Hypertension Flashcards
Which htn drug to choose initially if black
thiazide or CCB
when to start 2 1st line drugs
in stage 2 when avg SBP and SBP 150/90
which drugs should be used in pregnancy and when to start?
BP goal: if 160/105
may use labetalol and nifedipine ER 1st line or methyldopa
where do thiazide diuretics work?
distal convoluted tubule
What is in Zestoritic, Hyzaar, benicar, diovan?
ace/arb + hydrochlorothiazide
what is in lotrel, exforge
ace or arb + ccb
what is in tenoretic, ziac
betablocker + diuretic
what is in maxzide, dyazide
k sparing + hydrochlorothiazide
BP categories:
- Normal: 120/80
- Elevated: 120-130/80
- Stage 1: 130-139 OR 80/89
- Stage 2: greater than 140/90
When to start tx
If stage 2 (>140/90) or if stage 1 (130-140/80-89) with clinical CVD/10% 10 year ascvd risk
when to check BP
every 4 weeks
thiazide diuretic MOA
inhibit NA/cl cotransporter thus preventing its reabsorption into the blood and resulting in excretion of Na, Cl, H20, MG and K
Retains CA, UA,
All diuretics retain: LDL, TG, BG
Thiazide monitoring
renal function because not effective when CrCL <30
Norvasc
Amlodipine
Cardene
Nicardipine IV
Adalat CC, Procardia XL
Nifedipine ER
MOA of DHP CCB
blocks ca channels on peripheral smooth muscle to cause “vasodilation”
DHP CCB names end in
“pine”
DHP CCB side effects
- Vasodilator class s/e: peripheral edema, headache, flushing, palpitations, reflex tachy
- gingival hyperplasia
Non-DHP CCB MOA
inhibit ca entry into cardiac smooth muscle (but are more selective for myocardium) to decrease HR and contractility
big warning for non-dhp ccp
avoid in HF due to negative ionotropic and chronotropic effect that suppresses CO and ability of heart to pump even more
Which are non-DHP CCB
Diltiazem (Cardizem, Tiazac), Verapamil (Calan SR)
All CCB are substrates of what
CYP3a4
ace inhibitors end in
-pril
ace inhibitor MOA
prevent conversion of angiotensin 1 to 2 which downstream prevents aldosterone secretion and vasoconstriction
lotensin
benazepril
vasotec
enalapril (enalaprilat is Vasotec IV)
Prinivil, zestril
lisinopril
Accupril
quinapril
altace
Ramipril
ace/arb boxed warning and contraindications
BW: teratogenic
Contraindications: angioedema
Avoid use in bilateral renal artery stenosis
- ace only: not for use within 36 hours of entresto
side effects of ace/arb
cough, hyperkalemia, increased scr, hypotension
arb has less s/e
entresto components
valsartan and sacubitril which is a nephralysin inhibitor
what is contraindicated with the use of an ace or arb in diabetic patients
aliksiren
Avapro
Irbesartan
Losartan
Cozaar
Benicar
Olmesartan
Valsartan
Diovan
Aldactone
Spironolactone
Dyazide, Mazide
Triamterine + HCTz
Tenormin
Atenolol
Brevibloc
Esmolol
Lopressor
Metoprolol tartrate
Toprol XL
Metoprolol succinate Er
Beta blockers preferred in HF
Metoprolol succinate, bisoprolol, carvedilol
Atenolol, esmolol, metoprolol
b1 selective bb
Bystolic
Nebivolol (b1 selective with NO dependant vasodilation)
Inderal
Propanolol
Corgard
Nadolol
Non-selective B1/B2 blockers
propanolol and nadolol
Coreg
Carvedilol
Non-selective beta blockers
Carvedilol and labetalol
What are BB 1st line for?
Post-MI, Stable ischemic heart disease, heart failure
Acebutol
Beta blocker with intrinsic sympathomimetic activity
Catapres
Clonidine
Intuniv
Guanfacine ER
pneumonic for B1 selective beta blockers
AMEBBA
clonidine patch application
weekly, remove before MRI
effect of alpha 2 agonism on norepinephrine
decreases release
what are the dile drugs in this chapter?
methyldopa (alpha 2 agonist), hydralazine (direct vasodilators)
also isoniazid and minocycline from previous chapter
methyldopa warnings
requires coombs test (hemolytic anemoa), DILE, do not use with MAO inhibitors
