HTN Flashcards
Diuretics (general)
decrease blood pressure by decreasing blood volume (increase sodium excretion by kidneys, water follows)
MUST MONITOR ELECTROLYTES
Thiazide diuretics
hydrochlorothiazie
chlorthalidone
metalozone
indapamide
Thiazide dirueretic (Pros/Cons)
Pros: 12.5mg effective w/o side effects, often first line (especially older/black), also some dilation of peripheral resistance, good in combos
Cons: Not effective if GFR<30
Hypokalemia, hyperuricemia, hyperglycemia, diuresis
Loop diuretics
Furosemide
Toresemide
Bumetanide
Ethacrynic acid
Loop diuretics (Pros/Cons)
Pros: Also treat HF/edema, block Na/Cl re-absorption even if poor renal function, work quickly, decrease renal vascular resistance
Cons: rarely used alone for HTN, not first line
Potassium sparking diuretics
Amiloride Triamterene Spironolactone* Eplerenone* (*aldosterone receptor antagonist, diminish cardiac remodeling in HR)
Potassium sparking diuretics (Pros/cons)
Pros: Inhibit Na+ transport at late distal+collecting ducts (stays in urine), can be used with other diuretics to reduce loss of K+
Cons: not first line
Beta Blockers (general)
Block beta adrenergic receptors (1,2), decrease HR/CO, some inhibition of renin release
+ISA
Cardioselective OK for asthma, COPD, PV disease
Dose 1-2x daily
Non-selective beta blockers
-ISA: Nadolol
Propanolol
Timolol
\+ISA: Pindolol
Carteolol
PenbutololSelective beta blockers (B1)
-ISA: Atenolol
Metroprolol
Esmolol
Betaxolol
Bisorolol
\+ISA: AcebutololBeta blockers with vasodilatory properties
Labetolol (alpha-1 blocking)_
Carvedilol (alpha-1 blocking)
Nebivolol (NO activity)
Beta blockers (adverse affects)
Bradycardia, heart block, HF dyspnea, bronchospasm fatigue, dizziness, lethargy, depression decreased libido, erectile dysfunction Hyper/hypoglycemia Hyperkalemia hyperlibidemia
Beta blockers (cautions)
HR <60, respiratory disease, abrupt discontinuation (1-2 week taper), hypoglycemia (masked symptoms), hypokalemia (with diuretic)
Beta blockers (contraindicated)
Hypersensitivity, sinus node dysfunction/bradycardia, heart block, cardiogenic shock, decompensated HR
asthma (nonsenselective)
Calcium channel blockers (general)
blocks calcium movement into smooth muscles to prevent contraction of arterioles, results in dilation
usually short half life (except amlodipine), so prefer extended release
Calcium channel blockers (dihydropyridines)
greater affinity for vascular channels, not with atrial dysrhythmia, some coronary vasodilation
Calcium channel blockers (non-dihydropyridines)
vascular and cardiac channels, also decreases CO, coronary vasodilation, negative inotropic effects (not with HRrEF), blocks cardiac conduction via AV node (helps Afib),
Calcium channel blockers
Dihydropyridines:
nifedipine
amlodipine (ok for HF)
Non-dihydropyridines:
verapamil
diltiazemCalcium channel blockers (adverse effects)
(esp nondih) bradycardia, heart block, constipation, perpheral edema
headache, flushing, edema
(esp dihyd) gingival hyperplasia, reflex tachycardia
Calcium channel blockers (cautions)
heart rate <60 (nondi)
concomitant use with BB (heart block poss)
Calcium channel blockers (contraindications)
hypersensitivity, HFrEF (except amlodipine)
non-dihy: sinus node dysfunction/bradycardia, heart block, afib/flutter with accessory bypass tract
Angiotensin converting enzyme inhibitors (general)
inhibit conversion of angiotensin I to angiotensin II, allows for vascular vasodilation, decreased retention of Na/water
usually does 1x daily
Angiotensin converting enzyme inhibitors
benazepril captopril enalapril lisinopril moexipril perindopril quinapril trandolipril
Angiotensin converting enzyme inhibitors (adverse effects)
common: hyperkalemia, dry cough, reduced GRF/serum CR increase
serious: acute renal failure, blood dycrasias, angioedema
Angiotensin converting enzyme inhibitors (cautions)
Monitor electrolytes and renal function, adjust doses as needed
Caution: baseline hyperkalemia
Contraindication: pregnancy, hypersensitivity, bilateral renal artery stenosis (unilateral if only one working kidney), concurrent ARB use
Angiotensin receptor blockers (general)
block angiotensin II from binding to receptor, allows for vascular vasodilation, decreased retention of Na/water
usually dosed 1x daily
Angiotensin receptor blockers
azilsartan candesartan eprosartan irbesartan losartan olmesartan telmisartan valsartan
Angiotensin receptor blockers (AE)
hyperkalemia
renal function deterioration
angioedema
hypotension/syncope
Angiotensin receptor blockers (cautions)
Monitor electrolytes and renal function, adjust doses as needed
Caution: baseline hyperkalemia
Contraindication: pregnancy, hypersensitivity, bilateral renal artery stenosis (unilateral if only one working kidney), concurrant ACE-I use
Direct renin inhibitors (general)
directly inhibits renin, allows for vascular vasodilation, decreased retention of Na/water
direct renin inhibitors
aliskren
direct renin inhibitors (AE)
hyperkalemia
hypotension
direct renin inhibitors (cautions)
Monitor electrolytes (K+)and renal function (serum Cr, GFR)
Caution: severe renal impairment, deteriorating renal function, renal artery stenosis
Contraindication: pregnancy, combo with ACE-I or ARBs (especially in patients with diabetes)
Interactions: ACE-I, ARBs, cyclosporine, K+ sparing diuretics, K+ supplements or salt substitutes, furosemide, ketoconazole
Alpha 1 blockers (general)
block alpha 1 receptors to decrease vasoconstriction, peripheral resistance, blood pressure
Alpha 1 blockers
doxazosin
prazosin
terazosin
Alpha 1 blockers (AE)
syncope dizziness palpitations orthostatic hypotension falls
Alpha 1 blockers (cautions)
not for HTN monotherapy (increase CV events), 4th/5th line add on
contraindicated: hypersensitivity
Central alpha 2 agonist (general)
Inhibit NE release, causing reduced sympathetic outflow, enhanced parasympathetic activity, reduced HR, CO, total PR
may use occasionally for resistant HTN
Central alpha 2 agonist
clonidine
methyldopa
guanfacine
guanabenz
Central alpha 2 agonist (AE)
transient sedation, visual disturbances, sedation
Methyldopa: hepatotoxicity, hemolytic anemia, peripheral edema orthorstatic hypotension
Clonidine: orthostatic hypotension, dry mouth, muscle weakness
Central alpha 2 agonist (cautions)
Must taper clonidine when stop (severe rebound hypertension), taper BB first if on both, may have withdrawal (increased SNS activity)
Contraindications: hypersensitivity, MAO-I and/or hepatic disease and/or pheochromocytoma (methyldopa)
Peripheral sympathetic inhibitors (general)
Reduces sympathetic tone and PR, depletes NE for sympathetic nerve endings
slow acting
Peripheral sympathetic inhibitors
reserpine
Peripheral sympathetic inhibitors (AE)
Gastric ulceration, depression, sexual side effects, orthostatic HTN, nasal congestion, fluid retention, peripheral edema, diarrhea, increased gastric secretion
Peripheral sympathetic inhibitors (cautions)
Poorly tolerated, interacts with OTC cold/cough meds (acute hypertensive)
Contrindications: hypersensitivity, peptic ulcer disease, ulcerative colitis, hx depression or ECT
Direct Vasodilators (general)
Relax smooth muscles in arterioles, activate baroreceptors
Used for resistant hypertension
Consult with specialist before prescribe
Direct Vasodilators
isorbide dinatrate/hydralazide
hydralazine
minoxidil
Direct vasodilators (AE)
edema, hyper trichosis (minoxidil)
tachycardia
lupus-like syndrome (hydralazine)
Direct vasodilators (caution)
May cause reflex tachycardia, fluid retention so use with BB and diuretics
Contraindicated: hypersensitivity, pheochromocytoma (minoxidil), increased ICP (isosorbide)
Pregancy
Methyldopa is first line
Labetalol also ok
Consult before others (fetal concerns)
