10/26 Flashcards
CCBs
inhibit influx of Ca across cardiac and smooth muscle cell membranes, block high-voltage (L-type) Ca channels resulting in vasodilation
-DHP vs non-DHP (different pharmacology but same antihypertensive effect)
CCB indications
HTN, angina, arrythmias
CCB CI
preexisting bradycardia, conduction defects, HF due to systolic dysfunction
DHP CCBs
amlodipine, nifedipine
- more potent vasodilators than non-DHPs
- baroreceptor-mediated reflex tachycardia due to potent vasodilation
- do not alter AV conduction; not effective in supraventricular tachyarrythmias
DHP AE
more reflex sympathetic discharge: tachycardia, dizziness, HA, flushing, peripheral edema, gingival hyperplasia
non-DHP CCB CI
heart block
non-DHP CCB
diltiazem, verapamil
-decrease HR, slow AV node conduction (may treat supraventricular tachyarrythmias), ER products preferred in HTN (block SA and AV nodes: reduce HR)
non-DHP CCB AE
bradycardia, HA, dizziness, AV block, systolic HF, gingival hyperplasia, constipation
non-DHP CCB drug interactions
inc CCB effect: grapefruit juice, cimetidine, ranitidine
dec CCB effect: rifampin, phenobarbital
CCB monitoring parameters
BP, HR, peripheral edema, constipation
beta blockers
“olols”
- second line in JNC8: preferred for compelling indications - reduce mortality in pts w HF and useful in treatment of atrial fibrilation
- decrease HR and force of contraction -> dec CO
BB AE
bronchospasm, bradycardia, mask hypoglycemia, fatigue
vasodilators (direct arterial vasculature)
last line in HTN - reserved for patients w special indication or very difficult-to-control BP
fluid retention and reflex tachycardia are frequent SE (drug-induced rash and lupus can occur w hydrazaline)
concomitant therapy w diuretic and HR-reducing agent usually needed
hydrazaline
PO and IV
AE: palpations, tachycardia, chest pain, GI effects, HA, hematologic dyscrasias, hepatotoxicity, lupus
minoxidil
more potent that hydrazaline
AE: palpations, tachycardia, chest pain, GI effects, HA, hematologic dyscrasias, hepatotoxicity
CI: dissecting aortic aneurysm
minoxidil BBW
- pericarditis and pericardial effusion
- inc oxygen demand and exacerbate angina
- should be given w diuretic to minimize fluid gain and a BB to prevent tachycardia
African american
inc prevalence and severity of HTN
use thiazides and CCBs
elders
2/3 of people over 65 have HTN
goal:
dementia
occurs more often in people w HTN
control HTN to slow progression
women
contraception can inc BP
pregnant women w THN
methyldopa, BBs and vasodialtors
ACE and ARB CI in pregnancy
hypertensive crisis
BP > 180/120
TOD = emergency
management of hypertensive crisis
gradually decrease BP to normal over 24-48 hours to avoid significant TOD
short acting drugs are recommended initially (clonidine, labetolol, captopril)
emergency goal
decrease MAP 25% within 2 hours, decrease BP over next 2-6 hours
start IV drugs and decrease BP slowly
resistant HTN treatment
aldosterone antagonists could be 4th line option
BB not great in practice
combo products
thiazide, ARB, CCB
