drugs to treat Hypertension and HTN urgency/emergency Flashcards
lowering blood pressure has been known to do what?
Prolong life!
Page Mosaic Theory of hypertension
what is considered the slow but ultimate regulator of blood pressure?
Renal blood volume control due to its infinite gain
Kidneys are super important when it comes tp to blood pressure
what are the 2 types of hypertension and their sub groups?
Primary Hypertension
- most common form
- divided into 3 groups:
- low renin (AA and elderly)
- Normal renin
- High renin
- no identifiable cause
- chronic progressive disorder
- drugs can treat BP but not underlying cause
Secondary Hypertension:
- has identified primary cause
- can be cured by treating the cause
- usually new onset or uncontrolled hypertension in adults
what are the main causes of secondary hypertension?
- Renal parenchymal disease
- renovascular disease
- primary aldosteronism
- obstructive sleep apnea
- drug or alcohol induced
- pheochromocytoma
what are the best proven non-pharmacological interventions and preventions of hypertension
- weight loss
- healthy diet
- reduced intake of dietary sodium
- enhanced intake of Potassium
- physical activity
- moderation of alcohol
what are the primary agents for oral hypertensive drugs
- Thiazide diuretics
- ACE inhibitors
- ARBs
- CCB dihydropyridines
- CCB nondihydropyridines
what are the secondary agents of oral antihypertensive drugs?
- loop diuretics
- K+sparing diuretics
- aldosterone antagonists
- Beta blockers cardioselective
- Beta blockers non cardio selective
- beta blockers a and b receptor
- alpha 1 blockers
- central alpha 2 blockers
- direct vasodilators
- direct renin inhibitor
MOA, Effects and Clinical applications of Hydrochlorothiazide?
MOA: inhibits sodium reabsorption at the distal tubules by blocking the Na Cl co transporter
Effects:
-increased urinary excretion of Na, H20, K, Mg
Clinical applications:
- management of hypertension alone or in combination
- not effective in patients with a low GFR
- off label calcium nephrolithiasis
Pharmacokinetics and toxicities of Hydrochlorothiazide
Pharm: well absorbed
- excreted in urine
- half life 6-15 hrs
Toxicities:
- sulfonamide (hypersensitivity
- Hypotension
- hypokalemia
- hypomagnesemia
- hyponatremia
- hypochloremic metabolic alkalosis
what are the other drugs similar to hydrochlorothiazide
Chlorothiazide: poor oral absorption
chlorthalidone: longer half life
Metolazone: long acting thiazide diuretic useful in treatment of congestive heart failure
MOA, effects, and clinical applications of Furosemide?
MOA: inhibits the Na L 2Cl cotransporter in the TAL of loop of henle
-indirectly inhibits reabsorption of Ca and Mg due to loss of K
Effects:
- increased H20, Na, Cl, K, Mg, Ca excretion
- massive fluid removal
CLinical applications:
- edema associated with HF, Hepatic disease, renal disease
- decrease preload
- decrease ECV
- treeatment of hypertension in patients with a low GFR
Pharmacokinetics and toxicities of furosemide
Pharm:
- elminated in urine
- short half life
Toxicities:
- Ototoxicity
- sulfonamide
- hypo calcemia, natremia, kaemia, alkalosis
- hyper glycemia, urcemia
what are the other drugs that act similar to furosemide?
Torsemide: longer half life and better oral absorption (thought to be better against HF)
Bumetanide: more predicatble oral absorption
Ethacrynic acid: Non sufonamide loop diuretic
(used for hypersensitivity patients)
MOA, Effects and Clinical applications of Amiloride?
MOA: blocks epithelial sodium channels (EnaC) in the collecting ducts and collecting tubules
Effects: small changes in Na excretion
- blocks K elimination (K sparring)
- decreased H, Mg, Ca excretion
Clinical applications: counteracts K loss by other diuretics
Pharmacokinetics and toxicites of amiloride
Pharm:
- given orally
- half life 6-9 hrs
- ecreted in urine and feces
- enhances other diuretics
Toxicites:
- Hyperkalemia (BB warning)
- hyponatremia
- hypovolemia
- dizziness and fatigue
- nausea vomiting
