21-31 Antihypertensive Agents Flashcards
a chronic elevation in arterial presssure above an arbitrarily defined normal valvue
chronic systemic arterial hypertension
stage 1 HTN
140/90
stage 2 HTN
160/100
> 180 or >120 with no associated acute end organ damage
hypertensive urgency
bp must be reduced over hrs to days
markedly elevated bps with presence of acute end organ damage
hypertensive emergency
requires immediate therapy to reduce bp within minutes to hrs
both hypertensive urgencies and emergencies and is more reflective of the the high degree of bp elevation
hypertensive crisis
bp that is uncontrolled despite the use of 3 or more antihypertensive drugs, taken at optimal doses, and of which one is a diuretic
resistant htn
risk factors for RHTN
- old
- obese
- CKD
- DM
- obstructive sleep apnea
- high salt diet
- african american
- female
idiopathic htn
essential/primary htn
90% of cases
principle of htn treatment
treat with intent of reducing risk of cv events and thereby reducing cv morbidity and mortality
bp goal for those over 60 yo
150/90
diabetes and HTN –>
ACEi or ARB
CKD and HTN –>
ACEi or ARB
CAD and HTN –>
B blocker and ACEi or ARB
LV dysfunction and HTN –>
diuretic and ACEi or ARB and B blocker
previous ischemic stroke and HTN –>
ACEi with or without thiazide diuretic
special pharmokinetics for ACEi
reduce dose in kidney failure (cleared by kidney)
reduce dose in pts with high plasma renin levels ( cause hyperresponsiveness)
ACEi examples
captopril
lisinopril
fosinopril
contraindications for ACEi
pregnancy
bilateral renal a. stenosis
hx of angioedema
situations with potentially favorable effects for ACEi
low K
prediabetes
albuminuria
unfavorable:
high K
hyperkalemia
volume depletion
common adverse effect of ACEi
coughing
poor responders to ACEi
elderly african americans
ARBs
losartan
valsartan
cadesartan
contraindications for ARBs
pregnancy
bilateral renal a. stenosis
potentially favorable effects of ARBs
low K
prediabetes
unfavorable:
high K
hyperkalemia
volume depletion
dihydropyridine calcium channel blockers for HTN
nifedipine
amlodipine
felodipine
contraindications for dihydropyridine CCBs
left ventricular dysfunction
siturations with potetially favorable effects from DHP- CCBs
reynaud syndrome
elderly pts with isolated systolic HTN
cyclosporine induced HTN
potentially unfavaroable: peripheral edema, high HR
alternative to b blockers in CAD
verapamil
diltiazem
non DHP CCB
contraindications for nonDHP-CCB
second or third degree heart block
LV dysfunction
situations with potentially favorable effects with nonDHP-CCB
reynaud’s
migraines
arrhythmia
high HR
unfavorable: peripheral edema, low HR
contraindications for thiazides for HTN
allergic to sulfa
gout
hyponatremia
hypokalemia
first line therapy for compelling indications of HTN and LV dysfunction or previous ischemic stroke
thiazide diuretics
situations with potentially favorable effects for thiazides
osteoporosis
high K+
unfavorable: gout prediabetes low K elevated glucose
situations with potentially favorable effects for b-blockers for HTN
migraines high HR hyperthyroidism tremor preop HTN
aldosterone antagonists
spironolactone
eplerenone
role of aldosterone antagonists in HTN therapy
for RHTN
and those with LV dysfunction and CAD
situations with potentially favorable effects for aldosterone antagonists and HTN
low K
CKD
unfavorable:
high K
alpha1 adrenergic receptor blockers
prazosin
doxazosin
terazosin
added benefits of prazosin therapy for HTN
lowers LDL, TG and cholesterol
adverse effects of alpha1 adrenergic receptor blockers
tolerance
reflex tachycardia
sexual dysfunction
MOA clonidine
central alpha2 agonist
indications for clonidine
labile HTN
early morning surges in HTN
MOA a-methyldopa
central alpha2 agonist
indications for a-methyldopa in HTN
pregnancy
MOA hydralazine
arterial vasodilator
adverse effect hydralazine
SLE
reflex tachycardia and sodium retention (use with diuretic and beta blocker or NDPH-CCB)
MOA minoxidil
arterial vasodilator
MOA sodium nitroprusside
arterial vasodilator
indications for sodium nitroprusside
HTN emergency or emergency CHF
adverse effects sodium nitroprusside
cyanide poisoning
methemoglobinemia
MOA aliskiren
direct renin inhibitor
adverse effect aliskiren
hyperkalemia if used with other drugs in pathway
MOA reserpine
blocks transport of NE into storage vacuoles –> decreased sympathetic tone
most effect use of reserpine for HTN
with a thiazide diuretic
side effects reserpine
increased parasymp activity
diarrhea, bradycardia, stuffiness
most common cause of apparent treatment ressistance
inadequate diuretics
