Hypertension Flashcards
Thiazide and thiazide-like diuretics?
Chlorthalidone, Hydrochlorothiazide, indapamide, metolazone
Thiazide like diuretics MOA?
inhibit Na/Cl cotransporter in the distal convoluted tubule, resulting in increased Na and fluid excretion.
TZD-like diuretics place in HTN?
- 1st line: uncomplicated HTN, Diabetes (w/ normal albuminuria), ISH, LVH, BP control in past stroke/TIA, + black pts.
- 2nd line (additive): HF, CKD, SIHD.
AEs of TZD-like diuretics?
rash, photosensitivity, metabolic effects, ↑ Ca, ↓ (Na, K (esp. w/ salbutamol), Mg, + Zn).
TZD-like CI’s?
Anuria, gout, ?sulfa allergy.
Metolazone: hepatic coma/precoma.
TZD-like DIs?
Digoxin (↑ toxicity if ↓ K), ↑ Li, NSAIDs, steroids.
TZD-like diuretics monitoring?
renal fx, lytes
TZD-like diuretics intricacies?
- chlorthalidone vs HCTZ
- indapamide preferred?
- use in pregnancy
- chlorthalidone 1.5-2x longer acting + more potent than HCTZ, more ↓ K risk.
- indapamide preferred if ↑ lipid or DM due to less effect on lipids + glucose, may be more effective than others in those w/ ↓ CrCl.
- appears safe in pregnancy.
TZD-like diuretics response time?
usually 4 weeks
Loop diuretics examples?
furosemide, ethacrynic acid
Loop diuretics MOA?
inhibit Na/K/Cl cotransporter in the ascending loop of henle + inhibit Na reabsorption at proximal + distal tubules, resulting in increased Na + fluid excretion.
MRA examples?
Spironolactone, Eplerenone
MRA MOA?
competative antagonist of aldosterone, bind to aldosterone receptors on Na/K exchange site in the distal convoluted tubule, resulting in increased Na and fluid excretion.
Central Alpha Agonist Examples?
Clonidine, Methyldopa
Central alpha agonist MOA?
stimulate alpha-2 receptors in the brain stem, resulting in a decrease sympathetic outflow and decreased peripheral resistance.
Alpha blockers examples?
Doxazosin, terazosin, prazosin
Alpha blockers MOA?
Competatively inhibit post-synaptic alpha-1 receptors, resulting in vasodilation that decreases peripheral resistance and BP.
Vasodilators examples?
Hydralazine, minoxidil
Vasodilators MOA?
dilate arteriolar smooth muscle resulting in decreased peripheral resistance.
CCBs examples?
DHP? non-DHP?
DHP: amlodipine, felodipine, nifedipine
non-DHP: diltiazem, verapamil
CCB MOA?
inhibit Ca entry into vascular smooth muscle and cardiac muscle. This prevents muscle contraction leading to vasdilation and decreased HR.
BBs example?
Metoprolol, bisoprolol, atenolol, propranolol
BBs MOA?
block beta-adrenergic receptors which decreases effects of catecholamines (epi/norepi) on the heart. This decreases HR, CO, and renin release from kindeys.
Diret Renin Inhibitor example?
Aliskerin
