24- Antihypertensive Drugs Flashcards
diltiazem
Calcium channel blocker
1: 1 cardiac:VSM
- block voltage sensitive L-type Ca channels
- relax VSM and decrease peripheral resistance
- decrease MAP– reflex increase sympathetic discharge and HR
- negative chronotropic
- used for HTN (especially low renin) blacks and older patients with systolic HTN
- side effects- headache, contraindicated in heart failure, depresses A-V conduction & contractility
verapamil
Calcium channel blocker
1: 1 cardiac:VSM
- block voltage sensitive L-type Ca channels
- relax VSM and decrease peripheral resistance
- decrease MAP– reflex increase sympathetic discharge and HR
- negative chronotropic
- used for HTN (especially low renin) blacks and older patients with systolic HTN
- side effects- headache, contraindicated in heart failure, depresses A-V conduction & contractility
amlodipine
Calcium channel blocker (dihydropyridine)
-10:1 VSM:cardiac
-block voltage sensitive L-type Ca channels
-relax VSM and decrease peripheral resistance
-decrease MAP– reflex increase sympathetic discharge and HR
-negative chronotropic
used for HTN (especially low renin) blacks and older patients with systolic HTN
side effects- headache, contraindicated in heart failure, depresses A-V conduction & contractility
nicardipine
Calcium channel blocker (dihydropyridine)
- 10:1 VSM:cardiac
- block voltage sensitive L-type Ca channels
- relax VSM and decrease peripheral resistance
- decrease MAP– reflex increase sympathetic discharge and HR
- negative chronotropic
- used for HTN (especially low renin) blacks and older patients with systolic HTN
- side effects- headache, contraindicated in heart failure, depresses A-V conduction & contractility
nifedipine
Calcium channel blocker (dihydropyridine)
- 10:1 VSM:cardiac
- block voltage sensitive L-type Ca channels
- relax VSM and decrease peripheral resistance
- decrease MAP– reflex increase sympathetic discharge and HR
- negative chronotropic
- used for HTN (especially low renin) blacks and older patients with systolic HTN
- side effects- headache, contraindicated in heart failure, depresses A-V conduction & contractility
chlorothiazide
- inhibits Na/Cl transport in distal tubule and collecting duct
- drug interaction- NSAIDs, sulfonamides
- Side effects- hypokalemic metabolic alkalosis, hyperuricemia, hyperglycemia, hyponatremia, muscle weakness
chlorthalidone
- inhibits Na/Cl transport in distal tubule and collecting duct
- drug interaction- NSAIDs, sulfonamides
- Side effects- hypokalemic metabolic alkalosis, hyperuricemia, hyperglycemia, hyponatremia, muscle weakness
hydrochlorothiazide
- inhibits Na/Cl transport in distal tubule and collecting duct
- drug interaction- NSAIDs, sulfonamides
- Side effects- hypokalemic metabolic alkalosis, hyperuricemia, hyperglycemia, hyponatremia, muscle weakness
bumetanide
Na/K/2Cl transport inhibition in thick loop of Henle
-used in severe HTN, renal insufficiency, cardiac failure
short duration of action
-drug interactions- allergic reaction (sulfonamide), can be inhibited by NSAIDs
-side effects- hypokalemic metabolic alkalosis, ototoxicity, hyperuricemia, hypomagnesmia
ethacrynic acid
Na/K/2Cl transport inhibition in thick loop of Henle
- used in severe HTN, renal insufficiency, cardiac failure
- short duration of action
- drug interactions- can be inhibited by NSAIDs
- side effects- hypokalemic metabolic alkalosis, ototoxicity, hyperuricemia, hypomagnesmia
furosemide
Na/K/2Cl transport inhibition in thick loop of Henle
- used in severe HTN, renal insufficiency, cardiac failure
- short duration of action
- drug interactions- allergic reaction (sulfonamide), can be inhibited by NSAIDs
- side effects- hypokalemic metabolic alkalosis, ototoxicity, hyperuricemia, hypomagnesmia
torsemide
Na/K/2Cl transport inhibition in thick loop of Henle
- used in severe HTN, renal insufficiency, cardiac failure
- short duration of action
- drug interactions- allergic reaction (sulfonamide), can be inhibited by NSAIDs
- side effects- hypokalemic metabolic alkalosis, ototoxicity, hyperuricemia, hypomagnesmia
amiloride
inhibit Na influx through luminal channels
- act on the collecting duct
- used to avoid excessive K depletion and enhance the natriuretic effects of other diuretics
- drug interaction- can be inhibited by NSAIDs
- side effects- hyperkalemia (increased risk by renal disease, renin inhibitors, angiotensin II blockers), hyerchloremic acidosis
triamterene
inhibit Na influx through luminal channels
- act on the collecting duct
- used to avoid excessive K depletion and enhance the natriuretic effects of other diuretics
- drug interaction- can be inhibited by NSAIDs, acute renal failure when used in combination with indomethacin
- side effects- hyperkalemia (increased risk by renal disease, renin inhibitors, angiotensin II blockers), hyerchloremic acidosis
eplerenone
Aldosterone Receptor Antagonist
- bind to mineralocorticoid receptors and blunt aldosterone activity
- act on the collecting duct
- used to avoid excessive K depletion and enhance the natriuretic effects of other diuretics
- drug interaction- can be inhibited by NSAIDs
- side effects- hyperkalemia (increased risk by renal disease, renin inhibitors, angiotensin II blockers), hyerchloremic acidosis
spironolactone
Aldosterone Receptor Antagonist
- bind to mineralocorticoid receptors and blunt aldosterone activity
- act on the collecting duct
- used to avoid excessive K depletion and enhance the natriuretic effects of other diuretics
- drug interaction- can be inhibited by NSAIDs
- side effects- hyperkalemia (increased risk by renal disease, renin inhibitors, angiotensin II blockers), hyerchloremic acidosis
captopril
ACE inhibitor
- inhibits production of angiotensin II from angiotensin I thus reducing aldosterone secretion
- inhibits breakdown of bradykinin
- leads to inc. Na+ and H2O excretion
- decreases peripheral vascular resistance (CO and HR unchanged)
- improved intra-renal hemodynamics in CKD
- dec. cardiac hypertrophy and remodeling
- Diabetes
- Adverse effects: dry cough, alt. taste, hyperkalemia (dec. aldosterone), angioedema, rash, pregnancy problems, hypotension in presence of hypovolemia
- NSAIDs may inhibit effects
enalapril
ACE inhibitor
- inhibits production of angiotensin II from angiotensin I thus reducing aldosterone secretion
- inhibits breakdown of bradykinin
- leads to inc. Na+ and H2O excretion
- decreases peripheral vascular resistance (CO and HR unchanged)
- improved intra-renal hemodynamics in CKD
- dec. cardiac hypertrophy and remodeling
- Diabetes
- Adverse effects: dry cough, alt. taste, hyperkalemia (dec. aldosterone), angioedema, rash, pregnancy problems, hypotension in presence of hypovolemia
- NSAIDs may inhibit effects
fosinopril
ACE inhibitor
- inhibits production of angiotensin II from angiotensin I thus reducing aldosterone secretion
- inhibits breakdown of bradykinin
- leads to inc. Na+ and H2O excretion
- decreases peripheral vascular resistance (CO and HR unchanged)
- improved intra-renal hemodynamics in CKD
- dec. cardiac hypertrophy and remodeling
- Diabetes
- Adverse effects: dry cough, alt. taste, hyperkalemia (dec. aldosterone), angioedema, rash, pregnancy problems, hypotension in presence of hypovolemia
- NSAIDs may inhibit effects