Anti-hypertensives Flashcards
THIAZIDE DIURETICS MOA
Inhibits distal convoluted tubule sodium and
chloride resorption
THIAZIDE DIURETICS Indication
HTN, peripheral edema
THIAZIDE DIURETICS contraindications/cautions
anuria
caution if renal impairment, severe
caution if electrolyte
abnormalities
caution if volume depletion
THIAZIDE DIURETICS adverse effects
hypokalemia, severe
electrolyte imbalance
arrhythmias
pancreatitis
renal failure
THIAZIDE DIURETICS follow up & pearls
Follow-up & Monitoring:
Cr at baseline; electrolytes at baseline, then
periodically
PEARLS:
Can work synergistically with loop diuretics
Watch for hyponatremia by itself
ACEi can help mitigate hypokalemia (ACEi can increase K+)
THIAZIDE DIURETICS
Chlorthalidone
Hydrochlorothiazide
Indapamide
Metolazone
POTASSIUM-SPARING DIURETICS
Amiloride
Triamterene
Aldosterone Receptor Antagonists
Spironolactone
Eplerenone
POTASSIUM-SPARING DIURETICS contraindications
hyperkalemia
severe renal dysfxn or dz
POTASSIUM-SPARING DIURETICS adverse reactions
anaphylaxis
ventricular arrhythmias
hyperkalemia
POTASSIUM-SPARING DIURETICS BBW
hyperkalemia risk
potentially fatal if uncorrected; 10% incidence
if not used w/ kaliuretic diuretic; incr. incidence
in renal impairment, diabetes (even w/out
recognized diabetic nephropathy) and elderly
pts; risk decr. to 1-2% in combo w/ thiazide
diuretics;
POTASSIUM-SPARING DIURETICS MOA
inhibits Na reabsorption at the distal convoluted tubule, decreasing water reabsorption
and increasing K retention
LOOP DIURETICS MOA
inhibits loop of Henle and proximal and distal convoluted tubule sodium and chloride
resorption
LOOP DIURETICS indications
HTN, edema, acute pulm edema, hypercalcemia
LOOP DIURETICS adverse effects
hypokalemia, severe
electrolyte imbalance, severe
metabolic alkalosis
hypovolemia/dehydration
ototoxicity
LOOP DIURETICS BBW
Fluid and Electrolyte Depletion
potent diuretic in excessive amts can cause profound diuresis w/ water/electrolyte
depletion; individualize dose and schedule w/ medical supervision
ACE INHIBITORS
Lisinopril 10-40 mg, QD
Enalapril 5-40, QD-BID
Fosinopril 10-40 mg, QD
Captopril 12.5-150 mg, BID-TID
Ramipril 2.5-10 mg, QD-BID
ACE INHIBITORS MOA
inhibits angiotensin converting enzyme, interfering w/ conversion of angiotensin I
to angiotensin II
ACE INHIBITORS Indications
HTN, Acute MI, CHF
ACE INHIBITORS Contraindications/Cautions
ACE inhibitor angioedema hx
caution if renal impairment
caution if volume depletion
caution if hyponatremia
caution if hypotension
caution in black pts
ACE INHIBITORS Adverse effects
angioedema, head/neck
angioedema, intestinal
hyperkalemia
ACE INHIBITORS BBW
Fetal Toxicity
fetal/neonatal morbidity/mortality may occur when drugs that act directly on the renin-angiotensin system are used in pregnancy; D/C drug ASAP once pregnancy detected
Angiotensin-Receptor Blockers (ARB)
Losartan 25-100 mg, QD
Valsartan 80-320, QD
Olmesartan 20-40 mg, QD
Candesartan 4-16 mg, QD
Irbesartan 150-300 mg, QD
Angiotensin-Receptor Blocker (ARB) MOA
Selectively antagonizes angiotensin II AT1 receptors
Angiotensin-Receptor Blocker (ARB) Indications
HTN, HFrEF, Stroke prevention, DM nephropathy
Angiotensin-Receptor Blocker (ARB) Adverse reactions
hyperkalemia*
angioedema
anaphylaxis
hypotension, severe
BETA BLOCKERS, CARDIO-SELECTIVE (BB)
Metoprolol Succinate 50-200 mg, QD
Metoprolol Tartrate 100-400, BID
Atenolol 25-100 mg, QD-BID
BETA BLOCKERS, CARDIO-SELECTIVE (BB) MOA
selectively antagonizes beta-1 adrenergic receptors
BETA BLOCKERS, CARDIO-SELECTIVE (BB) Indications
HTN, angina, acute MI, post-MI prevention, CHF, migraine prophylaxis
BETA BLOCKERS, CARDIO-SELECTIVE (BB) contraindications/cautions
sinus bradycardia
HR <45 bpm (MI use)
2nd or 3rd degree AV block
AV block, PR interval >0.24sec (MI use)
heart failure, uncompensated
heart failure, mod-severe (MI use)
SBP <100 mmHg (MI use)
cardiogenic shock
sick sinus syndrome w/o pacemaker
BETA BLOCKERS, CARDIO-SELECTIVE BBW
Avoid Abrupt Cessation
severe angina exacerbation, MI, and ventricular arrhythmias in angina pts after abrupt D/C; taper gradually over 1-2wk and monitor when D/C chronic tx, especially in ischemic heart dz; restart tx even temporarily if angina worsens or acute coronary insufficiency develops; warn pts to avoid tx interruption or D/C w/o MD
advice; avoid abrupt D/C in all pts in case of unrecognized CAD
BETA BLOCKERS, NON-SELECTIVE (BB)
Propranolol 160-480 mg, BID
Labetalol 200-800, BID
Carvedilol 3.25-50 mg, BID
BETA BLOCKERS, NON-SELECTIVE (BB) MOA
selectively antagonizes alpha-1 adrenergic receptors (carvedilol); antagonizes beta-1
and beta-2 adrenergic receptors (selective alpha and non-selective beta blocker)
BETA BLOCKERS, NON-SELECTIVE (BB) Indications
HTN, CHF, HTN emergency
BETA BLOCKERS, NON-SELECTIVE (BB) Contraindications/cautions
bradycardia, severe
2nd or 3rd degree AV block
heart failure, uncompensated
cardiogenic shock
sick sinus syndrome w/o pacemaker
BETA BLOCKERS, NON-SELECTIVE (BB) side effects
dizziness
fatigue
bradycardia
dyspnea
asthenia
VASODILATORS MOA
directly dilates peripheral vessels
VASODILATORS
Hydralazine 10-200 mg, BID-TID
Minoxidil 5-100 mg, QD-TID
VASODILATORS indications
HTN, CHF, HTN emergency/crisis
CALCIUM CHANNEL BLOCKERS, DHP
Amlodipine 2.5-10 mg, QD
Felodipine 5-10 mg, QD
Nifedipine LA 60-120 mg, QD
Nicardipine SR 5-20 mg, QD
CALCIUM CHANNEL BLOCKERS, DHP Side effects
peripheral edema
CALCIUM CHANNEL BLOCKERS, NON-DHP
Verapamil IR 40-80 mg, TID
Diltiazem SR 180-360 mg, BID
CALCIUM CHANNEL BLOCKERS, NON-DHP MOA
Inhibits calcium ion influx into vascular smooth muscle and myocardium (class IV
antiarrhythmic)
CALCIUM CHANNEL BLOCKERS, NON-DHP Indications
HTN, angina, PSVT conversion, PSVT prevention, AFib/Aflutter, Migraine
prophylaxis
CALCIUM CHANNEL BLOCKERS, NON-DHP Contraindications/Cautions
LV dysfxn, severe
2nd or 3rd degree AV block
atrial fibrillation or flutter
w/ bypass tract
sick sinus syndrome
CALCIUM CHANNEL BLOCKERS, NON-DHP Pearl
PEARL: can be constipating
ALPHA-2 AGONISTS
Methyldopa 250-1000 mg, BID
Clonidine 0.1-0.8 mg, BID
ALPHA-2 AGONISTS MOA
stimulates alpha-2 adrenergic receptors (centrally-acting antihypertensive).
Suppressing norepinephrine, renin -> thus decrease vascular resistance
ALPHA-2 AGONISTS Indications
HTN mod-severe
SELECTIVE ALPHA-1 BLOCKER
Prazosin 2-20 mg, BID-TID
Doxazosin 1-8 mg, QD
Terazosin 5-10 mg, QD
SELECTIVE ALPHA-1 BLOCKER MOA
antagonizes peripheral alpha-1 adrenergic receptors
SELECTIVE ALPHA-1 BLOCKER Indications
HTN, BPH, PTSD nightmares, Pheo*
SELECTIVE ALPHA-1 BLOCKER combination to be cautious of
Caution with PDE-5 inhibitors à combination can result in severe hypotension
DIRECT RENIN INHIBITOR
Aliskiren 150-300 mg, QD
DIRECT RENIN INHIBITOR MOA
decreases plasma renin activity, interfering w/ conversion of angiotensinogen to
angiotensin I (direct renin inhibitor)
DIRECT RENIN INHIBITOR Indication
HTN
DIRECT RENIN INHIBITOR BBW
Fetal Toxicity
fetal/neonatal morbidity/mortality may
occur when drugs that act directly on
the renin-angiotensin system are used
in pregnancy; D/C drug ASAP once
pregnancy detecte
Polypills, combination pills use
Given that these individuals may already
require multiple types of medications, may
have several different conditions, and their
hypertension may be difficult to control with
just one antihypertensive, combination pills
help reduce pill intake burden, may reduce co-
pay costs, and improve medication adherence
Common combinations of polypills
1) Diuretic + diuretic
2) BB + diuretic
3) ACEi + diuretic
4) ARB + diuretic
5) Misc combos
guiding principles for adding a HTN med
1) Start low, go slow on titration
2) Measure, measure, measure - BP before and after medication
3) Discuss BP symptoms, and drug class related symptoms to watch for
