HTN Flashcards
bp goal for everyone
< 130/80
aa
thiazides and CCBs
CKD
ace or arb
dialysis
thiazide or CCBs, nothing left to preserve
gen population 1st line tx
thiazide, ace, arb, ccb
mean arterial pressure (MAP)
systolic + 2(diastolic) / 3
bp can be reduced by
- volume of fluid or
- dilate the vessels (- inotrope, - chonotrope)
decrease volume via kidneys
diuretics (ex. thiazide, loops, k sparing)
electrolyte disturbances
meds that increase bp
- estrogen
- corticosteroids (nsaids, COX2)
- SNRI’s
- migraine meds
lifestyle modifications for weight loss
- lose weight
- sodium intake <2.4 g a day
- dash diet
- less alcohol
bb ONLY for pts with
heart disease, not recommended for initial tx of uncomplicated htn
HTN in patients with CAD
- BB with ace/arb
good for patients with: - angina
- post MI
- after heart attack
HTN in patients with CHF
- low dose BB
- ace/arb
- entresto (sacubitril + arb (valsartan)
- aldosterone antagonist
diruretics for htn
thiazides
duretics for hf
loops
crcl <30
use loops or metolazone (zaroxolyn)
thiazides (proximal DCT)
hydrochlorothiazide (microzide)
chlorothiaizde (diuril)
thiazide like diuretics (proximal DCT)
chlorthalidone
indapamide (lozol)
metolazone (zaroxolyn)
loops (thick asc loop of henle)
bumetanide (bumex)
ethacrynic acid (edecrin)
furosemide (lasix)
torsemide (demadex)
k sparing diuretics (distal dct and collecting ducts)
amiloride (midamor)
triamterene (dyrenium)
spironolactone (aldactone)
eplerenone (inspra)
thiazide side effects
↓ nacl
↓ k
↓ mg
↑ glucose
↑ uric acid
↑ ca
caution with thiazides
DM
gout
preg category B
sulfa allergy
sexual dysfunction
drug interactions with thiazides
risk of lithium toxicity due to ↓ na
risk of digoxin toxicity due to↓ k and↓ mg
risk of allopurinol hypersensitivity
chlorothalidone
longer acting and more potent than hydrochlorothiazide
bumetanide (bumex)
for edema
1 mg oral bumetanide = 40 mg oral furosemide
1 mg iv bumetanide = 20 mg iv furosemide
ethacrynic acid (edecrin)
for edema
causes more ototoxicity than other loops
can give in pts with sulfa allergy
furosemide (lasix) and torsemide (Demadex) indication
edema and HTN
with fursemide IV/IM, protect from light
loop slide effects
↓ nacl
↓ k
↓ mg
↓ ca
↑ glucose
↑ uric acid
sexual dysfunction
rash
lupus
ototoxicity
ALL aldosterone antagonists
spironolactone (aldactone)
eplerenone (inspra)
taz/tazmin (has drosperenone - analog of spironolactone)
amiloride (midamor) and triampterene (dyrenium) indication?
edema
spironolactone and eplerenone indication?
spironlactone: HTN, edema, CHF, off label: acne and hirtuism in women
eplerenone: HTN, chf after MI
spironolactone and eplerenone dosage for htn and hf?
HTN: 50 mg qd to start, 50 mg BID max
HF: 12.5-25 mg qd to start, 50 mg qd max
side effects of k sparing diuretics?
hyperkalemia, spironolactone: gynecomastia
meds that decrease testosterone cause gynecomastia, which are?
spironolactone, ketoconazole, and cimetidine (tagamet)
spironolactone does not affect?
glucose or uric acid
k sparing diuretics are always additives
to thiazides/loops to prevent hypokalemia
beta blockers
- acebutolol (sectral) - can cause drug induced lupus (+ ANA test)
- atenolol (tenormin) - orange juice, apple juice, and green tea decrease effects of drug by 40%, take within 4 hours of each other
- betaxolol (kerlone) - renal elimination
- bisoprolol (zebeta)
- esmolol (brevibloc) - iv can be used for SVT, HTN emergency, tachycardia, HTN
- metoprolol: lopressor is metoprolol tartrate (w food) and toprol xl is metoprolol succinate. IV available
- nadolol (corgard) - same as atenolol
- penbutolol (levatol_
- pindolol
- propanolol (hemangeol, inderal la/xl, innopran x)
- sotalol (betaspace) - for ventricular arrythmias, do not sub betaspace for betaspace af
-nebivolol (bystolic) - nitric oxide - carvedilol (coreg) - with food. start 3.125 mg BID for HF and 6.25 mg BID for HTN
- labetolol (trandate)
propanolol IR vs ER?
IR: empty stomach
ER: with or without food
do not sub er for ir on mg for mg basis
beta 1 selective BB
MAN BABE
metoprolol
atenolol
nebivolol
betaxolol
acebutolol
bisoprolol
esmolol
beta 1 blockers are better for COPD patients
beta blockers that come in IV
MAPLES
metoprolol
atenolol (injection not available in the US)
propanolol
labetolol
esmolol
sotalol - only for arrhythmias
ISA’s intrinsic sympathomimetic activity
decreases hr less
acebutolol
penbutolol
pindolol
when to use BB
CHF?
BB, ace/arb, diuretics, aldosterone antagonists
when to use BB
post MI
BB, ace/arb, aldosterone antagonists
when to use BB
angina pectoric
BB, CCB
when to use BB
Afib or flutter
ABCD
A - amiodarone or dronedarone (multaq)
B - BB
C - non CCB’s
D - digoxin
bb used in chf
- carvedilol
3.125 mg =10 mg ER
6.25 mg = 20 mg ER
12.5 mg = 40 mg ER
25 mg = 80 mg ER
take with food - metoprolol succinate - they can be scored
- bisoprolol (zebeta)
bb side effects
B bradycardia, bronchospasm
L decrease libido, increase lipids
O orthostatic hypotension
C av block
K raynauds phenomenon (TX with ccb)
E exhaustion/emotional depression
BB contraindicated in
ergots
non - dihydropyridine CCB
diltiazem
diltiazem - cardizem, cardizem CD, cardizem LA, dilt xr, cartia xt, tiazac, taztia xt, matzim la
non - dihydropyridine CCB
verapamil
calen, calen sr, isoptin sr, verelan, verelan pm
CCBs
amlodipine (norvasc) - does not affect the heart
felodipine (pendil) - always er, dont crush or chew
nisoldipine (sular) - always er, dont crush or chew
isradipine (dynacirc) - BID
nicardipine - cardene - IV
nifedipine - procardia xl, atalat cc (DECREASES BP MORE THAN ANY OTHER CCB)
nimodipine - nimotop nymalize - oral (ONLY FOR SUBARACHNOID HEMMORHAGE)
clevidipine - cleviprex - iv emulsion
taztia xt, and tiazac
caps may be opened and sprinkled
verelan and verelan PM
caps may be opened and sprinkled
verapamil affects
diltiazem affects
both of these drugs can also cause ____ and not be used in patients with ____
heart (can cause constipation)
heart and vessels
they are negative inotrope and chronotrope effects
bradycardia/av block; hf patients
nifedipine er
empty stomach
celvidipine (cleviprex)
milky appearing lipid emulsion
do not exceed > 1000 mL in 24 hours due to lipid load
CI in soy or egg allergy
same with dipovan/propofol
if its drug induced, it will always be
bilateral edema
