HTN Flashcards
increasing sodium can lead to what in pts on diuretics
increase K loss
SE of diuretics
” Hypokelmia
“ Incrased uric acid reabsorption & BSLower DBP 8-15mm Hg
“ Improved long-term survival
can also increase cholesterol but usually is transient
diuretics effect Ca in what way?
reabsorption of Ca
can reduce fracture risk
what populations do we see less effected by ACEI and why
elderly and AA are more likely to have low renin HTN
these drugs block angiotensin II receptor
AIIRB
Aliskiren (Tekturna) MOA
direct renin inhibitor (DRI)
just upstream of ACEI target
Aliskiren CI with
Avoid concomitant use with ACEI or ARB in pt with diabetes
because of rash and angioedem
Aliskiren indication
only if pts have already tried another drug but will probably have the same SE
CCB dihydropyridines have most of their effect where
peripheral vascular
CCB nondihydropyridines effect
directly on the heart
negative inotropic effect
negative conotropic effect because they directly block at the SA node and AV node
CCB nondihydropyridines CI with
BB
because of effect directly on the heart
when would you consider using a loop diuretic for HTN?
GFR less than 30
dosing with loops
2x daily but not at night because you don’t want to get up an pee
no later than 12 noon
resistant HTN defined as
what is recommended
3 drugs with elevated bp
or 4 drugs (max dose)
aldosterone antagonist are recommended here
be careful because a lot of pts would have secondary aldosteronism HTN and this could dramatically drop bp
BB with ISA
intrinsic sympathetic activity
partial agonist
makes it look like partial agonist is an antagonist
binds to the receptor but the maximum activity is less than
which bb do we see used most frequently for HTN
Atenelol
and
Metoprolol
Alpha 2 agonist
will block NE release
Work in the CNS and block sympathetic outflow from the CNS
Alpha 1 antagonist will cause what effect
Alpha 1 antagonist at the smooth muscle will cause vasodilation
Doxazosin
Prazosin
Terazosin
are all
Alpha Blockers
Doxazosin MOA
” Block post-synaptic alpha1 receptor
“ Potent vasodilation
why don’t we use alpha blockers for HTN
not considered first line therapy
because higher incidence of developing HF
Prazosin is also used for
PTSD
ADE with alpha blockers
" 1st dose syncope (postural hypotension) " Fluid retention " Dizziness " HA " Nausea " Floppy iris syndrome stress incontinance in women
counseling for pts on alpha 1 blockers
educate that on really hot days with alcohol they will have a higher risk of postural symptoms
feel “tired and washed out”
Alpha2 agonist work on __________
” Alpha2 agonist work on vasomotor centers of the brain
“ ↓PVR, CO–> ↓BP
Clonidine is also used for
-0.2-1.2mg/d
will prevent peripheral manifestations of alcohol withdrawal but will not prevent seizures (benzos)
Methyldopa is really only used in _____ why?>
pregnancy HTN because you need to dose all the time
ADE with alpha 2 blockers like clonidine
" Severe rebound HTN & Insomnia " HA w/ palpitations if d/c suddenly " All have anticholinergic effect: Sedation, dry mouth, " Orthostatic hypotension " Bradycardia, fluid retention
TCA will have what effect on a2
they increase NE levels so they work against each other
Hydralazine
Minoxidil
are both
Direct Arterial Vasodilator
” Direct arterial vasodilator (alters cellular Ca metabolism)
ADE with direct arterial vasodialtors
" Reflex tachycardia---> " Angina exacerbated " HA " Lupus-like syndrome " Flushing " Fluid retention
when would you use a direct arterial vasodilator
” Best to give these with BB & DHP CCBs to help with this + diuretic d/t increased HR response from arterial dilation
” Minoxidil also used for
hair growth (Rogaine)
can also make facial feature more corse
Reserpine
Peripheral Adrenergic Inhibitors
” Depletes catecholamine stores (Norepi NT) —> ↓PVR
Reserpine
(Peripheral Adrenergic Inhibitors)
avoid in
peptic ulcer disease
PUL
HTN emergency
life threatening complications
HTN crisis
> 180/120
goal to reduce MAP by 25% in minutes to hours (NOT < 140/90)
goal to reduce MAP by 25% in minutes to hours (NOT < 140/90)
Particularly good for elevated BP with myocardial ischemia
dilates venous (primarily) and coronary vessels → decreases . preload, myocardial O2 demand
Nitroglycerin
Fenoldopam (Corlopam)
May be good for kidney insufficiency
selective D1-agonist and a2 receptor agonist; vasodilator and increases renal blood flow.
Labetalol – mixed beta/alpha blocker
Onset 5-10 min, duration 30-60 min
Not in acute HF
used for
HTN crisis
need person supine b/c of high risk of orthostasis
PAH group
based on associated etiology with group 1 isiopathic
