Antihypertensives Flashcards
Goal Blood Pressure
140/90 in patients 60 yo
Initial monotherapy
3 classes, all equal in effectiveness:
Long acting CCBs
ACEIs or ARBs
thiazide diuretics
Initial monotherapy based on age and race
younger patients respond mostly to ACEIs and ARBs
Black and elderly patients respond best to thiazide diuretics or long acting CCB
Combination therapy
indicated if not at goal BP w/ monotherapy
ACE-I plus long-acting CCB
ACE Inhibitor Drugs
Lisinopril
Captopril
Enlapril
ACE-I MOA
inhibits enzyme that converts ANG I to ANG II, thus blocking ANG II action that causes vasoconstriction and ALDO secretion. decreases bradykinin inactivation
ACE-I Side effects
Dry cough
Contraindicated in pregnancy.
hyperkalemia
severe hypotension if hypovolemic
Angiotensin Receptor Blocker (ARBs) Drugs
Losartan
Valsartan
ARBs MOA
selectively inhibits ANG II at the AT1 receptors
ARBs Side effects
Contraindicated in pregnancy.
no angioedema or cough (bradykinin mediated)
Diuretics for HTN
1st line: Thiazides. chlorthalidone is preffered over HTZ
Loop diuretics are reserved for pts w/ low kidney fx
K sparing sometimes
anti-HTN MOA
Diuretics
increased Na excretion, reducing circulating BV
Diuretic Side effects
hypokalemia, hyperglycemia, hyperlipidemia
CCBs for HTN
the “dipines”
verapamil
diltiazem
Anti-HTN MOA
CCBs
inhibition of Ca2+ influx in arterial smooth muscle = relaxation of vasculature and decrease in PVR
CCBs Side effects
headache, dizziness, flushing
Direct vasodilator Drugs
Hydralazine
Minoxidil
third line, add-on agents. usually used with a beta blocker
Direct vasodilators MOA
Hydralazine - dilates arterioles
Minoxidil - dilates arteriols, reserved for accelerated malignant HTN
Beta blockers for HTN MOA
negative inotropic activityfrom B1 in heart as well as reduced renin production via B1 kidney
