Anti-Hypertensives Flashcards
Stage 1 Hypertension
140-159/90-99
Stage 2 HTN
> 160/>100
Isolated systolic HTN
> 140/
Hypertensive Crisis
encompasses both hypertensive urgencies and emergencies
more reflective of high degree BP elevation
Hypertensive urgency
SBP >180 or DBP>120
NO ASSOCIATED END ORGAN DAMAGE
reduced over hours to days
Hypertensive emergency
markedly elevated BP’s
PRESENCE OF ACUTE END ORGAN DAMAGE
reduce BP within mins to hrs
Resistant HTN
uncontrolled despite optimal usage of three or more anti-hypertensive drugs
ACE Inhibitors (3 examples)
Captopril
Lisinopril
Fosinopril
ACE Inhibitor MOA
inhibits ACE to decrease AT II
also INCREASE bradykinin - serves as a vasodilator
Clinical Use of ACE-I’s
first line for uncomplicated HTN
first line for compelling indications of: diabetes, CKD, CAD, left ventricular dysfunction, ischemic stroke
Pharmacologic Aspects of ACE-I’s
reduce dose with kidney failure
elevated levels of renin causes hyperresponsiveness to ACE-I’s - need to decrease dose as well
Avoid ACE-I’s in
Potentially unfavorable effect in?
PREGNANCY
Hyperkalemia, Volume depletion
Adverse effects of ACE-I’s
Coughing - d/t bradykinin build up
Angiotensin Receptor 1-Blockers (3 examples)
Losartan, Valsartan, Candesartan
AR-1 Blockers MOA
block angiotensin receptor-1
does not cause build up of bradykinin
Dihydropyridine CCB’s (3)
Nifedipine
Amlodipine
Felodipine
Avoid use of Dihydropyridine CCB’s in
also unfavorable effects with?
left-ventricular dysfunction
high-normal heart rate or tachycardia or peripheral edema
Non-dihydropyridine CCB’s
Verapamil
Diltiazem
Non-Dihydropyridine CCB’s Clinical use
Avoid use in
first line/add on for uncomplicated HTN
add on for diabetes
alternative to B-blockers
do not use in LV DYSFUNCTION
Thiazide diuretics Role in HTN therapy
first line/add on for uncomplicated HTN
first line for LV dysfunction, previous ischemic stroke
Alpha-1 Blockers
Prazosin
Doxazosin
Terazosin
Central alpha-2 agonists
Clonidine
Alpha-methyldopa
Central Alpha-2 Agonist important side effect
rebound HTN
Alpha-methyldopa importantly used for
gestational HTN
chronic HTN management in pregnancy
Hydralazine MOA
decreases Ca in smooth muscle - leads to vasodilation
also opens K channels - leads to hyperpolarization
Hydralazine particularly useful in what two patient populations
severe chronic kidney disease
gestational HTN
Adverse effects of Hydralazine
drug-induced lupus
compensatory tachycardia and Na retention
Minoxidil MOA
opens K channels - relaxes arteriolar VSMC’s
increases blood flow to heart, skin, skeletal muscle, GI, CNS
Clinical use of Minoxidil
only for severe refractory HTN
combo with Beta-blockers and diuretics
Adverse effects of minoxidil
reflex increase in myocardial contractility
Sodium nitroprusside MOA
Delivered how?
donates NO - causes cGMP-mediated Ca sequestration
decreases PRE-LOAD and AFTERLOAD
Intravenous - short term
Sodium nitroprusside adverse effects
methemoglobinemia
cyanide poisoning
cell death
Aliskiren MOA
directly inhibits renin
prevents formation of angiotensin I from angiotensinogen
Aliskiren adverse effects/precautions
Hyperkalemia
NEVER USE IN PREGNANCY
Reserpine MOA
inhibits vesicular storage of catecholamines
Reserpine most effectively used in combo with what?
thiazide diuretic
Resistant HTN Management considerations
What diuretic is preferred?
Excessive dietary Na - reduction should be integrated
Considering change in diuretics
Chlorthalidone
