Drugs Used in HPN Flashcards by Jamaira Belmes

Toxicities of Thiazides

HYPER GLUC
Glycemia
Lipidemia
Uricemia
Calcemia

hypokalemic metabolic alkalosis

hypercalcemia
hypercalciuria

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Toxicities of Loop Diuretics

OH DANG

Ototoxicity
Hypokalemia
Dehydration
Allergy to Sulfa
Nephritis
Gout

hypocalcemia
hypercalciuria

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Drugs that can cause GINGIVAL HYPERPLASIA

Nifedipine
Cyclosporine
Phenytoin
Verapamil

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Drugs used to CONTROL BP in PHEOCHROMOCYTOMA

Phenoxybenzamine
Phentolamine
Labetalol

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Medications that may cause DRUG INDUCED LUPUS

HIPP

Hydralazine
Isoniazid
Procainamide
Penicillin

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Accelerated form of severe HPN associated w/ rising BP and rapidly progressing end organ damage

MALIGNANT HYPERTENSION

Management:

Nitroprusside, Fenoldopam or Diaxozide) PLUS Diuretics (Furosemide) and Beta Blockers
lower BO to 140-160/90-110

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Diuretics

INC UO – DEC BV — DEC CO — DEC BP

THIAZIDE
Chlorothiazide
Hydrochlorothiazide
Indapamide
Chlorthalidone
Metolazone

LOOP 
Furosemide
Torsemide
Bumetanide
Ethacrynic Acid

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MOA of Sympatholytics in treating HPN

(-) SYMPA – DEC HR

DEC VR. DEC HR, DEC contractile force
DEC CO, DEC TPR

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CNS Sympa Outflow Blockers

alpha 2 agonist

Clonidine
Methyldopa

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Causes rebound HPN upon withdrawal

Clonidine

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Causes hemolytic anemia and (+) Coombs test

Methyldopa

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Alpha 1 Blockers

Prazosin
Terazosin
Doxazosin
Alfuzosin

Tamsulosin
Silodosin

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Causes orthostatic hypotension

Alpha 1 Blockers

Prazosin
Terazosin
Doxazosin
Alfuzosin

Tamsulosin
Silodosin

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MOA of Beta Blockers in treating HPN

DEC HR, DEC contraction –> DEC CO –> DEC BP

block renin secretion

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SELECTIVE Beta Blockers

BBEAAMC

Betaxolol
Bisoprolol
Esmolol
Atenolol
Acebutol
Misoprolol
Celiprolol

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NON SELECTIVE Beta Blockers

Propanolol
Penbutolol
Carteolol
Carvedilol
Labetalol
Timolol
Nadolol

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Ganglion Blockers

NOT longer used d.t. side effects

Hexamethonium
Trimethaphan
Mecamylamine

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Nerve Terminal Blockers

NOT used anymore d.t. PSYCHIATRIC side effects

Reserpine

Guanethidine

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Irreversibly blocks VMAT

Reserpine

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(-) Vesicular Release of NE

Guanethidine

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Vasodilators

directly RELAXES arterioles – DEC TPR

Hydralazine
Sodium Nitroprusside
Diazoxide
Minoxidil

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Adverse effects of Hydralazine

SLE

reflex tachycardia

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Adverse effects of Sodium Nitroprusside

hypotension

cyanide toxicity

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MOA of CCB in treating HPN

smooth muscle relaxation –> vasodilation –> DEC TPR –> DEC BP

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DIHYDROPYRIDINE CCB

1st Gen Nifedipine ``` 2nd Gen Amlodipine Felodipine Isradipine Nicardipine Nisoldipine Nimodipine ```

NON - DIHYDROPYRIDINE CCB

Verapamil | Diltiazem

Adverse effects of DIHYDROPYRIDINE CCB

pretibial edema | constipation

Adverse effect of Verapamil

gingival hyperplasia

MOA of Nitroprusside in treating HPN

INC NO --> INC cGMP --> smooth muscle relaxation

MOA of Fenoldopam in treating HPN

DOPAMINE AGONIST arteriolar vasodilation of afferent and efferent arterioles

MOA of ACE (-) in treating HPN

DEC angiotensin --> DEC vasoconstriction --> PR DEC angiotensin II --> DEC aldosterone --> NaH20 retention --> DEC BV --> DEC CO DEC aldosterone --> K retention (hyperkalemia)

ACE Inhibitors

-PRIL Captopril Enalapril Benazepril Fosinopril

MOA of Angiotensin Receptor Blockers in treating HPN

blocks the binding of ang II to ang II receptors --> DEC TPR (afterload) and DEC venous tone (preload) DEC aldosterone --> K retention (hyperkalemia)

Adverse effects of ACE Inhibitors

cough | angioedema

Adverse effects of Angiotensin Receptor Blockers

hypotension hyperkalemia teratogenic

Treatment for Uncomplicated HPN 140/90 - therapeutic threshold 130/80 - GOAL

MONOTHERAPY/ COMBINED ACE (-) or ARBs CCBs Thiazide

Treatment for HPN w/ CAD, ACS, high sympathetic drive and pregnant women

Beta Blockers CHF *Bisoprolol, Carvedilol, Metoprolol Succinate, Nebivolol

Treatment for BP >150/100 elderly - BP 160/100

ARB or ACE (-) PLUS CCB or Diuretics

Treatment for HPN + DM ≥ 140/90 - therapeutic threshold 130/80 - GOAL XXX - 120/70

LOW DOSE COMBINATION of RAAS BLOCKERS (ACE (-) OR ARBs) AND CCB OR Thiazide or Thiazide like diuretics

Treatment for CKD PREDIALYSIS ≥ 140/90 - therapeutic threshold <140/90 - TARGET for LOW RISK <130/80 - TARGET for HIGH RISK

REDUCE CV EVENTS IN CKD Px ACE (-) ARBs Thiazide-like diuretics Dihydropyridine Calcium Blockers

Treatment for CKD + albuminuria/proteinuria

ACE (-) or ARBs (at maximally tolerated dose) - 1ST LINE *UACR ≥ 30 CCB (NON-Dihydropyridine) Verapamil Diltiazem

ACE (-) or ARBs used for the treatment of CKD albuminuria/proteinuria should NOT be discontinued UNLESS

serum crea rise >30% over baseline during the 1st 2 mos hyperkalemia (>5.6 mmol/L)

Treatment for CKD + resistant HPN

Mineralocorticoid Receptor Antagonist * Eplerenone * Spironolactone

Treatment for CKD BP ≥ 160/100

2 DRUGS or SINGLE PILL COMBINATIONS address volume depletion type of HPN *CCB and Diuretics for renin dependent type *ACE, ARB, Beta Blockers

Acute Ischemic Stroke (AIS) eligible for IV thrombolysis but NOT for mechanical thrombectomy BP >185/110 - therapeutic threshold BP <185/110 - maintained prior to treatment and during infusion BP <180/105 next 24 h after treatment

referral to neurologist or stroke generalist NICARDIPINE 1-5 mg/h titrated up by 2.5 mg/h q 5-15 mins w/ maximum of 15 mg/h LABETALOL 10 mg IV now over 1-2 min followed by continuous IV infusion of 2-8 mg/min

Acute Ischemic Stroke (AIS) NOT eligible for IV thrombolysis or mechanical thrombectomy 110-130 mmHg - MAP TARGET >220 SBP - therapeutic threshold > 120 DBP

NICARDIPINE reduce the BP by 15% during the 1st 24 h after the onset of stroke

Acute Hypertensive Parenchymal Intracerebral Hemorrhage (ICH) SBP ≥ 180 - Therapeutic Threshold SBP <180 - GOAL

NICARDPINE - DOC Labetalol careful lowering to 140-160

(+) history of stroke 140/90 - Therapeutic Threshold ≤ 130/80 - GOAL

RAS Blockers, CCBs, Thiazides

Thiazide Diuretics (-) Na/Cl transporters for HPN, HF, hypercalciuria, renal calcium stones, nephrogenic diabetes insipidus

"MICH" Metolazone Indapamide Chlorthalidone Hydrochlorothiazide

Appears in cord blood and crosses placenta and may cause hypokalemia, hyponatremia, hypoglycemia, jaundice and thrombocytopenia

Metolazone

Loop Diuretics (-) Na/K/2Cl transporter powerful diuresis, increased calcium excretion HF, pulmonary edema hypercalcemia, acute renal failure, anion overdose

Furosemide Bumetanide Torsemide Ethacrynic Acid - can be used in px with sulfur allergy

Drugs used to control BP in pheochromocytoma

Phenoxybenzamine Phentolamine Labetalol

Common SE of vasodilators

hypotension reflex tachycardia edema headache

Most effective vasodilator Bort arteriolar and venodilator SE: cyanide toxicity

Nitroprusside increase NO -- increase cGMP -- smooth muscle relaxation

D1 receptor agonist Arteriolar vasodilation of afferent and efferent arterioles INCREASED renal blood flow

Fenoldopam

MOA of Vasodilators

alters intracellular calcium metabolism (Hydralazine) opens K channels in vascular smooth muscle = hyperpolarization - smooth muscle relaxation = vasodilation (Minoxidil, Diazoxide) Calcium channel blockade increase NO -- increase cGMP -- smooth muscle relaxation D1 receptor agonist - Fenoldopam

Alters intracellular calcium metabolism vasodilates ARTERIOLES -- decreased afterload for preeclampsia, HPN heart failure - + ISDN SE: psychiatric depression, suicidal ideation DRUG INDUCED LUPUS MI

Hydralazine

Opens K channels in vascular smooth muscle = hyperpolarization - smooth muscle relaxation = vasodilation for alopecia, HPN SE: hirsutism DRUG INDUCED LUPUS

Minoxidil *stimulates hair follicles (telogen phase) to differentiate into growth follicles (anagen phase) Diazoxide

Angiotensin Receptor Blockers

-SARTANS ``` Losartan Candesartan Valsartan Telmisartan Irbesartan Eprosartan Azilsartan Olmesartan ```

Drug Induced Lupus

HIPP Hydralazine Isoniazid Procainamide Penicillamine

Why are patients with diabetic nephropathy treated with ACE (-)

ACE (-) decrease albumin excretion and slow progression from micro - to - macroalbuminuria (renoprotective effect)