- thiazide diuretic - distal convoluted tubule: Na/Cl cotransporter; also increases Ca reabsorption - 1st line therapy - high doses-->more diuresis--> more side effects and not greater at lowering BP

- thiazide diuretic - distal convoluted tubule: Na/Cl cotransporter; also increases Ca reabsorption - 1st line therapy -high doses-->more diuresis--> more side effects and not greater at lowering BP (just like chlorthalidone)

- loop diuretic - loop of henle: inhibits Na/K Cl- transporters - pts with reduced renal function; in severe htn when drugs that retain Na are being used - short-half-life; don't work as well as equally potent thiazide dose

- loop diuretic - loop of henle: inhibits Na/K Cl- transporters - pts with reduced renal function; in severe htn when drugs that retain Na are being used - short-half-life; don't work as well as equally potent thiazide dose (just like furosemide)

- potassium sparing diuretic - collecting duct: Na+ channel blocker - 2nd line drug; to counteract K+ loss with the loop and thiazide diuretics

- aldosterone antagonist - inhibits aldosterone-->diuresis - 2nd line drug; to counteract K+ loss with the loop and thiazide diuretics

- non-DHP calcium channel blocker - block L-type Ca channels; decreases TPR in smooth m. cell arterioles and can act on heart: decrease HR and CO - 1st line therapy, use long acting - sinus brady, AV block, exacerbation of HF or pulmonary edema, constipation (due to decreased in sm. m contractility)

-non-DHP calcium channel blocker - block L-type Ca channels; intermediate effect btw. DHP and verapamil (decrease TPR, and some effect of decreased CO and HR) - 1st line therapy, use long acting -sinus brady, AV block, exacerbation of HF or pulmonary edema, constipation (due to decreased in sm. m contractility)

- renin inhibitor - prevents conversion of angiotensinogen-->ang I-->decreases TPR (like ARBs, bradykinin not affected) - 2nd line for htn due to side effects (none listed); like ARBs, much less cough and angioedema - do not dual blockade RAAS due to side effects (none listed)

-non-selective B blocker -B1 on heart: decreased CO -B1 on kidney: decreased renin-->decreased ang II and aldosterone -B in CNS: decreased sympathetic discharge Overall: decreased CO and TPR - 2nd line drug; BUT use in HF with reduced EF, and ischemic HD-->reduces mortality of acute and post-MI - do not give to pts with: asthma, COPD, diabetes, PVD, HF, symptomatic brady, 2nd or 3rd degree AV block, hyperlipidemia, stable angina

Antihypertensives Flashcards by Alefiyah Adam

chlorthalidone

thiazide diuretic
distal convoluted tubule: Na/Cl cotransporter; also increases Ca reabsorption
1st line therapy
high doses–>more diuresis–> more side effects and not greater at lowering BP

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hydrochlorothiazide

thiazide diuretic
distal convoluted tubule: Na/Cl cotransporter; also increases Ca reabsorption
1st line therapy

-high doses–>more diuresis–> more side effects and not greater at lowering BP
(just like chlorthalidone)

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furosemide

loop diuretic
loop of henle: inhibits Na/K Cl- transporters
pts with reduced renal function; in severe htn when drugs that retain Na are being used
short-half-life; don’t work as well as equally potent thiazide dose

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ethacrynic acid

loop diuretic
loop of henle: inhibits Na/K Cl- transporters
pts with reduced renal function; in severe htn when drugs that retain Na are being used
short-half-life; don’t work as well as equally potent thiazide dose

(just like furosemide)

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triamterene

potassium sparing diuretic
collecting duct: Na+ channel blocker
2nd line drug; to counteract K+ loss with the loop and thiazide diuretics

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amiloride

potassium sparing diuretic
collecting duct: Na+ channel blocker
2nd line drug; to counteract K+ loss with the loop and thiazide diuretics

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spirinolactone

aldosterone antagonist
inhibits aldosterone–>diuresis
2nd line drug; to counteract K+ loss with the loop and thiazide diuretics

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antihypertensive actions of diuretics: acute effect vs. chronic effect

acute: increase Na+ and H2O excretion by kidney–>decrease EC and plasma volume–>decrease preload and CO
chronic: 6-8 wks–>plasma volume and CO return to previous values–> decreased BP due to decreased TPR

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verapamil

non-DHP calcium channel blocker
block L-type Ca channels; decreases TPR in smooth m. cell arterioles and can act on heart: decrease HR and CO
1st line therapy, use long acting
sinus brady, AV block, exacerbation of HF or pulmonary edema, constipation (due to decreased in sm. m contractility)

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diltiazem

-non-DHP calcium channel blocker

block L-type Ca channels; intermediate effect btw. DHP and verapamil (decrease TPR, and some effect of decreased CO and HR)
1st line therapy, use long acting

-sinus brady, AV block, exacerbation of HF or pulmonary edema, constipation (due to decreased in sm. m contractility)

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nifedipine, amlodipine- anything ending in “dipine”

dihydropiridines
block L-type Ca2+ channels: vasodilation–> decrease TPR (does NOT act on heart like non-DHPs)
1st line therapy, use long acting
1st week of therapy: reflex tachycardia, vasodilatory side effects (most vasoeffective): flushing, headache, dizziness, peripheral edema

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enalapril, lisinopril, anything ending in “pril”

ACE inhibitors
acts on ACE to decrease Ang II (vasoconstrictor) and increase bradykinin (vasodilator)–>dilates arterioles–>decrease TPR (small effect on HR, CO, and blood volume)
1st line therapy; use in acute and post-MI (reduced mortality), 1st line for heart failure, diabetic and non-diabetic nephropathy (renoprotective)
DO NOT use in pts who have functional renal insufficiency due to predisposing conditions: microvascular renal disease, renal artery stenosis, solitary kidney–>reduction in renal blood flow or perfusion pressure–>impairs GFR–>renal insufficiency/failure
adverse effects: hypotension, hyperkalemia, hematologic effects, lost of taste/metallic taste, skin rash, angioedema, cough, TERATOGEN

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losartan, valsartan, anything ending in “sartan”

Angiotensin II receptor blocker (ARBs)
prevents Ang II from binding to receptor–>dilates arterioles–> decrease TPR (bradykinin not affected)
1st line therapy; much less or no cough/angiodema
do not dual blockade RAAS- too many side effects (none listed)

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Aliskerin

renin inhibitor
prevents conversion of angiotensinogen–>ang I–>decreases TPR (like ARBs, bradykinin not affected)
2nd line for htn due to side effects (none listed); like ARBs, much less cough and angioedema
do not dual blockade RAAS due to side effects (none listed)

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propanalol

-non-selective B blocker

-B1 on heart: decreased CO
-B1 on kidney: decreased renin–>decreased ang II and aldosterone
-B in CNS: decreased sympathetic discharge
Overall: decreased CO and TPR

2nd line drug; BUT use in HF with reduced EF, and ischemic HD–>reduces mortality of acute and post-MI
do not give to pts with: asthma, COPD, diabetes, PVD, HF, symptomatic brady, 2nd or 3rd degree AV block, hyperlipidemia, stable angina

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nadalol

non-selective B blocker

- refer to propanolol

timolol

non-selective B blocker

- refer to propanolol

pindolol

non-selective B blocker

- refer to propanolol

carteolol

non-selective B blocker

- refer to propanolol

levobunolol

non-selective B blocker

- refer to propanolol

prazosin, terazosin, doxazosin, ends in “zosin”

alpha 1 selective blocker
acts on alpha 1 receptors of arterioles and veins–> decrease TPR with minimal effect on CO
2nd line therapy for htn, can treat BPH and Reynaud’s dz (can relax arteriolar, prostatic, trigone, and venous smooth m.)
reflex tachy, edema, ortho hypotension (1st dose effect), headache, weakness, dizziness

metoprolol

selective B1 blocker
refer to propanolol mechanism–>decrease CO and TPR
clinical use and adverse effects same as non-selective B blockers
all B blockers overall equally effective as antihypertensives

-think BEAM: all B1-selective blockers start with one of these letters

atenolol

selective B1 Blocker
refer to propanolol and metoprolol
BEAM

acebutolol

selective B1 Blocker
refer to propanolol and metoprolol
BEAM

betaxolol

- selective B1 Blocker - refer to propanolol and metoprolol - BEAM

bisoprolol

- selective B1 Blocker - refer to propanolol and metoprolol - BEAM

esmolol

- selective B1 Blocker - refer to propanolol and metoprolol - BEAM

phentolamine

- non-selective alpha blocker - MOA same as alpha 1 selective - IV drug for htn emergencies - same side effects as alpha 1 selective

phenoxybenzamine

- non-selective alpha blocker - MOA same as alpha 1 selective - PO drug for htn from catecholamine excess (pheochromocytoma) - same side effects as alpha 1 selective

labetalol

- alpha and beta blocker - partial antagonist of B2, full a1 antagonist-->vasodilation-->decrease TPR with little effect on HR and CO from B2 antagonism - 2nd line therapy for chronic htn, htn emergencies (IV form) - bronchospasm, prolonged/enhanced hypoglycemia, hypotension and ortho hypotension, N/V, sexual dysfunction

methyldopa

- centrally acting alpha 2 agonist - lipid soluble agents that gain access to CNS-->activate a2 receptors-->decrease symp. outflow-->decrease TPR - htn in pregnancy - sodium and H2O retention, positive coombs test, hemolytic anemia (rare), hepatotoxicity

clonidine

- centrally acting alpha 2 agonist - lipid soluble agents that gain access to CNS-->activate a2 receptors-->decrease symp. outflow-->decrease TPR, HR, and CO - 2nd line therapy for chronic htn, hypertensive URGENCIES, (transdermal patch better) - sedation, dry mouth, depression, impotence, sodium and H2O retention, contact dermatitis (patch), and with abrupt withdrawal-->rebound htn and nervousness, tachy, headache, sweating

hydralazine

- direct vasodilator - dilate arterioles-->decrease TPR - oral: chronic therapy for severe htn (add on drug); IV: hypertensive emergencies - general adverse effects: excessive vasodilation and hypotension-->tachy, Na and H2O retention, flushing, dizziness, angina, headache, nausea, sweating (SNS activated) - hydralazine specific adverse effects: Lupus-like syndrome, fever, arthralgia, skin rashes

minoxidil

- direct vasodilator - dilate arterioles-->decrease TPR - chronic therapy for severe htn (add on drug) - general adverse effects: refer to clonidine - minoxidil specific: hypertrichosis (rogaine)

nitroprusside

- direct vasodilator - sodium nitroprusside-->NO-->increases cGMP-->dilates arterioles and veins-->overall decrease TPR - hypertensive emergencies (IV infusion with rapid onset (sec) and short action duration (1-2 min), controlled hypotension during surgery - cyanide and thiocyanate toxicity, vasodilation and hypotension-->headache, N/V, dizziness, palpitations