HTN Flashcards
What classes of drugs are used to control Essential HTN?
Thiazides, ACEIs, ARBs, CCBs, and sometimes BBs
Name common Thiazides, ACEIs.
HCTZ, Metolazone, Chlorthalidone
Captopril, Lisinopril, Ramipril, Enalapril
Name Adverse Effects of Thiazides.
GLUC: Hyperglycemia, Hyperlipidemia, Hyperuricemia, Hypercalcemia.
Name common CCBs and their adverse effects
Verapamil, Diltiazem, Nifedipine, Amlodipine, Nicardipine. Flushing, Constipation, Edema, Gingival Hyperplasia. Headache, Nausea.
Name common ARBs and adverse effects.
Valsartan, Candasartan, Losartan. Increased Creatinine, Hyperkalemia, HoTN.
What are the adverse effects of ACEIs and which patients are never to use them?
Cough, life-threatening Angioedema, Teratogen (renal), Hyperkalemia. Taste changes. Never offer to lung pts or pregnant women. (ACEIs are ideal for diabetics - as they are renal protective at the Efferent arteriole). Btw, ACEIs can also cause Hyperkalemia just like ARBs.
Name some popularly used ACEIs.
Lisinopril, Captopril, Enalapril, Quinapril, Ramipril.
What medication is never given in decompensated HF or Cardiogenic Shock?
Beta Blockers will ruin the only mechanism these pts have to maintain cardiac output at the Beta1 receptor of the heart.
What drugs are used in pregnant hypertensive pts? And which concerns do we have for each?
Happy Moms Love Nifedipine. Hydralazine, but avoided due to significant swelling and reflex tachycardia and don’t forget DIL. Methyl-dopa - but must check for potential hemolytic anemia w/ positive Coombs and concern for CNS depression from a2 receptor agonism. Labetalol - can induce asthma due to its nonselectivity. Nifedipine is the dream - tho can cause flushing, pitting peripheral edema, gingival hyperplasia, and constipation.
What are we attempting to change in a Primary HTN pt?
MAP = CO x TPR. We wish to reduce either CO or TPR or both. Reduction of Preload by widening veins or reduction of afterload by widening of arteries. Or volume decrease in the case of diuretics.
Hypertensive medications ideal for a diabetic patient. What two classes of meds do we avoid in DM and why?
ACEIs are renal protective as the lack of angiotensin at the Efferent arteriole allows less glomerular pressure, thereby reducing the Non-enzymatic glycosylation which occurs in high pressure in a Diabetic. We do not use beta blockers because they may mask the Sxs of hypoglycemia (inversely we use Propranolol to mask performance anxiety - sweating, tremors, shaking) and we do not use Thiazides as they can cause hyperglycemia.
Which drugs should we not use in asthmatics or those with lung problems?
Never use non-selective BBs, as they will increase bronchoconstriction. Never use ACEIs as they can induce cough, compromising air flow.
Which CCBs are dihydropyridines and which are non? Also, what’s the relevance?
Nondihydropyridines are used as cardiac specific L type antiarrhythmics: Verapamil (most potent/selective) and Diltiazem. Amlodipine and Nifedipine are dihydropyridines and specific to the smooth vascular muscle L-type channels. We use these for angina and HTN.
Which two CCBs are used as antiarrhythmics and which class do they belong to?
Verapamil and Diltiazem are Class IV Antiarrhythmics to treat A-fib and Atrial flutter. They act at cardiac pacemaker AV nodes cells at Phase 0 - causing increased refractoriness.
Which CCB is specifically indicated for SubArachnoid Hemmorage?
Nimodipine. The irritation of the arachnoid layer by blood leads to vascular vasospasm, depriving the brain of even more blood. Nimodipine prevents this.
