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214 Cards in this Set
- Front
- Back
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What is the treatment schedule for a pt with DM?
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1) ACE-I or ARB
2) Ca-Channel Blocker 3) Diuretic 4) β-Blocker Note: Both ACE-Is & ARBs are additionally beneficial due to renal protection |
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What is the treatment schedule for a pt with HF?
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1) ACE-I or ARB
2) Beta-Blocker 3) Aldosterone blocker 4) Diuretics (Loop) are used for symptoms |
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What is the treatment algorithm for angina?
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- β-Blockers
- Calcium Channel Blockers |
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What is the treatment algorithm for atrial tachycardia?
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- β-Blockers
- Non-dihydropyridine CCBs - ACE-I - ARBs |
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What is the treatment algorithm for atrial fibrillation?
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- β-Blockers
- Non-dihydropyridine CCBs - ACE-I - ARBs |
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What is the treatment algorithm for Cyclosporine-induced HTN?
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- Calcium Channel Blockers
- Thiazide Diuretics (possibly) |
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What is the treatment algorithm for dislipidemia?
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- α-blockers
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What is the treatment algorithm for prostatism (BPH)?
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- α-blockers
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What is the treatment algorithm for essential tremor?
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- Non-selective β-blockers
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What is the treatment algorithm for hyperthyroidism?
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- β-blockers
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What is the treatment algorithm for migraine?
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- Non-cardioselective β-blockers
- Non-dihydropyridine CCBs |
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What is the treatment algorithm for osteoporosis?
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- Thiazides
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What is the treatment algorithm for perioperative HTN?
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- β-blockers
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What drug class(es) are contraindicated in patients with a co-morbid condition such as bronchospastic disease?
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- β-blockers
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What drug class(es) are contraindicated in patients with a co-morbid condition such as depression?
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- β-blockers
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What drug class(es) are contraindicated in patients with a co-morbid condition such as dyslipidemia?
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- β-blockers
- Diuretics |
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What drug class(es) are contraindicated in patients with a co-morbid condition such as DM (Type I/II)?
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- β-blockers
- High-dose diuretics |
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What drug class(es) are contraindicated in patients with a co-morbid condition such as gout?
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- Diuretics
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What drug class(es) are contraindicated in patients with a co-morbid condition such as HF?
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- β-blockers **Except carvediolol, metoprolol & bisoprolol**
- Calcium Channel Blockers **Except amlodipine & felodipine** |
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What β-blockers can you use in heart failure?
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- Carvediolol
- Metoprolol - Bisoprolol |
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What Calcium Channel Blockers can you use in heart failure?
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- Amlodipine
- Felodipine |
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Name the four classes of diuretics.
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1) Carbonic Anhydrase Inhibitors
2) Thiazides 3) Loop 4) K+ sparing |
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Name an example diuretic from the class Carbonic Anhydrase Inhibitors
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Acetazolamide
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Name an example diuretic from the class thiazides
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Hydrochlorothiazide & Chlorthalidone
**Hydrochlorothiazide is one heck of a Scrabble word** |
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Name an example diuretic from the class loop diuretics
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Furosemide & Bumetanide
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Name an example diuretic from the class potassium-sparing diuretics
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Triamterene & Spironolactone
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Which is the most effect class of diuretics when used alone?
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Thiazides
- Loops and K-sparing are only weakly effective |
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What are four advantages of diuretics compared to other classes?
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1) Cheap
2) Q Daily dosing 3) Lots of data 4) Possible reduction in hip fractures |
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What are six disadvantages of diuretics?
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1) Electrolyte Disturbances - Monitor SCr and K
2) Diabetes - Effects glucose 3) Gout - Effects urea 4) Hyperlipidemia - Effects cholesterol 5) Thiazides lose efficacy as kidney function decreases 6) Orthostasis, especially in the elderly |
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What is happens when a pt takes HCTZ and cholestryamine?
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Reduced HCTZ absorption
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What is happens when a pt takes a diuretic and lithium?
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Serum lithium concentration is reduced
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What is happens when a pt takes a diuretic and a NSAID?
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NSAIDS antagonize the effects of diuretics, reducing diuresis
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What is happens when a pt takes a diuretic and digoxin?
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Increases the risk of digoxin toxicity
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What is happens when a pt takes a diuretic and sulfonylureas?
Sulfonylureas are used in DM management and include drugs like glipizide |
There is reduced sulfonylurea efficacy
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What is happens when a pt takes a diuretic and cylcophosphamide, fluorouracil or methotrexate?
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There is myelosuppresion
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What is the three mechanisms of action of β-blockers?
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1) Reduces CO via Negative Chronotropic and Inotropic Effects
2) Reduces Renin Release 3) Reduce Pulmonary Vascular Resistance |
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How do we differentiate among the different β-blockers?
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By the following:
1) Cardioselectivity 2) ISA - Intrinsic Sympathomimetic Activity 3) Metabolism |
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Name an example of Non-Selective, -ISA β-blockers
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- Propranolol
- Timolol - Nadolol |
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Name an example of Non-Selective, +ISA β-blockers
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- Pindolol
- Carteolol - Penbutolol |
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Name an example of Selective, -ISA β-blockers
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- Atenolol
- Metoprolol - Bisoprolol - Betaxolol |
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Name a Selective, +ISA β-blockers
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- Acebutolol
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What β-blockers are primary excreted via the liver?
i.e. Consider liver function |
- Propranolol
- Metoprolol - Labetaolol |
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What β-blockers are primary excreted via the kidney?
i.e. Consider renal function |
- Atenolol
- Nadolol |
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What are six advantages of β-blockers?
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1) Modest Cost
2) QD/BID dosing 3) Lower CAD mortality and progression 4) Lower post-MI mortality (Not +ISA drugs) 5) Lowers morbidity and mortality in CHF (metoprolol, bisoprolol, carvediolol) 6) No routine lab monitoring |
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What β-blockers are good for CHF?
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- Metoprolol
- Bisoprolol - Carvediolol |
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What is the disadvantage of β-blockers and pts with DM?
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Causes glucose intolerance while masking hypoglycemia
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What are eight disadvantages of β-blockers?
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1) DM issues
2) May increase lipids 3) CI in asthma/COPD 4) Caution in CHF 5) Angina with ISA agents 6) Sexual dysfunction 7) Decreased exercise capacity 8) Withdrawl syndrome (rebound HTN) |
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What are four common side effects of β-blockers?
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1) Bradycardia
2) Tiredness 3) Cold extremities 4) CNS |
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What β-blockers are CI in patients with angina?
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ISA Agents
- Pindolol - Carteolol - Penbutolol - Acebutolol |
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What is Nebivolol?
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Bystolic - Newest β-blocker
- Selective β1 antagonist - Vasodilation via NO release - Similar tolerance to carvediolol - Possible better side effect profile (glucose in DM pt) |
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Carvediol
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Coreg
A β-blocker |
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Tenormin
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Atenolol
A selective β-blocker |
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Toprol
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Metoprolol
A selective β-blocker |
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Coreg
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Carvediolol
A β-blocker |
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Atenolol
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Tenormin
A selective β-blocker |
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Metoprolol
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Toprol XL (Extended release form)
A selective β-blocker |
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Propranolol
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Inderal
A non-selective β-blocker |
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Inderal
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Propranolol
A non-selective β-blocker |
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What are the main concerns with the usage of β-blockers?
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They do not reduce central SBP as well and that some, especially atenolol, do not lower stroke risk as well as other classes
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What is the drug interaction between cimetidine and metoprolol, labetaol and propranolol?
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It decreases the metabolism of these drugs
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What is the drug interaction between amiodarone and β-blockers?
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Causes hypotension and bradycardia
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What is the drug interaction between ritonavir and β-blockers?
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Leads to increased metoprolol concentrations
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What is the drug interaction between digoxin and β-blockers?
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AV nodal block
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What is the drug interaction between 2D6 inhibitors (SSRIs) and β-blockers?
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Increased metoprolol concentrations
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What is the drug interaction between diltiazem/verapamil and β-blockers?
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The following is increased:
1) Bradycardia 2) Hypotension 3) AV Node conduction abnormalities |
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What is the MOA of ACE inhibitors?
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It inhibits the converison of angiotensin I to angiotensin II
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What are example drugs of the class ACE-I?
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- Ramipril
- Enalapril - Lisinopril - Benazepril ~ Basically anything that ends in -pril |
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What class of drug promotes the regression of left ventricular hypertrophy?
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ACE-Is
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What are the main benefits of ACE-Is?
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1) Regression of left ventricular hypertrophy, improving sys and dia function
2) ↓ CHF mortality 3) ↓ DM nephropathy progression 4) ↓ CKD progression 5) ↓ mortality from CV causes (MI, stroke) |
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What is the main concerns pertaining to fluid balance with a patient taking an ACE-I?
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1) Salt substitutes (contain K)
2) K supplements and K sparing diuretics |
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What are the advantages of ACE-Is?
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1) Highly effective in Caucasians and younger pts - AA ↑ response w/ diuretic
2) Lipid neutral 3) Renal protective 4) ↑ survival in HF 5) ↓ mortality in HTN similar to conventional therapy |
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What are the disadvantages of ACE-Is?
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1) ↑ hypotensive response in renovascular HTN, CHF, hypovolemia, + of diuretic
2) Cough (fairly common) 3) SCr and K monitoring |
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What conditions are ACE-I CI in?
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- Pregnancy
- Bilateral renal artery stenosis (RAS) - leads to acute renal failure |
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What are the common SE of ACE-Is?
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1) Rash
2) Angioedema 3) Hyperkalemia 4) Renal Failure (if RAS present) |
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What two drug classes have the annoying side effect of cough?
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ACE-I and ARBs
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Altace
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Ramipril
ACE-I |
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Vasotec
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Enalapril
ACE-I |
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Ramipril
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Altace
ACE-I |
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Enalapril
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Vasotec
ACE-I |
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Zestril
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Lisinopril
ACE-I |
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Prinivil
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Lisinopril
ACE-I |
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Lisinopril
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Zestril or Prinivil
ACE-I |
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Benazepril
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Lotensin
ACE-I ~Get it, low-tensin... ok maybe not |
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Lotensin
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Benazepril
ACE-I |
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What is the MOA of angiotensin II receptor blockers (ARBs)?
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It competitively inhibits Angiotensin II at the AT1 receptor
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Cozaar
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Losartan
ARB |
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Losartan
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Cozaar
ARB |
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Valsartan
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Diovan
ARB |
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Diovan
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Valsartan
ARB |
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Atacand
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Candesarten
ARB |
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Candesarten
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Atacand
ARB |
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What are three advantages to using an ARB?
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1) Similar benefits to ACE-I: ↓ CV mortality, DM nephropathy, etc
2) No lipid or glucose changes 3) Useful in combo with other anti-HTN drugs |
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What are three disadvantages to using an ARB?
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1) Expensive
2) Cancer and CV event concerns 3) Has same ACE-I SE profile, although the cough is not quite as bad |
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What is the MOA of Calcium Channel Blockers?
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Smooth muscle relaxation (vasodilation) via negative inotropic and chronotropic effects
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What are the three classes of Ca-Channel Blockers and example drugs?
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- Benzothiazepines (Diltiazem)
- Phenyalkylamines (Verapamil) - Diphydrophyridines (Nifedipine, Felodipine, Amlodipine) |
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What are examples of non-Diphydrophyridines?
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Diltiazem and Verapamil
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What are the effects of non-Diphydrophyridines Ca-Channel Blockers?
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1) Coronary and systemic vasodilation
2) Decreased myocardial contractility 3) Decreased HR 4) Decreased AV node conduction |
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What are the effects of Diphydrophyridines Ca-Channel Blockers?
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1) Coronary and systemic vasodilation
2) None or decreased myocardial contractility 3) None or increased HR 4) NO EFFECT ON AV NODE |
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What is the primary risk with short-acting Ca-Channel Blockers?
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Possible increased mortality via increased risk in MI via reflex tachycardia
Namely with nifedipine |
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What are five advantages to using Ca-Channel Blockers?
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1) Good response in elderly for systolic HTN
2) Effective in CAD, reduces angina sx 3) QD dosing 4) Additive BP effects w/ ACE-I, BB 5) Lipid/Glucose Neutral |
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What are three disadvantages to using Ca-Channel Blockers?
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1) Increased MI risk with short-acting agents
2) More expensive 3) Caution in heart failure (amlodipine, felodipine only) |
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What are the side effects of Ca-Channel Blockers?
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1) Constipation
2) Bradycardia 3) AV Block 4) CHF 5) Edema (Peripheral) 6) Dizziness 7) HA 8) Tachycardia (esp dihydrophyridines) 9) Gingival hyperplasia (nifedipine) |
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Which HTN drug causes gingival hyperplasia?
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The Ca-Channel Blocker Nifedipine
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What are the only Ca-Channel Blockers you can use in pts with heart failure?
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Amlodipine and Felodipine
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Amlodipine
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Norvasc
Calcium Channel Blocker |
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Norvasc
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Amlodipine
Calcium Channel Blocker |
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Nifedipine
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Procardia, Nifediac, Adalat
Calcium Channel Blocker |
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Procardia
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Nifedipine
Calcium Channel Blocker |
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Adalat
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Nifedipine
Calcium Channel Blocker |
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Nifediac
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Nifedipine
Calcium Channel Blocker |
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Plendil
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Felodipine
Calcium Channel Blocker |
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Felodipine
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Plendil
Calcium Channel Blocker |
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Verapamil
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Calan
Calcium Channel Blocker |
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Calan
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Verapamil
Calcium Channel Blocker |
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Diltiazem
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Cardizem or Cartia
Calcium Channel Blocker |
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Cardizem
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Diltiazem
Calcium Channel Blocker |
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Cartia
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Diltiazem
Calcium Channel Blocker |
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What is the MOA of alpha-1 antagonists?
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These drugs inhibit efferent sympathetic activity.
Selective alpha-1 antagonists avoid the reflex tachycardia associated with non-selective alpha antagonists |
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Doxazosin
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Cardura
Alpha-1 Antagonist |
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Cardura
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Doxazosin
Alpha-1 Antagonist |
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Minipress
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Prazosin
Alpha-1 Antagonist |
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Prazosin
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Minipress
Alpha-1 Antagonist |
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What are advantages to using a Alpha-1 Antagonist?
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- Positive impact on lipids
- Improves BPH symptoms |
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What HTN medication class is also effective in treating BPH?
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Alpha-1 Antagonists
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What are disadvantages to using a Alpha-1 Antagonist?
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- Hypotension with 1st dose (take qHS)
- Not recommended as initial mono-tx |
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What are side effects associated with using a Alpha-1 Antagonist?
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- HA
- Fatigue - Drowsiness - Weakness - Vivid dreams |
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Why did the ALLHAT study not recommend a Alpha-1 Antagonist for initial HTN therapy?
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Due to an increased risk in heart failure
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What is the MOA for Central Alpha-2 Agonists?
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Stimulate central alpha-2 receptors which inhibit sympathetic outflows
Leads to decreased NE, HR, CO and PVR |
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Clonidine
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Catapres
Central Alpha-2 Agonists |
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Catapres
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Clonidine
Central Alpha-2 Agonists |
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Methyldopa
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Aldomet
Central Alpha-2 Agonists |
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Aldomet
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Methyldopa
Central Alpha-2 Agonists |
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What are the advantages to using Central Alpha-2 Agonists?
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- Cheap
- Neutral on lipids - Available as a patch - Methyldopa is safe in pregnancy |
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What HTN medication is first line for a patient who is pregnant?
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Methyldopa
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What are the disadvantages to using Central Alpha-2 Agonists?
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- Withdrawl symptom; rebound HTN due to increase in NE
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What are the side effects of Central Alpha-2 Agonists?
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- CNS effects (sedation, lowered alertness, depression)
- Dry mouth - Bradycardia - Sodium/fluid retention (methyldopa) |
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What is the MOA of Renin Inhibitors?
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Block renin (hard to believe, I know)
Prevents the conversion of angiotensinogen to angiotensin I |
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Aliskiren
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Tekuturna
Renin Inhibitor |
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Tekuturna
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Aliskiren
Renin Inhibitor |
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What are the side effects to renin inhibitors?
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- GI (diarrhea)
- Cough - Rash - Hyperuricemia - Gout - Kidney Stones |
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What are the advantages to using a renin inhibitor?
|
- Well-tolerated
- No dose reduction in elderly or hepatic/mild-renal impairment - Safe in combo with ARB/CCB/thiazide - Little hyperalkemia - Reduced incidence of: rash, cough, angioedemia when compared to ACE-I/ARB |
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What are the disadvantages to using a renin inhibitor?
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- Expensive
- Avoid combo with ACE-I / ARB in diabetics - High fat meal reduces absorption - Half-life (Qdaily dosing) - Metabolized by 3A4 |
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What is the MOA of direct vasodilators?
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- Cause direct arteriolar smooth muscle relaxation
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What drug class is known as the afterload reducing agents and what does this mean?
|
Direct vasodilators
- Decrease systemic pressure in the arterial system - Impedance to myocardial contractility |
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Hydralazine
|
Apresoline
Direct Vasodilator |
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Apresoline
|
Hydralazine
Direct Vasodilator |
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Minoxidil
|
Direct Vasodilator
|
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What are the advantages to using direct vasodilators?
|
- Cheap
- Added with isosorbide is useful in CHF |
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What are the disadvantages to using direct vasodilators?
|
- Reflex sympathetic activation leads to increased HR & CO, renin release
- Increase in angina in pts with CAD |
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What are the side effects to direct vasodilators?
|
- Hypertrichosis with Minoxidil (Remember a hairy Heidman)
- Lupus-like syndrome with Hydralazine - Dermatitis - Drug Fever - Peripheral neuropathy - Hepatitis - HA |
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What is the MOA for Postganglionic Sympathetic Inhibitors?
|
These deplete NE from postganglionic nerve terminals which inhibit NE in response to sympathetic stimulation
Decrease CO and PVR |
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What are Postganglionic Sympathetic Inhibitors usually reserved for in HTN management?
|
Almost always for refractory HTN
|
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|
Guanethidine
|
Ismelin
Postganglionic Sympathetic Inhibitors |
|
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Guanadrel
|
Hylorel
Postganglionic Sympathetic Inhibitors |
|
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Hylorel
|
Guanadrel
Postganglionic Sympathetic Inhibitors |
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Ismelin
|
Guanethidine
Postganglionic Sympathetic Inhibitors |
|
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What are the advantages to using
Postganglionic Sympathetic Inhibitors? |
- Cheap
- Highly effective |
|
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What are the disadvantages to using
Postganglionic Sympathetic Inhibitors? |
- Orthostatic Hypotension
- Syncope |
|
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What are the side effects for
Postganglionic Sympathetic Inhibitors? |
- Impotence
- Diarrhea - Weight Gain |
|
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What is the MOA for Reserpine?
|
It depletes NE from sympathetic nerve endings, blocking transport of NE into the storage granules.
This decreases sympathetic tone and depletes catecholamines |
|
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What are the advantages to using Reserpine?
|
- Cheap
- Highly efficacious |
|
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What are the disadvantages to using Reserpine?
|
- ***Depression
- Sedation - Na/Fluid Retention - Diarrhea |
|
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What was the purpose of the ALLHAT Trial?
|
Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial
To test whether or not there are differences between classes of anti-HTN agents |
|
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What is the BP goal of the ALLHAT trial?
|
<140/90 mmHg
|
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What was type of control was indicated as needed for patients by the ALLHAT trial?
|
Therapy requiring at least 2 agents is most likely required.
For diabetics, the name of agents is likely >2 drugs |
|
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What type of HTN is a unique characteristic of the elderly population?
|
Isolated systolic hypertension
|
|
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What drug class(es) do you use to treat Isolated Systolic Hypertension?
|
Beta-blockers
Watch changes to lipids, metabolic effects and renal/liver metabolism |
|
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What are considerations to be made in choosing a therapy in the elderly?
|
1) BP reduced slowly and cautiously
2) Lifestyle modifications 3) Target BP <140/90 4) Non-drug therapy 5) Agents started at lowest dose, then titrated 6) ADR more common |
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What class of drug would you want to avoid in elderly patients with CHF?
|
CCBs
|
|
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What is the HYVET study?
|
Hypertension in the Very Elderly Trial
Age >80 years old, HTN drugs were effective |
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What is pre-eclampsia?
|
An increase in BP (30/15) occurring after the 20th week of pregnancy.
Accompanied by edema, proteinuria or both |
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What drug classes are contraindicated in pregnant women?
|
ACE-Is and ARBs
|
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When are diuretics okay to use in pregnant women?
|
If they were used for chronic HTN prior to the pregnancy and if volume depletion is avoided
Do not use for women with pre-eclampsia |
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What are the drug therapy considerations in african american populations?
|
1) Use diuretics first
2) CCBs and alpha/beta blockers effective Avoid mono-tx with beta-blockers and ACE-I (less effective) |
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How do you treat resistant HTN?
|
- Use drugs with complimentary MOAs
- Assess efficacy of each new med - Discontinue those who do not work - Retry different combinations - Consider home BP readings |
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Define: "Hypertensive Emergency"
|
Acute, marked elevation
DBP > 120mmHG Leads to acute and progressing end-organ damage |
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Define: "Hypertensive Urgency"
|
Acute elevation in BP
Not immediately life-threatening and preventing no symptoms or progressing TOD |
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Define: "Malignant Hypertension"
|
Marked elevated BP that is a life-threatening emergency.
Possesses encephalopathy or nephropathy and papilledema |
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Define: "Accelerated Hypertension"
|
Similar to malignant HTN, but with no papilledema or other complications
Less rapidly progressive as well |
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What are the risk factors for a hypertensive crisis?
|
- Pheochromocytoma
- Renal Vascular Disease - Poorly-controlled accelerated essential HTN - Noncompliance with therapy |
|
|
Describe some of the signs and symptoms of a hypertensive crisis
|
CNS - HA, dizziness, N/V, anorexia, confusion, slurred speech, nystagmus
Heart - acute CHF, angina, MI Eyes - Blurred vision, loss of eyesight, funduscopic findings Kidneys - hematuria, proteinuria, pyelonephritis, elevated BUN & SCr |
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What are the different signs between urgency and emergency hypertensive crises?
|
Emergency crisis has TOD, CNS & Heart signs
Urgency crisis has minimal TOD, HTN associated with CAD, post/pre-op HTN |
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How are hypertensive emergencies treated?
|
Immediate BP reduction via IV agents
Reduce mean arterial BP by no more than 25% within minutes to 2 hours with a goal of 160/100 within 2-6 hours |
|
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How would you treat a hypertensive urgency?
|
Use of oral antihypertensives over several hours to days
|
|
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Under what circumstances would you not use oral hypertensives for a hypertensive urgency?
|
If:
1) Perioperative HTN 2) Intractable epistaxis 3) Sympathomimetic drug overdose 4) Increaed circulating catecolamines 5) MAOI-tyramine interaction |
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What oral agent should you avoid in a hypertensive crisis and why?
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Nifedipine
The short acting form has been associated with CVA, MI and death due to profound hypotensive response precipitating cerebral and coronary ischemia |
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Name the parenteral agents discussed in lecture
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1) Nitroprusside
2) Nitroglycerin 3) Hydralazine 4) Labetaolol 5) Esmolol 6) Fenoldopam 7) Phentolamine |
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What is the MOA of nitroprusside?
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Direct-acting arterial and venous vasodilator
Does not affect CO and increases myocardial contractility and HR in pts without CHF |
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What is the agent of choice when a minute to minute control is needed in a hypertensive crisis?
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Nitroprusside
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What are the disadvantages of nitroprusside?
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1) Metabolized to cyanide, then thiocyanate. Must monitor levels if infused for >72 hours
2) Increased risk of renal dysfunction |
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What are advantages to using nitroprusside?
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1) Rapid action
2) Fast on/off 3) Can adjust infusion to meet BP goal 4) No sedation |
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What are the side effects to nitroprusside?
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- Fatigue
- Nausea - Anorexia - Disorientation - Psychotic Behavior - Muscle Spasms |
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What is the MOA of nitroglycerin?
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... Just kidding
Aterial and Venous vasodilator which decreases preload, afterload and myocardial oxygen demand |
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What parenteral agent should be avoided in patients with hypertensive encephalopathy?
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Nitroglycerin
Increases intracranial pressure |
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What is a concern with prolonged use of nitroglycerin?
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Tachphylaxis after a use of >24-48 hours
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What is the MOA of hydralazine
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Arterial vasodilator which decreases TPR
Reduces dias > sys |
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What are the disadvantages to using hydralazine as a parenteral agent?
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- Increased intracranial pressure
- Increased pressure wave (avoid in aortic dissection) - Marked reflex tachycardia - Increased Oxygen demand - May precipitate chest pain in pts with CAD |
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What is the parenteral agent of choice for a hypertensive crisis in pregnant women?
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Hydralazine
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What is the parenteral agent of choice for a hypertensive crisis in patients with renal insufficiency?
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Hydralazine
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When is using parenteral labetaolol useful?
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In pts with CAD or MI as it reduces myocardial oxygen demand
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What is the MOA of Esmolol
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Fast-acting cardioselective beta blocker for IV use
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What are the advantages to using Esmolol?
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- Easily titratable
- Rapid onset and cessation - Metabolized by RBC's (no hepatic or renal involvement) |
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What are the side effects of Esmolol?
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- Diaphoresis
- Dizziness - Nausea |
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What is the MOA of Fenoldopam?
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Selective post-synaptic dopaminergic receptor aganoist
Peripheral vasodilator causing diuresis and natriuresis while increasing renal blood flow |
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What are the side effects to Fenoldopam?
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- HA
- N & V - Flushing - Increased IOP |
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What are the benefits to using Fenoldopam?
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As a parenteral agent it has an immediate onset of action with a similar efficacy to nitroprusside
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What is the MOA of Phentolamine?
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Non-selective alpha blocker
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What drug is most effective in a hypertensive crisis pertaining to excessive catecholamine?
i.e. pheochromocytoma, cocaine, amphetamine ODs, MAOI crisis |
Phentolamine
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What is the preferred hypertensive crisis treatment in a patient with acute pulmonary edema?
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Nitroprusside or Fenoldopam w/ nitroglycerine and a loop diuretic
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What is the preferred hypertensive crisis treatment in a patient with acute MI?
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Labetaolol or Esmolol in combination with nitroglycerine
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What is the preferred hypertensive crisis treatment in a patient with Hypertensive Encphalopathy?
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Labetalol, Nicardipine or Fenoldopam
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What is the preferred hypertensive crisis treatment in a patient with acute aortic dissection?
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Labetalol OR combo of nitroprusside or fenoldopam with Esmolol
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What is the preferred hypertensive crisis treatment in a patient with eclampsia?
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Hydralazine
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What is the preferred hypertensive crisis treatment in a patient with acute renal failure/microangiopathic anemia?
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Fenoldopam or nicardipine
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