HTN Flashcards
First-line medications for HTN
-Thiazide diuretics
-ACE-inhibitors
-ARBs
-Calcium channel blockers
Thiazide-type diuretic medications
-Hydrochlorothiazide (HCTZ)
-Chlothalidone
-Indapamide
-Metolazone
Thiazide mechanism of action
Reduce sodium reabsorption in the distal convoluted tubule of the kidney; by impairing sodium transport into the tubule, natriuresis and concomitant water loss is induced
Thiazide adverse effects
-Hypokalemia
-Hyponatremia
-Hyperuricemia - caution in pts with gout
Thiazide monitoring
-ineffective with CrCl < 30
- monitor SCr, sodium and potassium 7-10 days after initiation and titration
ACE-inhibitor medications
-Lisinopril
-Enalapril
-Captopril
-Fosinopril
-Ramipril
ACE mechanism of action
Prevent conversion of antiotensin 1 to angiotensin 2
ACE contraindications
-Bilateral renal artery stenosis
-Pregnancy
-Angioedema
ACE adverse effects
-Dry cough due to bradykinin
-Increased SCr-rise up to 30% above baseline is acceptable
-Hyperkalemia
-Angioedema
ACE monitoring
SCr and potassium 7-14 days after therapy initiation and titration
ARBs medication
-Candesartan
-Eprosartan
-Irbesartan
-Losartan
-Telmisartan
-Valsartan
ARB mechanism of action
Selective, competitive angiotensin 2 receptor antagonist
ARB adverse effects
-Dry cough
-Angioedema
-Increased SCr-rise up to 30% above baseline is acceptable
-Hyperkalemia
ARB monitoring
SCr and potassium 7-14 days after initiation and titration
Calcium Channel Blocker (Dyhydropyridines) medications
-Amlodipine
-Felodipine
-Nifedipine
Calcium Channel Blocker (Dyhydropyridines) mechanism of action
Act by relaxing smooth muscle on the arterial wall, decreasing total peripheral resistance, and hence, reducing blood pressure
Calcium Channel Blocker (Dyhydropyridines) adverse effects
Peripheral edema
Calcium Channel Blockers (Non-Dihydropyridine) medications
-Diltiazem
-Verapamil
Calcium Channel Blockers (Non-Dihydropyridine) mechanism of action
Acts as a potent vasodilator of the coronary vessels, increasing blood flow and decreasing heart rate via strong depression of atrioventricular node conduction
Calcium Channel Blockers (Non-Dihydropyridine) adverse effects and contraindications
-Bradycardia, heart block
-Constipation
*these drugs are potent CYP450 inhibitors = many drug interactions
*contraindicated in pts with heart failure
Beta-blocker (Selective) medications
-Metoprolol
-Atenolol
-Bisprolol
-Nebivolol - good for pts with sexual dysfunction
Beta-blocker (Non-selective) medications
-Propranolol
-Carvedilol
-Labetalol
-Nadolol
-Sotalol
Beta-blocker mechanism of action
Selective agents block the beta-1 adrenergic receptor in the heart with little or no effect on beta-2 receptors (which are more prominent in the bronchial smooth muscle)
-dose-dependent action, meaning with higher doses, you lose selectivity for the beta-1 receptor
Beta-blocker indications
-Heart failure (metoprolol succinate, carvedilol, bisprolol) in combo with an ACE
-Post-MI
-High coronary artery disease risk
Beta-blockers adverse effects
-Bradycardia
-Heart block
-Potential to worsen bronchospastic disease
(caution in pts with asthma)
-Mask symptoms of hypoglycemia (except
sweating)
-Exercise intolerance - can improve
-fatigue - can improve
-sexual dysfunction - persists
Renin Inhibitor medication and administration requirement
Aliskiren
-no data for monotherapy
-CAN NOT be combined with ACE or ARB
Alpha-blocker medications
-Terazosin
-Doxazosin
-Prazosin
Alpha-blocker mechanism of action
Selective alpha-1 antagonist work by blocking the action of adrenaline on the smooth muscle of the blood vessel walls
Alpha-blocker clinical use
-hypertensive male with concomitant bph
-not considered 1st line therapy, usually 4th or 5th
Alpha-blockers adverse effects
-Dizziness
-Orthostatic hypotension- recommend to take at night while in bed
Loop diuretic medications
-Furosemide
-Torsemide
-Bumetanide
-Ethacrynic acid - no sulfa
Loop diuretic treatment consideration
NOT an effective blood pressure lowering agent.
-Should be used to manage edema
Loop diuretic adverse effects
-electrolyte disturbances
-photosensitivity
Potassium-sparing diuretic medications
-Triamterene
-Amiloride
Potassium-sparing diuretic mechanism of action
Block epithelial sodium channel on the lumen side of the kidney collecting tubule
Potassium-sparing diuretic adverse effect
hyperkalemia- especially in combination with ACE or ARB
-often used in combination with thiazide-type diuretics to maintain potassium balance
Aldosterone antagonist medications
-Spironolactone
-Eplerenone
Aldosterone antagonist mechanism of action
inhibit the effect of aldosterone by competing for intracellular aldosterone receptors int he cortical collecting duct; decreases the reabsorption of sodium and water while decreasing the secretion of potassium
Aldosterone antagonist clinical use
-evidence for low-dose spironolactone for pts with resistant hypertension
-heart failure
Aldosterone antagonist contraindications
-anuria
-acute renal insufficiency
-hyperkalemia (>5)
-creatinine clearance <30 mL/min
Aldosterone antagonist adverse effects
-hyperkalemia
-gynecomastia with spironolactone, but not eplerenone
Central alpha-2 agonist medications
-Clonidine
-Methyldopa
-Guanfacine
Central alpha-2 agonist mechanism of action
Stimulates alpha-2 receptors in the brain, which decreases sympathetic outflow cardia output and peripheral vascular resistance, lowering blood pressure and heart rate
Central alpha-2 agonist clinical use
-resistant htn
-hypertensive urgency
Central alpha-2 agonist adverse effects
-Dizziness and orthostatic hypotension
-drowsiness
-dry mouth
Central alpha-2 agonist monitoring
-rebound htn if weaned too quickly or missed dose
-avoid in pts with heart failure
-quite sedating
Vasodilators medications
-Hydralazine
-Minoxidil
Vasodilators mechanism of action
Direct-acting smooth muscle relaxant that acts as a vasodilator primarily in the arteries and arterioles
Vasodilators clinical use
-resistant htn
Vasodilators adverse effects
-hydralazine can cause lupus-like syndrome
-minoxidil associated with hirsutism (used topically for alopecia)
What drug can be helpful for resistant htn (pt on all 4 anti-hypertensive classes and still uncontrolled)
Spironolactone
Preferred medication for htn and pregnancy
-Methyldopa
-Labetalol
-Hydralazine for preeclampsia
HTN medications to avoid in pregnancy
-ACE
-ARB
-Renin-inhibitors
-Atenolol
-thiazide diuretics are questionable
