Drugs for Hypertension Flashcards
JNC7 blood pressure goals for:
- no comorbidities?
- diabetes mellitus?
- chronic kidney disease?
JNC7 blood pressure goals:
- no comorbidities: < 140/90
- diabetes mellitus: <130/80
- chronic kidney disease: <130/80
JNC8 blood pressure goals for:
- no comorbidities?
- diabetes mellitus?
- chronic kidney disease?
JNC8 blood pressure goals:
- no comorbidities: < 150/90
- diabetes mellitus: <140/80
- chronic kidney disease: <140/80
Class: thiazide (sulfur-containing) diuretic
MOA: inhibits the Na/Cl transporter in the DCT, MODERATE diuresis, reduced Ca excretion
Uses: HTN (FIRST LINE), HF, hypercalcuria, renal calcium stones, nephrogenic diabetis insipidus
SE: hypokalemic metabolic alkalosis, dilutional hyponatremia, potassium wasting, hyperglycemia, hyperlipidemia, hyperuricemia, sulfa allergy, hypercalcemia, “hyperGLUC”
Similar:
CHLORTHALIDONE
INDAPAMIDE
METOLAZONE
HYDROCHLOROTHIAZIDE
Class: loop diuretic (sulfur-derivative)
MOA: inhibits the Na/K/2Cl transporter in the TAL of the loop of Henle, POWERFUL diuresis, increased Ca excretion
Uses: HF, pulmonary edema, HTN, hypercalcemia, acute renal failure, anion overdose
SE: hypokalemic metabolic alkalosis, potassium wasting, dehydration, ototoxicity, hyperuricemia, hypomagnesemia, nephritis
Similar:
BUMETANIDE - sulfur derivative
TORSEMIDE - sulfur derivative
ETHACRYNIC ACID
FUROSEMIDE
Class: CNS sympathetic outflow blocker (sympathomimetic), alpha-2-agonist
MOA: selectively activates alpha-2 receptors, decreases central sympathetic outflow
Uses: HTN, cancer pain, opioid withdrawal
SE: sedation, rebound hypertension (treated with PHENTOLAMINE, avoided via tapering), dry mouth
CLONIDINE
Class: CNS sympathetic outflow blocker (sympathomimetic), alpha-2-agonist
MOA: selectively activates alpha-2 receptors, decreases central sympathetic outflow
Uses: pre-eclampsia
SE: sedation, hemolytic anemia (idiosyncratic positive Coomb’s test)
Similar:
GUANABENZ
GUANFACINE
METHYLDOPA
Class: ganglionic (Nn) blocker
MOA: competitively blocks Nn ACh receptors
Uses: hypertensive emergencies, HTN (obsolete)
SE: postural hypotension, dry mouth, BOV, constipation, sexual dysfunction
Similar:
TRIMETHAPHAN
MECAMYLAMINE
HEXAMETHONIUM
Class: nerve terminal blocker
MOA: irreversibly blocks vesicular monoamine transporter (VMAT)
Uses: HTN (obsolete)
SE: sedation, severe psychiatric depression, suicidal ideation
RESERPINE
Class: nerve terminal blocker
MOA: inhibit vesicular release of NE from presynaptic neuron
Uses: HTN (obsolete)
SE: sedation, severe psychiatric depression, suicidal ideation
GUANETHIDINE
Class: alpha-1 blocker
MOA: selelctively blocks alpha-1 receptors
Uses: BPH, HTN
SE: first dose orthostatic hypotension, reflex tachycardia (less)
Similar: DOXAZOSIN TERAZOSIN TAMSULOSIN - most selective for prostatic smooth muscle SILODOSIN ALFUZOSIN
PRAZOSIN
Class: non-selective beta-blocker
MOA: blocks beta-1 and beta-2 receptors, blocks sympathetic effects on the heart and BP, reduces renin release
Uses: angina prophylaxis, HTN, arrhythmias, migraine, performance anxiety, hyperthyroidism
SE: bronchospasm, AV block, HF, CNS sedation, erectile dysfunction; masks symptoms of hypoglycemia in diabetics
Similar: PINDOLOL TIMOLOL LABETALOL - combines alpha- and beta-blocker CARVEDILOL - combined alpha- and beta-blocker NADOLOL LEVOBUNOLOL METIPRANOLOL
PROPANOLOL
Class: vasodilator
MOA: alters intracellular Ca metabolism, relaxes arteriolar smooth muscle, causing vasodilation, decreases afterload
Uses: HTN, HF (in combination with ISDN, more effective than ACE-inhibitors in blacks), pre-eclampsia
SE: edema, reflex tachycardia, myocardial ischemia, drug-induced lupus
HYDRAZALINE
Class: vasodilator
MOA: opens K channels in vascular smooth muscle, causing hyperpolarization, muscle relaxation and vasodilation; (also stimulates hair follicles/telogen phase to differentiate into growth follicles/anagen phase)
Uses: HTN, alopecia
SE: edema, reflex tachycardia, angina, pericarditis, pulmonary HTN, hypertrichosis
Similar:
DIAZOXIDE
MINOXIDIL
4 drugs that can commonly cause lupus
HYDRALAZINE
ISONIAZID
PROCAINAMIDE
PENICILLAMINE - used for Wilson’s disease and copper intoxication
mnemonic: it’s HIPP to have Lupus!
Class: non-dihydropyridine Ca channel blocker
MOA: blocks voltage-gated L-type Ca channels (cardiac > vascular)
Uses: angina, HTN, SVT, migraine
SE: constipation, pretibial edema, flushing, dizziness, gingival hyperplasia, HF, AV block, sinus node depression
Similar:
DILTIAZEM
VERAPAMIL
Class: dihydropyridine Ca channel blocker
MOA: blocks voltage-gated L-type Ca channels (cardiac > vascular)
Uses: angina, HTN
SE: constipation, pretibial edema, nausea, flushing, dizziness
Similar: AMLODIPINE FELODIPINE NICARDIPINE NISOLDIPINE CLEVIDIPINE ISRADIPINE
NIFEDIPINE
Class: vasodilator (cyanide-containing)
MOA: relaxes venous and arteriolar smooth muscle by increasing cGMP
Uses: hypertensive emergencies, acute HF, cardiogenic shock, controlled hypotension
SE: hypotension, headache, CYANIDE TOXICITY
NITROPRUSSIDE
Class: dopamine agonist (D1 agonist)
MOA: arteriolar vasodilation of the afferent and efferent, increases renal blood flow
Uses: hypertensive emergencies
SE: hypotension, hypokalemia
FENOLDOPAM
Drug(s) of choice for HF
ACE-inhibitors
angiotensin receptor blockers (ARBs)
Class: ACE-inhibitor
MOA: inhibits angiotensin-converting enzyme and formation of angiotensin II, decreases aldosterone secretion
Uses: HTN, HF, post-myocardial infarction, diabetic nephropathy
SE: cough, taste disturbance, angioedema, hypotension, teratogenesis, hyperkalemia (reduce aldosterone levels and cause K retention); slows ventricular remodeling, increases survival in HF; delays progression of diabetic nephropathy (decreases albumin exretion and slows progression from mirco- to macro-albuminuria, “renoprotective effect”)
Similar: ENALAPRIL BENAZEPRIL FOSINOPRIL LISINOPRIL QUINAPRIL RAMIPRIL TRANDOLAPRIL MOEXIPRIL PERINDOPRIL
CAPTOPRIL
Class: ARB
MOA: blocks angiotensin receptors (AT1 receptors) in vascular smooth muscle and adrenal cortex, decreases aldosterone secretion
Uses: HTN, HF, diabetic nephropathy
SE: hypotension, teratogenesis, hyperkalemia (reduce aldosterone levels and cause K retention); slows ventricular remodeling, increases survival in HF; delays progression of diabetic nephropathy
Similar: CANDESARTAN VALSARTAN IRBESARTAN EPROSARTAN TELMISARTAN AZILSARTAN OLMESARTAN VALSARTAN
LOSARTAN
Class: renin antagonist
MOA: inhibits renin, prevents conversion of angiotensinogen to angiotensin I
Uses: HTN
SE: headache, diarrhea, angioedema, renal impairment
ALISKIREN
An accelerated form of severe HTN associated with rising blood pressure and rapidly progressing end-organ disease
malignant hypertension
BP target of malignant hypertension
140-160/90-110
Treatment of malignant hypertension
combination:
- powerful vasodilator (nitroprusside, fenoldopam, diazoxide)
- diuretic (furosemide)
- beta-blockers
