HTN drugs Flashcards
Captopril, Lisinopril, Fosinopril (ACEI)
MoA
- Blocks Angiotension-Converting enzyme
–> results in decrease effects of Angiotensin II
–> builds up bradykinin
captopril, lisinopril, fosinopril
application
- First-line or add-on therapy for uncomplicated HTN
- First-line therapy for compelling indications of
–> diabetes
–> chronic kidney disease
–> coronary artery disease
–> left ventricular dysfunction
–> previous ischemic stroke
- enahnce the efficacy of diruertic drugs –> good combo
Describe ACEI pharm
- cleared mostly by the kidney –> reduce dose in kidney failure
- elevated plasma renin activity causes hyperresponsive to ACEIs –> reduce doses in pts with HIGH PLASMA RENIN LEVELS (HF, Na+ depleted patients)
describe various situtations of ACEI
AVOID: PREGNANCY, bilateral renal artery stenosis, history of angioedema
- POTENTIALL FAVORABLE SITuTATIONS FOR EFFECTS
–> low-normal potassium, PREDIABETES, Albuminuria
- Situations with potentially UNFABORABLE EFFECTS
–> HYPERKALEMIA
–> VOLUME DEPLETION
–> high-noraml K+
describe adverse effects of ACEI
ADVERSE:
–> hypotension
–> COUGHING (5-20%) - consider ARB when severe
–> angioedema
–> increased plasma K+
–> acute renal failure
–> fetopathic potential
Losartan, valsartan, candesartan (-ARTAN)
(MoA)
ANGIOTENSIN RECEPTOR 1 BLOCKER
EFFECTS OF losartan, valsartan, candesartan
Inhibit Ang II-induced
- contraction of vascular smooth muscle
- Thirst
- Vasopressin release
- aldosterone secretion
- release of adrenal catecholamines
- enhancement of noradrenergic NT
- increases in sympathetic tone
- changes in renal function
- cellular hypertrophy and hyperplasia
ROle of losartan, valsartan, candesartan role in antihypertensive therapy
- first-line or add-on therapy for compliated hypertension (as effective as ACEIs)
- first-line therapy for compelling indications of diabetes, chronic kidney disease, coronary artery disease, left ventricular dysfunction
- commonly used as an alternative for patients with intolerance to ACE inhibitors
describe various situations to use or not use angiotension receptors blockers (ARB)
- avoid use: PREGNANCY, bilateral renal artery stenosis
- Situations with potentially favorable effects
–> low-normal potassium
–> prediabetes
- situations with potentially ufnaorable effects
–> high-normal K+
–> hyperkalemia
–> volume depletion
Nifedipine, amlodipine, felodipine
MoA = DIHYDROPYRIDINE Calcium channel blocker
- Role in antihypertensive therapy:
–> FIrst-line or add-on therapy for uncomplicated hypertension
–> add-on therapy for: Diabetes, coronary artery disease
- Avoid: Left ventricular dysfunction
- Situations with potentially FAVORABLE effects
–> elderly patients with isolated sytolic hypertension
- situations with potentially UNFAVORABLE effects
–> high-normal heart rate or tachycardia or PERIPHERAL EDEMA
Verapamil, Diltiazem
NON-DIHYDROPYRIDINE calcium channel blocker
- ROLE in antihypertensive therapy
–> first line or add-on therapy for uncomplicated HTN
–> alternative to Beta-blockers in coronary artery disease
- AVOID: LEFT VENTRICULAR DYSFUNTION
- FAVORABLE: MIGRNAE HEADACHE, ARRHYTHMIAS, HIGH-normal heart rate or tachycardia
- UNFAVORABLE: LOW-normal heart rate
describe Thiazide diuretics for HTN
- Role of antihypertensive therapy
–> first line or add-on for uncomplicated HTN
–> first-line therapy in pts with LEFT VENTRICULAR DYSFUNCTION or PREVIOUS ISCHEMIC STROKE
- AVOID USE if pts: allergic rxn to sulfa-type drugs, GOUT, HYPOnatremia, HYPOkalemia
- FAVORABLE: osteoporosis or high-normal K+
- UNFAVORABLE: gout, prediabetes, low-normal K+, elevated fasting glucose
Propranolol, Metoprolol, Pindolol, Labetalol
Propranolol (non-selective), Metoprolol (cardio-selective),
Pindolol (ISA), Labetalol (mixed alpha/beta)
- TX: First-line therapy for pts with CORONARY ARTERY DISEASE or LEFT VENTRICULAR DYSFUNCTION
- FAVORABLE: Migraine headache, tachyarrhythmia, normal heart rate or tachycardia, hyperthyroidism
