium Channel Blockers
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.
Diazoxide
Parenteral Vasodilator
Opens potassium Channels
Adverse Effects: Hypotension, hyperglycemia, and salt and water
Retention.
ACE Inhibitors Properties
Reduce levels of angiotensin II and aldosterone (and probably increase
in Bradykinin).
Adverse effects: cough (30%), renal damage in some patients and fetus.
Angiotensin Receptor Blockers
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.
Steps for Stepped Care of Hypertensive Patients
1. Lifestyle measures
2. Diuretics
3, Sympathoplegics
4. Vasodilators
5. ACE inhibitors
Pregnancy considerations
No ACE Inhibitors and Angiotensin II receptor Blockers
Methyldopa Widely used
Beta-blockers not recommended if early
African American considerations
Diuretics 1st choice
Ca blockers and Alpha/beta blockers effective
Do not respond well to ACE or Beta blocker alone
Elderly patients Considerations
Smaller Doses Slower Incremental increases in dosing
Close monitoring for side effects
Diabetes
ACE inhibitors, alpha-antagonists, and calcium antagonists can be effective, and
have few adverse effects on carbohydrate metabolism.
Hyperlipidemic
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.