hypertension Flashcards

Question

Hypertension Hydrochlorothiazide

Answer 1

Generic: hydrochlorothiazide Trade: Classification: Thiazide-like diuretic Therapeutic Indication: HTN, edema, HF. *first line diabetes WITHOUT complications/CV risk factors (alternative to ACE-I/ARB) Used in combination with other medications for SBP >160 and/or DBP >100. MOA: Inhibits sodium reabsorption primarily in distal convoluted tubule. Causes excretion of sodium, water, potassium and hydrogen ions, and increased urine production. Results in decreased extracellular fluid volume and reduced afterload and cardiac output. Dosing: Initial 12.5-25 mg once daily Titrate dose based on response. Doses >25 mg/day not recommended. Adverse S/E: - Electrolyte disturbances - gout or renal calculi from hyperuricemia - glucose intolerance - transient hyperlipidemia - hypersensitivity reactions - ocular effects - Photosensitivity (advise re: sun safety) - skin cancer (4x risk of non-melanoma skin cancer eg SCC and BCC) Contraindicated: anuria, hypersensitivity Precautions: pre-existing electrolyte abnormalities, hepatic dysfunction, glucose intolerance, predisposed to gout, renal impairment or arrhythmia. Replace thiazide diuretics with loop diuretics when GFR <30 mL/minute. Monitoring: Na, K, BUN, creatinine, glucose. Therapeutic effect: Hypotension and decreased extracellular volume. Approximately 4 weeks for optimal effect. BEER's Criteria: Geriatric considerations: caution in use > 65 (may trigger SIADH)

Answer 2

Generic: ramipril Trade: Classification: ACE-I Therapeutic Indication: HTN, HF *first line DM with or without microalbuminuria/CKD/CVD/CVD risk factors; non-diabetic CKD; CAD; CVD; HF MOA: prevents the conversion of angiotensin I to angiotensin II Dosing: Oral: Initial: 2.5 mg QD; titrate dose based on patient response after 2 to 4 weeks up to 20 mg daily in 1 or 2 divided doses. Adverse S/E: Serious Angioedema (0.2%), cholestatic jaundice, hematologic effects (neutropenia, thrombocytopenia, anemia), hypersensitivity reaction (severe anaphylactoid reaction), hypotension/syncope, renal function deterioration. Common: HA, dizziness, cough (7-12%), hypotension Contraindications: hypersensitivity, pregnancy , hx angioedema, bilateral renal artery stenosis Precautions: electrolyte imbalance, severe renal impairment Monitoring: - Obtain serum creatinine and potassium before initiation of therapy, after the first week of therapy, monthly during the first 3 months, and when increasing the dose. - Liver function tests (LFTs) should be performed prior to initiating therapy. - For patients with renal impairment assess urine protein prior to initiation, every 2-4 weeks for the first 3 months of therapy, and regularly thereafter for up to 1 year. WBC count with differential should be monitored prior to initiation of therapy, monthly for the first 3-6 months, and periodically for up to 1 year for patients at risk for neutropenia (renal impairment, collagen vascular disease, high doses).

Answer 3

Generic: amlodipine Trade: Classification: CCB Therapeutic Indication: hypertension, Amlodipine is especially good for HTN pts with LV dysfunction and CHF MOA: Acts from inner side of cell membrane, binds to channels and directly block influx of calcium prolonged smooth muscle relaxation. Relax arterial smooth muscle, no effect on veins so significantly reduces afterload but limited effect on preload Negative inotrope (reduce contractility) and decrease SA/AV nodal conduction. Duration (interval) of treatment: Adverse S/E: Hypotension (dizziness, headache, fatigue, syncope), dry mouth, N/V, dry mouth, Photosensitivity and facial telangiectasia, heart failure Contraindications: All CCB after MI (esp type 1: negative inotrope, bradycardia), unstable angina Peripheral edema, ventricular dysfunction Precautions:CYP3A4 channel **drugs that inhibit CYP450 incl grapefruit juice will free drug level** Monitoring: LFT before initiating therapy Interaction: histamine2 blockers, alcohol, NSAIDs BEER's Criteria: Geriatric considerations: initiate on half of usual dose, increase gradually to reduce ADR