Hypertension Flashcards
First Line
thiazide diuretics
ACE
ARBS
CCB
Second Line Agents
Loop diuretics potassium-sparing diuretics androsterone receptor antagonist b- blockers 1- blockers central renin direct renin inhibitor direct vasodilators
HTN diabetes
all first line agents can be used (diuretics, ACEi, ARBS, CCBs)
Patients with albuminuria: Consider ACE or ARBS
HTN HFrEF
o B-blockers with an approved indication for heart failure: metoprolol succinate, carvedilol, bisoprolol
o ACEI, ARB, diuretics. aldosterone receptor antagonists
HTN CKD
Stage 1 or 2: ACE
Stage 3 and 4: ACE
*ARBS in unable to tolerate ACE
HTN SIHD
oFirst line: b- blockers, ACEI, ARBs
o Second line with angina: add DHP CCB if needed
o Second line without angina: add DHP CCB, thiazide diuretics, and/or MRAs
HTN pregnancy
Labetalol
Nifedipine ER
methyldopa
Examples of Thiazide drugs
- Chlorthalidone ( Hydroton)
- HCTZ ( hydrodiuril)
- Indapamide (lozol)
- Metolazone ( zaroxolyn)
Thiazide diuretics
- Contraindications: Hypersensitivity to sulfonamide-delivered drugs
- Drug interactions: Avoid drugs that cause sodium and water retention (NSAIDS)
- Adverse affects: Hyponatremia, hypokalemia, hypomagnesemia, hypercalcemia (!), hyperuricemia, hypovolemia, hyperglycemia, elevated lipids (LDL, triglycerides)
Not effective if CrCl < 30 mL/min
Dihydropyrines
Adverse effects: Peripheral edema, headache, dizziness, flushing, potential for reflex tachycardia (short acting agents only)
Pearls: can take up to one week to see full blood pressure lowering effects
do not use nifedipine IR in the setting of acute or chronic hypertension, can lead to profound hypotension, myocardial infarction, and/or death
Dihydropyridine drugs examples
Amlodipine(Norvasc) Nifedipine ER ( Procardia) Felodipine (plendil) Iscardipine (Dynacirc) Nicardipine (Cardene) IV Nisoldipine (Sular
Non-Dihydropyridines drugs
Diltiazem er ( cardizem) Verapamin ( Canalan)
Non-Dihydropyridines
Contraindications: Hypotension, cardiogenic shock
Drug interactions: CYP3A4
avoid in pt w HFrEF and w b-blockers
AE:
- Diltiazem: edema, headache, constipation, conduction disturbances, bradycardia, heart failure, exacerbation
- Verapamil: edema, constipation, gingival hyperplasia, headache, conduction disturbances, bradycardia, dizziness, heart failure, exacerbation
AE of Diltiazem
edema, headache, constipation, conduction disturbances, bradycardia, heart failure, exacerbation
AE of Verapamil:
edema, constipation, gingival hyperplasia, headache, conduction disturbances, bradycardia, dizziness, heart failure, exacerbation
ACE inh
-pril
Contraindications: Pregnancy, history of angioedema, use within 36 hours of an angiotensin receptor/neprilysin inhibitor [ARNI – sacubitril/valsartan]
Adverse effects: Hyperkalemia, acute renal failure (in patients with severe bilateral renal artery stenosis), dry cough, angioedema, hypotension
Discontinue of K ≥ 5.6 mmol/L
DIrect renin inh
Aliskiren ( Tektuna)
Contraindications Pregnancy, avoid use with ACEI or ARBs in patients with diabetes
Adverse effects: Hyperkalemia, acute renal failure (in patients with severe bilateral renal artery stenosis), diarrhea, hypotension
Cardioselective drugs
Atenolol ( tenormin) Betaxolol (Kerlone) Bisoprolol (Zebeta) Metoprolol tartrate (Lopressor) Metoprolol succinate ( Toprol XL)
Cardioselective and Vasodilatory
Nebibolol (Bystolic)
Intrinsic Sympathomimetic activity (ISA)
Acebutolol (sectral)
Penbutolol
Pindolol (Visken)
a and b- receptro blocker
Carvedilol (coreg)
Corvedilol CR ( Coreg (CR)
Labetalol (normodyne)
Propranolol ( Inderal)
Beta blockers
- Contraindications Severe bradycardia
- Adverse effects Bradycardia, heart block, worsening heart failure, bronchospasm, cold extremities, fatigue, depression, reduced exercise tolerance, decreased libido, insomnia, impotence
ob-blockers must be tapered upon discontinuation
Alpha blockers drugs
Doxazosin (Cardura)
Prazosin (Minipress)
Terazosin (Hytrin)
Alpha blockers
- Drug Interactions Use with caution when administered with PDE5 inhibitors
- Adverse effects Syncope, orthostatic hypotension, drowsiness, dizziness, headache
Central a2 agonist drugs
Clonidine PO ( Catapres) Methyldopa (Aldomet) Guanfacine (Tenex)
Central a2 agonist
•Contraindications Methyldopa: active liver disease, concurrent use of MAOIs
o a2 agonists must be tapered upon discontinuation
o Last-line due to significant central nervous system effects
o Methyldopa is a drug of choice in pregnancy
Loo[ diuretics
- Contraindications Hypersensitivity to sulfa drugs
- Adverse effects Hyponatremia, hypokalemia, hypomagnesemia, hypocalcaemia, hypochloremia, metabolic acidosis, hyperuricemia, ototoxicity, hyperglycemia, hypertriglyceridemia, orthostatic hypotension
Preffered over thiazide if CrCl < 30 ml/min
Potassium sparing diuretics drugs
Amiloride (midamor)
Triamteren (Dyrenium)
Potassium sparing diuretics
• Adverse effects Hyperkalemia, dehydration, hyponatremia, dizziness
o Avoid if CrCl < 45 mL/min
Direct vasodilators drugs
Hydralazine ( apresoline)
Minoxidil (Loniten)
Direct vasodilators
Adverse effects:
o Hydralazine: reflex tachycardia, peripheral edema, palpitations, DILE
o Minoxidil: reflex tachycardia, peripheral edema, hirsutism
•Pearls: Minoxidil is associated with sodium/water retention and reflex tachycardia (use with a diuretic and a b-blocker)
Mineralocorticoid receptor antagonists drugs
Eplerenone (selective)
Spironolactone (non-selestive)
Mineralocorticoid receptor antagonists:
Hyperkalemia, anuria
oEplerenone: contraindicated when CrCl < 50 mL/min or SCr > 2 mg/dL (males) or > 1.8 mg/dl (females)
•Drug Interactions Eplerenone: CYP3A4 substrate
AE:
o Dehydration, hyponatremia, dizziness
o Spironolactone: gynecomastia, breast tenderness, impotence
o Eplerenone: increased triglycerides
