Antihypertensives Day II Flashcards
dose of beta blockers
depends on which beta blocker
are beta blockers 1st line
no
when are beta blockers used
reserved for significant cardiac history
- heart failure
- post MI
- high coronary artery dz
- CKD
MOA of beta blockers
- beta 1 receptors located in heart and beta 2 receptors are located in the lungs
- beta blockers block beta 1 receptors thus decreasing the effects of epinephrine and nor-epinephrine which therefore decrease BP and HR
cardio selective beta blockers
AMEBBA: atenolol metoprolol esmolol bisoprolol betaxaolol acebutolol
mixed alpha and beta blockers
carvedilol and labetalol
ISA beta blockers
intrinsic sympathomimetic activity
CAPP - carteolol, aceutolol, penbutolol, pindolol
nonspecific beta blockers
nadolol, propanolol, timolol
common ADE of beta blockers
- beta blocker blues - tired fatigued depressed - chest might feel different due to change in heart beat
- sexual dysfunction (permanent), rebound HTN if suddenly discontinued
what can propanolol be used for other than HTN
stage fright
and migraines
Contraindications for beta blockers
- asthma and COPD
- diabetes - masks hypoglycemia
- severe peripheral vascular dz (can worsen symptoms)
- heart block
- severe acute heart failure
- pregnancy category C
what is sotalol used for?
class III anti-arrhythmic agent NOT HTN
examples of alpha 1 blockers
prazosin
terazosin
doxazosin
MOA of alpha 1 blockers
competitvely inhibits alpha 1 receptors in the periphery which causes vasodilation
alpha 1 blockers place in therapy
only as an add on especially in males not to be used often
uses of alpha 1 blockers
HTN - not monotherapy
BPH - Tamsulosin & Alfuzosin
alpha 1 blockers ADE
- first dose effect - significant orthostatic hypotension with first dose and any subsequent dose titrations
- orthostatic hypotension, dizziness, vertigo
- reflex tachycardia, especially early in therapy (not seen if also on beta blocker, but may worsen orthostatic effects)
- need to slowly titrate dose upward
- fatigue, vivid dreams, depression, dry mouth
dose of following alpha 1 blockers
- doxazosin
- terazosin
- prazosin
Dox - 1/day
Tera - 2/day
Praz - 2-3/day
examples of centrally acting alpha 2 agonists
- methylodpa
2. clonidine
MOA of alpha 2 agonists centrally acting
stimulates alpha 2 receptors in brain, reduces outflow of sympathetic system from brain, which produces a decrease in BP and peripheral vascular resistance
(tricks brain to think theres enough in the body)
place in therapy for centrally acting alpha 2 agonists
methylodopa - limited use, good for pregnancy!
clonidine - often used for resistant hypertension
other: substance abuse treatment - opiate withdrawal and avoidance & adjunct in pain management
centrally acting alpha 2 agonists ADE
- general
- methylodopa vs clonidine
- orthostatic hypotension, dizziness
- fatigue, depression, sedation
- sodium and water retention
- rebound tachycardia and HTN if stopped abruptly
Methylodopa - liver toxicities, hemolytic anemia
Clonidine - rash with patch, anticholinergic like side effects (dry mouth, sedation, constipation, urinary retention
which alpha 2 agonist is available as a patch
clonidine - applied every 7 days
effects begin within 12-24 hours and last up to 3 days after patch removal (start oral dose first to make sure it agrees with patient then can use the patch)
examples of vasodilators
hydralazine
minoxidil
MOA of vasodilators
direct vasodilator, especially in arteries and arterioles, leading to decreased systemic vascular resistance
causes peripheral vasodilation
common ADE of vasodilators
- reflex tachycardia, consider co administration of beta blocker
- increase in renin as response to vasodilation, consider co administration with diuretic
- H/A is common
- Hydralazine - lupus-like syndrome (butterfly rash), dermatitis, drug fever, peripheral neuropathy, hepatitis
- minoxidil - hirsutism - not used for HTN anymore - main ingredient in rogaine
common preferred combos for HTN
- ACE-I/ARB + thiazide
2. ACE-I/ARB + dihydropyridine CCB
not preferred but acceptable combos for HTN
- CCB + Thiazide
- Thiazide + K sparing diuretic
- beta blocker + diuretic or dihydropyridine CCB
OTC drug induced HTN
NSAIDS
Appetite suppressants
Caffeine
Pseudoephedrine
non OTC drugs that can induce HTN
corticosteroids alcohol - excessive ACTH amphetamines cyclosprine estrogen excess thyroid hormones duloxetine erythropeitin
3 most common beta blocker & doses
- atenolol - once/day
- metoprolol succinate - once/day
- metoprolol tartrate - 2/day
beta blockers approved for CHF
bisoprolol
metoprolol succinate
cardevidiolol
