Drugs for Hypertension Flashcards
What drugs can be used as monotherapy to decrease BP in 40-60% of patients (mild hypertension)?
Thiazide diuretics due to short term effects of decreasing body Na+, which leads to the long term effects of activating K+ channels and causing further hyperpolarization of VSMC, producing more of a vasodilation effect
What diuretic is considered a direct vasodilator?
Indapamide
What are the thiazide diuretics?
Hydrochlorothiazide, chlorothiazide, methlazone, quinethazone, chlorthalidone, indapamide
What are some side effects of thiazide diuretics? How do you solve this problem?
ED, gout, increased renin, REDUCED GLUCOSE TOLERANCE and INCREASED PLASMA LIPID CONCENTRATION; lower the dose
What is the DOC for HTN?
Thiazide diuretic
What happens every time you decrease blood pressure?
Increased renin release!
When should you reconsider thiazides?
sulfa allergies
In whom are thiazide diuretics most effective?
African Americans>Caucasians, Elderly>younger
When are loop diuretics used?
In renal insufficiency, CHF
What drugs should you not use with potassium sparing diuretics?
ARBs or ACE-Is
Since sympatholytics activate the baroreflex and lead to an increase in Na+ and H2O retention, what should you combine it with?
a diuretic
What are the therapeutic effects seen by sympatholytics?
decreased sympathetic outflow leads to decreased renin secretion, Clonidine will decrease HR and CO more than methyldopa
What two drugs are found in the sympatholytic class?
Clonidine and methyldopa
What is the DOC for HTN in PGN?
Methyldopa
What are some common side effects of sympatholytics? More serious?
Minor: sedation, CNS, xerostomia; Serious: HEMOLYTIC ANEMIA WITH A POSITIVE COOMBS TEST (decreased Hgb)
What are some precautions with sympatholytics? clonidine esp?
Not recommended for mootherapy, no TCA or yohimbine; SUDDEN WITHDRAWAL LEADS TO SEVERE REBOUND HTN
Which drug class is known to have a first dose response of severe orthostatic hypotension?
alpha 1 antagonists because baroreflex is completely inhibited
What drug would you use to block vasoconstriction if you were worried about elevating plasma lipids?
alpha 1 antagonists because they have no effect on insulin release!
What other disease may alpha 1 blockers have efficacy in?
BPH
What is the effect of alpha 1 blocker on renin? heart rate?
increased renin, some reflex tachy but not as much as there is with alpha 2 blockers
What are the non-selective B blockers?
(The letter N and below)
Propranolol, nadolol, timolol
What are the selective B1 blockers?
(The letter N and above except for nebivolol )
Metoprolol, atenolol, nebivolol, acebutolol
What are the B blockers with intrinsic sympathetic activity (ISA)?
acebutolol and pindolol, act as partial agonists. (decreased risk of bradycardia and bronchoconstriction, less effect on lipids)