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68 Cards in this Set
- Front
- Back
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Treatment for HF and HTN |
ACEI
ARB BB Diuretic Aldosterone antagonist |
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Treatment for MI and HTN
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ACEI
BB Aldosterone antagonist |
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Treatment for HTN and high risk of CAD
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ACEI
BB Diuretic CCB |
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Treatment for DM and HTN
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ACEI
ARB BB CCB Diuretic |
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Treatment for CKD and HTN
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ACEI
ARB |
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Treatment for recurrent stroke prevention and HTN
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ACEI
Diuretic |
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Hypertension Lifestyle Modifications
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Maintain normal weight and waist circumference
DASH diet Reduce sodium intake to = 2.4 g/d Increase physical activity Moderate alcohol consumption Smoking cessatino Control BG and Lipids to reduce CV disease risk |
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Chorthalidone
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Thalitone
Thiazide diuretic 12.5-25 mg (Max 100 mg/d) |
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Hydrochlorothiazide (HCTZ)
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Microzide, Oretic
Thiazide diuretic 12.5-25 mg/d (Max 100 mg/d) |
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Thiazide Diuretic Info
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Inhibits Na+ reabsorption in distal convoluted tubule
Contra - allergy to sulfonamides, anuria, renal decompensation Metolazone may work in pts w/ CrCl < 30 mL/min |
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Thiazide Diuretic Adverse Effects
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Hypokalemia
Hyperuricemia (can precipitate gout) Elevated lipids Hyperglycemia Hypercalcemia Hyponatremia, hypomagnesemia Dizziness, photosensitivity, rash, hypochloremic alkalosis |
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Furosemide
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Lasix
Loop Diuretic 20-80 mg QD or divided Oral equivalency dose - 40 mg IV:PO ratio --- 1:2 |
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Loop Diuretic Info
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Inhibit reabsorption of Na+ and Cl- in the thick ascending loop of Henle
*Used more for edema BLACK BOX - Profound diuresis --- fluid and electrolyte depletion Contra - anuria Warning - sulfa allergy (excludes ethacrynic acid) |
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Loop Diuretic Adverse Effects
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Hypokalemia
Orthostatic hypotension Decreased sodium, magnesium, chloride, calcium Increased uric acid, blood glucose, TGs, total cholesterol Photosensitivity Ototoxicity |
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Diuretic Interactions
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All antihypertensives increase risk of hypotension
Decrease lithium clearance (increases risk of toxicity) NSAIDs - decrease effectiveness of diuretics Loops - avoid ototoxic drugs; don't use ethacrynic acid w/ other loop diuretics Eplerenone - avoid CYP 3A4 inhibitors |
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Triamterene
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Dyrenium
Potassium-sparing diuretics 50-100 mg QD |
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Maxzide, Dyazide
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Triamterene
+ HCTZ |
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Potassium-sparing diuretics Info
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Compete w/ aldosterone in the distal convoluted tubule and collecting ducts
BLACK BOX - tumor risk w/ spironolactone Contra - renal impairment (CrCl < 30 mL/min) Monitor K+, BP, renal function |
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Spironolactone
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Aldactone
Potassium-sparing diuretic HF - 12.5-25 mg QD HTN - 25-50 mg QD SE - gynecomastia, breast tenderness, impotence |
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Potassium-Sparing Diuretic Adverse Effects
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Hyperkalemia
Increased SCr Hyperchloremic metabolic acidosis |
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Benazepril
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Lotensin
ACEI 10-40 mg QD-BID |
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Enalapril, Enalaprilat (IV)
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Vasotec
ACEI 5-40 mg QD-BID |
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Lisinopril
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Prinivil, Zestril
ACEI 5-40 mg QD |
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Quinapril
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Accupril
ACEI 10-80 mg QD |
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Ramipril
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Altace
ACEI 2.5-20 mg QD |
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ACEI Info
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Inhibit angiotensin-converting enzyme, thus prevent conversion of angiotensin I to angiotensin II
BLACK BOX - pregnancy (CATEGORY D); d/c as soon as detected Monitor BP, K+, renal function |
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ACEI Adverse Effects
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Cough
Angioedema Hyperkalemia Hypotension Acute renal insufficiency |
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ACEI Contraindications and Warnings
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Contra - angioedema, bilateral renal artery stenosis, concurrent use of aliskiren in diabetic patients; pregnancy
Warnings - concurrent use of aliskiren or ARB (generally avoid the combination) Pregnancy Category D |
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Valsartan
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Diovan
ARB 80-320 mg QD |
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Losartan
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Cozaar
ARB 25-100 mg QD |
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Olmesartan
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Benicar
ARB 20-40 mg QD Causes sprue-like enteropathy --- severe, chronic diarrhea w/ substantial weight loss |
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ARB Info
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Block angiotensin II from binding to AT-1 receptor on vascular smooth muscle
Same Contraindications as ACEI BLACK BOX - pregnancy (CATEGORY D) Monitor BP, K+, renal function |
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ARB Adverse Effects
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Hyperkalemia, angioedema, hypotension, acute renal insufficiency
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Direct Renin Inhibitor
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Aliskiren (Tekturna)
BLACK BOX - pregnancy (CATEGORY D) Contra - angioedema, bilateral renal artery stenosis SE - hyperkalemia, angioedema, hypotension Metabolized by CYP 3A4 |
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HTN Med used 1st line for pregnancy
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Labetalol
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Atenolol
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Tenormin
Beta-1 selective blocker 25-100 mg QD Pregnancy Category D*** |
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Metoprolol
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Tartrate (Lopressor); Succinate (Toprol XL)
IR - BID XL - QD HTN - 25-400 mg/d HF - 12.5-25 mg/d (Max 200 mg/d) Take IR w/ food |
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Nebivolol
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Bystolic
Beta-1 selective blocker w/ nitric oxide-dependent vasodilation 5-40 mg QD (CrCl < 30 mL/min or moderate liver impairment, start at 2.5 mg QD) SE - HA, fatigue |
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Propranolol
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Inderal LA, InnoPran XL
Nonselective beta-blocker 40-480 mg QD |
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Carvedilol
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Coreg, Coreg CR
Nonselective alpha and beta blocker Take w/ food HTN - IR 6.25 mg BID (max 25 mg BID) CR 20 mg QD (max 80 mg QD) HF - IR 3.125 mg BID (max 50 mg BID > 85 kg, 25 mg BID < 85 kg) CR 10 mg/d (max 80 mg/d) |
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Labetalol
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Trandate
Nonselective alpha and beta blocker 1st line for HTN in pregnancy 200-2400 mg/d |
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Beta Blocker Info
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Inhibit effect of catecholamines (esp. NE) at the beta adrenergic receptors
BLACK BOX --- don't withdraw abruptly Contra - sinus bradycardia, 2nd or 3rd degree heart block, sick sinus syndrome cardiogenic shock, active asthma exacerbation |
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Intrinsic Sympathomimetic Agents (ISA)
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Acebutolol
Carteolol Penbutolol Pindolol (CAPP); less risk of bradycardia |
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Beta Blocker Adverse Effects
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Bradycardia
Hypotension Fatigue Dizziness Depression, decreased libido, impotence Hyperglycemia; masks s/s of hypoglycemia Increased TGs, decreased HDL |
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Beta Blocker Interactions
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Enhances effects of insulin and oral hypoglycemics
Masks s/s of hypoglycemia (mostly w/ nonselectives) Caution in bradycardic drugs Nebivolol, Coreg --- both are 2D6 substrates Coreg - can increase digoxin and cyclosporine levels |
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Calcium Channel Blocker MOA
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Inhibits Ca ions from entering the "slow" channels or voltage-sensitive areas of vascular smooth muscle +/- myocardium
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Amlodipine
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Norvasc
Dihydropyridine CCB 2.5-10 mg/d |
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Nifedipine
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IR (Procardia); ER (Adalat CC, Procardia XL)
Dihydropyridine CCB 30-90 mg/d Don't use SL nifedipine - may increase risk of MI |
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Nicardipine
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Cardene
Dihydropyridine CCB 30-60 mg/d |
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Dihydropyridine CCB Adverse Effects
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Peripheral edema
HA, flushing Tachycardia/reflex tachycardia Gingival hyperplasia |
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Types of CCBs
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Dihydropyridine --- cause peripheral vasodilation; used for HTN and Prinzmetal's angina
Nondihydropyridine --- used primarily for arrhythmias, sometimes for HTN and angina; negative inotropes and chronotropes (decrease contraction force and HR) |
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Diltiazem
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Cardizem, Tiazax, Cartia XT
Nondihydropyridine CCB 120-420 mg QD 60-240 mg BID 30-120 mg TID |
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Verapamil
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Calan, Covera HS, Verelan
Nondihydropyridine CCB 100-300 mg QD 120-180 mg BID 40-120 mg TID |
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Nondihydropyridine CCB Adverse Effects and Contraindications
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SE - edema, HA, AV block, bradycardia, hypotension, arrhythmias, HF, gingival hyperplasia
- Verapamil --- Constipation Contra - severe HTN, 2nd or 3rd degree heart block, sick sinus syndrome, cardiogenic shock, acute MI, pulmonary congestion |
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Nondihydropyridine CCB Interactions
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Diltiazem and verapamil are 3A4 substrates and inhibitors
Avoid grapefruit juice |
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Lotrel
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Amlodipine + Benazepril
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Prinzide, Zestoretic
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Lisinopril + HCTZ
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Hyzaar
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Losartan + HCTZ
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Ziac
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Bisoprolol + HCTZ
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Dyazide, Maxzide
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Triamterene + HCTZ
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Terazosin
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Hytrin
Alpha Blocker 1-20 mg QHS |
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Doxazosin
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Cardura, Cardura XL
Alpha Blocker 1-16 mg QHS |
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Alpha Blocker Info
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Bind to alpha-1 receptors --- results in vasodilation of arterioles and veins
Used mostly for BPH; NOT 1st line for HTN SE - orthostatic hypotension, 1st dose syncope, dizziness, fatigue, HA, edema, priapism Caution w/ concurrent use of PDE-5 inhbitors |
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Direct Vasodilator Info
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Hydralazine, Minoxidil
Direct vasodilation of arterioles w/ little effect on veins Minoxidil SE - Edema, hirsutism |
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Hydralazine
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10-75 mg PO QID (max 300 mg/d)
10-20 mg IV Q4-6 hr PRN SE - HA, reflex tachycardia, anorexia, palpitations ** lupus-like syndrome** |
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Centrally-Acting Alpha-2 Agonists
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Stimulates alpha-2 receptors --- reduced sympathetic outflow from the CNS
SE - bradycardia, dry mouth, drowsiness and sedation, hypotension, depression, psychotic rxns, nasal stuffiness, sexual dysfunction **Must taper** |
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Clonidine
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Catapres
Centrally acting alpha-2 agonist 0.1-0.3 mg BID PO; 0.1-0.3 mg/24 hr patches Apply patches weekly |
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Methyldopa
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Centrally acting alpha-2 agonist
Can use during pregnancy 250 mg BID-TID (max 3 g/d) |
