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4 Cards in this Set

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Initial Drug Therapy
Thiazide like drugs

Hydrochlorothiazide is most common, or Indapamide

Titrate for 1-2 months because drugs take time to start working, remember to check for sulfa allergies
only 1 drug if stage 1 hypertension
Drug Combination Therpay
Thiazide +
ACEi-bradykinin effect, change if dry cough stop if angioedema
ARB-See above
Beta Blockers-if HR already 50-60 don't want to use cause of bradycardia effects
Calcium Channel Blockers-Verapamil is cardiospecific so good for patients with arrhythmias, "dipines" target vessels
If stage 1 start with thiazide, then add others if no improvement

If stage 2 start with 2 drugs
Additional Drugs
Thiazide +
first ACEi, ARB
Use beta blocker first if there is co-morbidity
Calcium channel blockers are 2nd, 3rd line
Menoxodil, clonidine-after all other drugs have been tried
If stage 1 start with thiazide, then add others if no improvement

If stage 2 start with 2 drugs
Special Cases
Ischemic Heart Disease-start with beta blocker, verapamil or ditiazem. If MI or post MI use beta blocker and ACEi

Heart Failure-ACEi and Beta Blocker (LV dysfunction requires ACEi (prevent angiotensin II), BB (stop renin and neurohormonoal), spironolactome (aldosterone antagonist) and loop)

Diabetic Hypertension-Two or more, Thiazide, BB, ACEi, CCB

Kidney Disease with low GFR and HTN-ACEi or ARB+loop, use ACEi only if chornic, if acute ACEi will make it WORSE

Stroke-ACEi (best data) and thaizide