Cardio: Drugs for HTN and HTN Emergency/Urgency Flashcards
What are the first line drugs used to treat HTN?
Thiazides
ACEi
ARBs
CCBs (both dihydropyridines/Non-dihyropyridines)
What are the secondary drugs for HTN?
Loop and K+ sparing Diuretics
B-Blockers (Cardio and Non-cardio)
a-1 blockers (-osins)
Aliskiren (direct renin inhibitors)
Central a-2 blockers (a-methyl-dopa and clonidine)
Direct Vasodilators (hydralazine, minoxidil)
MOA of Thiazides
Block NaCl in the DCT
-lowers Na, which lowers water and BP
Ca is reabsorbed in Proximal Tubule due to volume contraction
Clinical application of HCTZ?
HTN alone or with other hypertensives
Edema
Off label use of HCTZ
Calcium Nephrolithiasis prevention
Adverse effects of Hydrochlorothiazide?
Hypotension,
Electrolyte and Water depletion
Hypercalcemia, Hyperglycemia, Hyperuricemia
Sulfa allergy*
Preferred thiazide for HTN specialists?
Chlorthalidone
-longer halflife
Preffered thiazide for cardiologists?
Metolazone
-longer acting, great for HF
MOA of Amiloride
Blocks EnaC channels in collecting duct
-less H2O means lower BP
Clinical applications of amiloride
Blocks K+ loss in Loop/other diuretics
Also for ascites, Pediatric HTN
Adverse effects of amiloride?
Hyperkalemia
Hyponatremia, hypovolemia, metabolic acidosis
Dizziness, N/V
What should you monitor with ACEi or ARBs?
Serum creatine
-will increase shortly after giving it to pts
Also watch for Hyperkalemia
MOA of Aliskiren
Direct Renin inhibitor
-decreases ATII without increase in Bradykinin activity
Why would you stop ACEis? (main reason)
Angioedema
-can be deadly!
What are the a-receptor blockers and what is their MOA?
Phentolamine
-competitive a-receptor blocker
Phenoxybenzamine
-non-competitive a-receptor blocker
Adverse effects of phentolamine/phenoxybenzamine?
Hypotension, orthostatics, tachycardia (reflex), cardiac arrythmias
Miosis is for phenoxybenzamine
MOA of Prazosin? (and other osins)
competitively blocks a-1 receptors
-leads to vasodilation of veins, decreasing PVR and BP
Clinical applications of Prazosin
Late choice for HTN and PTSD
Toxicities associated with prazosin
Orthostatics, edema, palpitations, increase in urinary frequency, nasal congestion
and more
When would you use tamsulosin, terazosin?
Marketed specifically for BPH and to help pass kidney stones
-“potential drug for old man in wheelchair”
MOA of Clonidine?
Alpha-2 receptor agonsit
-results in transient increase in BP, followed by decreased sympathetic outflow so decrease in BP
Clinical applications for clonidine?
Oral tablets/patch for HTN
ADHD
Given for Severe cancer pain
Adverse effects of clonidine?
Drosiness, headache, fatigue
Xerostomia
Rebound HTN if dose missed**
MOA of a-methyldopa
a-2 agonist
-great for HTN due to reducing sympathetic flow
Clinical applications of a-methyldopa
Moderate to severe HTN
Drug of choice for gestational HTN**
Adverse effects of a-methyldopa
Bells Palsy Angina aggrevation Orthosatitcs Positive direct Coombs teset** SLE like syndrome**
MOA of propranolol
Nonselective B blocker
-decreases HR and contractility=decrease BP
Clinical applications of propranolol
HTN Angina Pectoris Essential tremor V-tach Prevention of MI Migraine
Adverse effects of Propranolol?
Bronchospasm, dyspnea, cold extremities
bradycardia, AV block, heart failure
Is propranolol indicated for PVD?
No, can worsen the cold extremities
MOA for atenolol
Cardioselective B-1 antagonist
-slows HR and contractility to decrease O2 demand
Clinical applications ofr Atenolol
HTN
Angina Pectoris
Secondary MI prevention
A-fib
Toxicities with atenolol
bradycardia, AV block, heart failure, chest pain, cold extremities
What makes metoprolol and bisprolol different in the category of B-1 antagonists?
Metoprolol is more lipid soluable, so has more CNS adverse effects
Bisoprolol is the most selective for B-1
What happens if an a-2 agonist or B-blockers is stopped abruptly?
Rebound sympathetic activity and death
Why has B-blocker use declined in recent years?
Does not prevent MI, HF or death as well as other therapies
Highest risk of stroke**
MOA of hydralazine
Vasodilator of Arterioles!
-reduced afterload, lower BP
When would you use hydralazine?
HTN emergency in pregnancy
HF that doesnt respond to ACEi/ARBs
Adverse effects of Hydralazine? (big 2)
Drug induced lupus*
Worsens angina pectoris or CAD
Many others
MOA of Nitroprusside?
Vasodilator of Veins and Arterioles
-decrease Afterload, increase CO
Clinical use of nitroprusside
HTN emergency
ADHF
HTN during surgery
Adverse effects of nitroprusside?
Flushing, HTN, orthostatics, tachycardia (reflex)
Cyanide toxicity**
-tinnitis, seizures, lactic acidosis
MOA of Minoxidil
Relaxes arterioles
-lowers vascular resistance=lower BP
Clinical applications of minoxidil
HTN emergency
Adverse effects of minoxidil
ECG changes (t-wave), pericardial effusion
Hypertrichosis (hair growth)
What do you use to treat HTN in stable ischemic heart disease?
B-blockers
-slide 83
Can add CCBs and diuretics if goal not met
How do you treat HTN in CKD?
ACEi or ARBs
Are non-dihydropyridine CCBs recommended for HTN in those w HFrEF?
No, contraindicated
How do you treat HTN in those with HFpEF
Diuretics for symptoms, and if HTN persists then add ACEi or ARBs+B-blocker
How do you treat HTN after renal transplantation?
Calcium antagonist
-CCB?
How do you treat HTN in those with a-fib?
ARBs are first line choice
How do you manage HTN in those with aortic disease?
B-blockers
What drugs are used in HTN emergencies?
CCBs (nicardipine, cleviidipine) Nitrates Hydralazine (pregnancy) Esmolol Labetalol Phentolamine Fendolapam (great for kidney damage) Enalaprilat (ACEi)
