HTN: Medications Flashcards
Thiazide Diuretics: MOA
Blocks Na+/Cl- symporter (DCT)
Prevents Na+ reabsorption –> shifts osmotic balance in renal filtrate
Thiazide Diuretics (5)
[CCHIM]
Chlorothiazide (Diuril) Chlorthalidone (Thalitone) Hydrocholorthiazide (Microzide) Indapamide (--) Metolazone (Zaroxolyn)
Thiazide: Primary Side Effects (7)
- ) Hypokalemia (muscle cramps)
- ) Hypomagnesmia
- ) Hyponatremia
- ) Hypercalcemia**
- ) Hyperuricemia
- ) Hyperglycemia
- ) Photosensitivity
**Take in morning (nocturia)
Thiazide: Monitoring Parameters (5)
- ) BP
- ) Electrolytes
- ) BUN/SrCr Levels
- ) Blood Glucose
- ) Uric Acid levels
Chlorothiazide
Brand: Diuril
Generic: Chlorothiazide
Class: Thiazide Diuretic (TZD)
Dose: 500-2000mg/day
Chlorthalidone
Brand: Thalitone
Generic: Chlorthalidone
Class: Thiazide Diuretic (TZD)
Dose: 12.5-100mg/day
Top 200
Hydrochlorothiazide (HCTZ)
Brand: Microzide
Generic: HCTZ
Class: Thiazide Diuretic (TZD)
Dose: 12.5-50mg/day
Top 200
Indapamide
Brand: —
Generic: Indapamide
Class: Thiazide Diuretic (TZD)
Dose: 1.25-5mg/day
Metolazone
Brand: Zaroxolyn Generic: Metolazone Class: Thiazide Diuretic (TZD) Dose: 2.5-5mg/day Other: Can be used in 30mL/min patients
Top 200
Loop Diuretics: MOA (2)
- ) Inhibit Na+ reabsorption in ASCENDING Loop of Henle
* *blocks Na+/K+/2Cl- symporter** - ) Decreases PRELOAD
Loop Diuretics (3)
[BFT]
Bumetanide (—)
Furosemide (Lasix)
Torsemide (Demadex)
Loop Diuretics: Contraindiation (1) + Key Drug Interactions (4)
1.) Sulfa Allergy
- ) Increase Li toxicity risk
- ) Increase OTOTOXICITY risk with aminoglycosides
- ) Decrease DIABETES medication efficacy (SLGTs?)
- ) NSAIDs decrease effects
Loop Diuretics: Primary Side Effects (8)
- ) Hypocalcemia***
- ) Hypokalemia
- ) Hypomagnesmia
- ) Hyponatremia
- ) Hyperglycemia
- ) Hyperuricemia
- ) Metabolic alkalosis **
- ) Azotemia (high nitrogen wastes in blood) **
(** vs TZDs)
Loop Diuretics: Monitoring (8)
- ) BP
- ) Electrolyte levels
- ) SrCl/BUN
- ) Blood Glucose
- ) Uric acids
- ) Jugular venous pressure (JVP)
- ) Urine output
- ) Weight (~0.5-1kg drop in first day)
Bumetanide
Brand: –
Generic: Bumetanide
Class: Loop
Dose: 0.5-10mg/day
Furosemide
Brand: Lasix Generic: Furosemide Class: Loop Dose: 20-600mg/day PO = 2x IV dose
Top 200
Torsemide
Brand: Demadex
Generic: Torsemide
Class: Loop
Dose: 10-200mg/day
Potassium-Sparing Diuretics (2) + Doses
[AT]
Amloride (–) [5-10mg/day]
Triamterene (Dyrenium) [50-100mg/day]
Potassium-Sparing Diuretics: Contraindications (2) + Drug Interactions (5)
- ) HyperKALEMIA
- ) CKD
Hyperkalemia Risking Meds
- ) K-supplements
- ) ACEis
- ) ARBs
- ) ARAs
- ) NSAIDs
Potassium-Sparing Diuretics: Primary Side Effects (1)
Hyperkalemia
Potassium-Sparing Diuretics: Key Monitoring (3)
- ) BP
- ) Potassium Levels
- ) BUN/Sr
Aldosterone Receptor Antagonists (ARAs) (2)
- ) Spironolactone (Aldactone)
2. ) Eplerenone (Inspra)
ARAs: Monitoring (5)
- ) Hyperkalemia
- ) Metabolic Acidosis (in cirrhotic patients)
- ) Altered clearance of salicylates and glycosides
- ) Diarrhea
- ) CYP3A4 inhibitors (eplerenone)
ARA: Mechanism
Block mineralcorticoid receptors –> prevent expression of aldosterone-induced proteins (AIPs)
Aldosterone Receptor Activation Induced Effects (8)
- ) Activation of Na+-channels
- ) Removal of Na+ channels from membrane (ENaC) inhibition
- ) De novo Na+-channel synthesis
- ) Activation of membrane-bound Na/K-ATPase
- ) Redistribution of Na/K-ATPase channels to membrane
- ) De novo Na/K-ATPase-channel synthesis
- ) Tight junction permeability changes
- ) Increased mitochondrial production
SGK1 Mechanism + Related HTN Disease
Activated by aldosterone
Inhibits Nedd4-2 phosphorylation (UBQ ligase)
**Nedd4-2 phosphorylates and internalizes ENaC
Liddle Syndrome (mutated Nedd4-2 binding domain on ENaC)
Beta Blocker: MOA ()
- Reduced cardiac output (CO)
- Negative ionotrope + chronotrope
Cardioselective BBs (6)
[BAMBAN]
Betaxolol Acebutolol Metoprolol Bisprolol Atenolol Nebivolol
Cardioselective BBs: MOA
Blocks beta adrenergic receptors (b1 > b2)
-Loss of cardioselectivity @ high doses
Intrinsic sympathomimetic activity (ISA) BBs
[CAPP]
Carvedilol
Acebutolol
Pindolol
Propranolol
BB: Lipophillic (6) + Primary Side Effect
CLPPMN
Carvedilol Labetalol Propranolol Pindolol Metoprolol Nebivolol
More likely to cause CNS side effects (i.e. fatigue)
BB: Hydrophillic
A
Atenolol
Acebutolol
Brand: Sectral
Generic: Acebutolol
Class: Cardioselective BB
Dose: 200-1,200mg/day
Atenolol
Brand: Tenormin
Generic: Atenolol
Class: Cardioselective BB
Dose: 25-100mg/day
Betaxolol
Brand: Kerlone
Generic: Betaxolol
Class: Cardioselective BB
Dose: 5-20mg/day
Bisoprolol
Brand: Zebeta
Generic: Bisprolol
Class: Cardioselective BB
Dose: 2.5-20mg/day
Metoprolol Tartrate
Brand: Lopressor
Generic: Metoprolol Tartrate
Class: Cardioselective BB
Dose: 25-400mg/day (BID dosing)
Metoprolol Succinate
Brand: Toprol XL
Generic: Metoprolol Succinate
Class: Cardioselective BB
Dose: 25-400mg/day (QD Dosing)
Nebivolol
Brand: Bystolic
Generic: Nebivolol
Class: Cardioselective BB
Dose: 5-40mg/day
Carvedilol IR
Brand: Coreg
Generic: Carvedilol IR
Class: Nonselective BB
Dose: 12.5-50mg/day (BID)
Carvedilol CR
Brand: Coreg CR
Generic: Carvedilol CR
Class: Nonselective BB
Dose: 20-80mg (QD)
Labetalol
Brand: Trandate
Generic: Labetalol
Class: Nonselective BB
Dose: 200-2,400mg/day
Nadolol
Brand: Corgard
Generic: Nadolol
Class: Nonselective BB
Dose: 20-320mg/day
Pindolol
Brand: –
Generic: Pindolol
Class: Nonselective BB
Dose: 5-60mg/day
Propranolol
Brand: Inderal
Generic: Propranolol
Class: Nonselective BB
Dose: 80-640mg/day
IR (BID-TID) + ER (QD)
Timolol
Brand: –
Generic: Timolol
Class: Nonselective BB
Dose: 20-60mg/day
Cardioselective BB: Primary Side Effects (9)
- ) Bradycardia/Heart block
- ) HF exacerbation
- ) Bronchospasm
- ) Cold extremities
- ) Fatigue
- ) Decreased exercise tolerance
- ) Depression (lipophilllc)
- ) Glucose intolerance
- ) Marked hypoglycemia (DM patients)
[same as nonselective]
Cardioselective BB: Contraindications + Drug Interactions
≥ 2nd Degree Heart Block
HF (EXCEPT bisoprolol and metoprolol succinate)
*avoid abrupt discontinuation (titration required)
Cardioselective BB: Monitoring Parameters (4)
- ) BP
- ) HR
- ) S/S HF
- ) Blood Glucose (DM patients)
Nonselective BB: Primary Side Effects
- ) Bradycardia/Heart block
- ) HF exacerbation
- ) Bronchospasm
- ) Cold extremities
- ) Fatigue
- ) Decreased exercise tolerance
- ) Depression (lipophilllc)
- ) Glucose intolerance
- ) Marked hypoglycemia (DM patients)
[same as selective]
Nonselective BB: Contraindications + Drug Interactions
- ≥ 2nd degree heart block (w/o pacemaker)
- HF (except carvedilol)
Nonselective BB: Monitoring Parameters
- ) BP
- ) HR
- ) S/S HF
- ) Blood Glucose (DM patients)
Combination Products: Tenoretic
Atenolol/chlorthalidone
Combination Products: Ziac
Bisoprolol/HCTZ
Combination Products: Corzide
Nadolol/Bendroflumethiazide
Combination Products: Inderide
Propranolol/HCTZ
Combination Products: Lopressor HCT
Metoprolol Tartrate/HCTZ
Combination Products: Dutoprol
Metoprolol Succinate/HCTZ
ACEi (10) Meds
BCEFLMPQRT
- ) Benazepril (Lotensin)
- ) Captopril (Capoten)
- ) Enalapril (Vasotec)
- ) Fosinopril (–)
- ) Lisinopril (Prinivil, Zestril)
- ) Moexipril (Univasc)
- ) Perindopril (Aceon)
- ) Quinapril (Accupril)
- ) Ramipril (Atlace)
- ) Trandolapril (Mavik)
ACEi: Contraindications (4)
- ) Pregnancy
- ) Hx: Angioedema or previous failure
- ) Hyperkalemia
- ) Bilateral artery stenosis
ACEi: Primary Side Effects (4)
- ) Hyperkalemia
- ) Renal insufficiency
- ) Cough (DRY)
- ) Angioedema
ACEi: Monitoring (3)
- ) BP
- ) BUN/SCr
- ) Potassium
Benazepril
Brand: Lotensin
Generic: Benazepril
Class: ACEi
Dosing: 4-50mg/day
Captopril
Brand: Capoten
Generic: Captopril
Class: ACEi
Dosing: 12.5-450mg/day
-Shortest duration of action
Enalapril
Brand: Vasotec
Generic: Enalapril
Class: ACEI
Dosing: 2.5-40mg/day
-Oral (Epaned) and Injectable (Enalaprilat) preparations available
Fosinopril
Brand: –
Generic: Fosinopril
Class: ACEi
Dosing: 5-80mg/day
Lisinopril
Brand: Zestril, Prinivil
Generic: Lisinopril
Class: ACEi
Dosing: 2.5-40mg/day
Moexipril
Brand: Univasc
Generic: Moexipril
Class: ACEi
Dosing: 3.75-30mg/day
Perindopril
Brand: Aceon
Generic: Perindopril
Class: ACEi
Dosing: 4-16mg/day
Quinapril
Brand: Accupril
Generic: Quinapril
Class: ACEI
Dosing: 10-80mg/day
Ramipril
Brand: Atlace
Generic: Ramipril
Class: ACEi
Dosing: 1.25-20mg/day
Trandolapril
Brand: Mavik
Generic: Trandolapril
Class: ACEi
Dosing: 0.5-4mg/day
ACEi: MOA
Inhibit ACE (angiotensin I --> II conversion) Decrease in aldosterone production Inhibit Bradykinin breakdown (cough source)
ARBs (8)
Azilsartan (Edarbi) Candesartan (Atacand) Eprosartan (Teveten) Irbesartan (Avapro) Losartan (Cozaar) Olmesartan (Benicar) Telmisartan (Micardis) Valsartan (Diovan)
ARB: MOA
Inhibit angiotensin II binding with AT1 receptors
Reduction in aldosterone production
NO EFFECTS ON BRADYKININ
ARB: Contraindications (4)
- ) Pregnancy
- ) Hx: Angioedema or previous failure
- ) Hyperkalemia
- ) Bilateral artery stenosis
ARB: Drug Interactions
Hyperkalemia risk with combinations (ACEi, supplements, etc.)
Increases lithium toxicity risk
Azilsartan
Brand: Edarbi
Generic: Azilsartan
Class: ARB
Dosing: 40-80 mg/day
Candesartan
Brand: Atacand
Generic: Candesartan
Class: ARB
Dosing: 4-32mg/day
Eprosartan
Brand: Teveten
Generic: Eprosartan
Class: ARB
Dosing: 400-800mg/day
Irbesartan
Brand: Avapro
Generic: Irbesartan
Class: ARB
Dosing: 75-300mg/day
Losartan
Brand: Cozaar
Generic: Losartan
Class: ARB
Dosing: 25-100mg/day
Olmesartan
Brand: Benicar
Generic: Olmesartan
Class: ARB
Dosing: 20-40mg/day
Telminsartan
Brand: Micardis
Generic: Telminsartan
Class: ARB
Dosing: 20-80mg/day
Valsartan
Brand: Diovan
Generic: Valsartan
Class: ARB
Dosing: 80-320mg/day
DRI (1) + MOA
Direct Renin Inhibitor
Aliskiren (Tekturna)
Blocks angiotensinogen –> angiotensin I conversion via Renin
DRI: Contraindications (4)
- ) Pregnancy
- ) Hx angioedema with ACEis/ARBs
- ) Hyperkalemia
- ) Bilateral renal artery stenosis
DRI: Drug Interactions
Hyperkalemia risk with other drugs (ACEs, ARBs, etc.)
Avoid taking with HIGH FAT
DM/Renal Impairment
Avoid with furosemide (decrease effects), itraconazole/cyclosporine (increase effects)
DRI: Side Effects (4)
- ) Headache
- ) Dizziness
- ) Diarrhea
- ) Hyperkalemia/renal insufficiency
DRI: Key Monitoring (3)
- ) BP
- ) BUN/SrCr
- ) Potassium Levels
Aliskiren Combo Products (3):
- ) Aliskiren/amlodipine (Tekamlo)
- ) Aliskiren/amlodipine/HCTZ (amturnide)
- ) Aliskiren/HCTZ (Tekturna HCT)
DHP CCB: MOA
Block L-type channels in vascular smooth muscle
Specific/selective to vascular tissues (POTENT)
NO alterations to cardiac conductivity
NO cardiac conduction alterations
Non-DHP CCB: MOA
Block L-type channels in vascular smooth muscle
Less peripheral dilation
Negative chronotropic effects
DHP CCB (6)
Amlodipine (Norvasc) Felodipine (Plendil) Nicardipine (--) Nifedipine (Procardia, Nifedical, etc.) Nisoldipine (Sular)
Non-DHP CCB (2)
Diltiazem (Cardizem)
Verapamil (Calan)
DHP CCB: Contraindications + Drug Interactions
None
CYP3A4 substrate (inhibitors increase, inducers decrease)
DHP CCB: Side Effects (6)
Reflex tachycardia Headache Flushing Peripheral edema Gingival hyperplasia HF exacerbation (NOT AMLODIPINE + FELODIPINE)
DHP CCB: Monitoring
BP
HR
Heart Failure S/Sx
Non-DHP CCB: Contraindications + Drug Interactions
≥ 2nd Degree Heart Block
Systolic HF
CYP3A4 interactions
Use with other negative choronotropes
Increase digoxin toxicity
Increase CYP3A4 substrate toxicity
Non-DHP CCB: Side Effects (5)
- ) Bradycardia/Heart block
- ) Constipation
- ) Peripheral edema
- ) Gingival hyperplasia
- ) HF exacerbation
Non-DHP CCB: Monitoring
BP
HR
Heart Failure S/Sx
Amlodipine
Brand: Norvasc
Generic: Amlodipine
Class: DHP CCB
Dosing: 2.5-10mg/day
Felodipine
Brand: Plendil
Generic: Felodipine
Class: DHP CCB
Dosing: 2.5-20mg/day
Isradipine
Brand: –
Generic: Isradipine
Class: DHP CCB
Dosing: 5-10mg/day
Nicardipine
Brand: Cardene
Generic: Nicardipine
Class: DHP CCB
Dosing: 60-120mg/day (BID-TID)
Nifedipine
Brand: Adalat, Procardia
Generic: Nifedipine
Class: DHP CCB
Dosing: 30-180mg/day
Nisoldipine
Brand: Sular
Generic: Nisoldipine
Class: DHP CCB
Dosing: 10-40mg/day
Diltiazem
Brand: Cardizem
Generic: Diltiazem
Class: Non-DHP CCB
Dosing: 120-540mg/day
Verapamil
Brand: Calan
Generic: Verapamil
Class: Non-DHP CCB
Dosing: 120-360mg/day
Alpha1-Receptor Antagonists: MOA
Block a1 receptors in peripheral blood vessels (both arterial and venous) –> dilation
Alpha1-Receptor Antagonists: Contraindications + Drug Interactions
Not in combination with PDE-5 inhibitors (hypotension risk)
Alpha1-Receptor Antagonists: Monitoring
BP
HR
Alpha1-Receptor Antagonists: Side Effects (5)
- ) Orthostatic hypotension
- ) Reflex tachycardia
- ) Peripheral Edema
- ) Headache
- ) Drowsiness
Take at bedtime to avoid orthostatic hypotension
Doxazosin
Brand: Cardura
Generic: Doxazosin
Class: Alpha1-Receptor Antagonists
Dosing: 1-16mg/day
Prazosin
Brand: Minipress
Generic: Prazosin
Class:
Dosing: 1-20mg/day
Terazosin
Brand: —-
Generic: Terazosin
Class:
Dosing: 1-20mg/day
Central Alpha2 Receptor Agonist: MOA
Stimulate a2 brain receptors –> decrease sympathetic outflow [lower norepinephrine release] –> lower HR/BP
Central Alpha2 Receptor Agonist: Monitoring
BP
HR
LFTs (methyldopa)
Tapering required (2w)
Central Alpha2 Receptor Agonist: Contraindications + Drug Interactions
Methyldopa (liver disease)
Other negative chronotropes (i.e. digoxin, verapamil, etc.)
Central Alpha2 Receptor Agonist: Side Effects (7)
- ) Sedation
- ) Orthostatic hypotension
- ) Depression
- ) Peripheral edema
- ) Dry mouth
- ) Bradycardia
- ) Hepatitis (methyldopa)
Clonidine
Brand: Catapres
Generic: Clonidine
Class: Central Alpha2 Receptor Agonist
Dosing: 0.2-2.4mg/day
Epidural injection available (pain)
Transdermal available (0.1-0.3mg QW)
treatment needs to overlap with oral therapy
Methyldopa
Brand: —
Generic: Methyldopa
Class: Central Alpha2 Receptor Agonist
Dosing: 250-1000mg/day
Safe in pregnant HIV patients
Direct Vasodilator: MOA
Increase cGMP –> aterial vasodilation
Direct Vasodilator: Side Effects
Reflex tachycardia Orthostatic hypotension Peripheral edema Lupus-like syndrome (hydralazine) Hirsutism (minoxidil)
Direct Vasodilator: Contraindications + Drug interactions
Acute MI
Aortic Dissection
None
Direct Vasodilator: Monitoring
BP
HR
S/Sx Lupus (chest pain, joint pain, fever, rash)
Hydralazine
Brand: —
Generic: Hydralazine
Class: Direct vasodilator
Dosing: 25-300mg/day
Injection available
Minoxodil
Brand: —
Generic: Minoxodil
Class: Direct vasodilator
Dosing: 2.5-100mg/day
LAST LINE THERAPY DUE TO SIDE EFFECTS (Hirsutism)
Topical and solution/foam available