Hypertension Drugs Flashcards
Target BP according to JNC 7 for:
no comorbidities?
DM?
CKD?
no comorbidities: <140/90
DM: <130/80
CKD: <130/80
Target BP according to JNC 8 for:
no comorbidities: >/= 60 years old? < 60 years old?
DM?
CKD?
> /= 60 years old: < 150/90, < 60 years old: < 140/90
DM: <140/90
CKD: <140/90
inhibits Na/Cl transporter in DCT
causes moderate diuresis and and reduced excretion of Ca (increased reabsorption)
first line for hypertension
heart failure, hypercalciuria, nephrogenic diabetes insipidus, renal calcium stones
thiazide diuretic
types of thiazide diuretic
Hydrochlorothiazide Chlorthalidone Indapamide Metolazone Chlorothiazide
side effects of thiazide diuretics
hypokalemic metabolic alkalosis
hyperlipidemia
hyperuricemia
sulfa allergy
inhibits Na/K/2Cl transporter in thick ascending limb of loop of henle
causes powerful diuresis and increased Ca excretion
used for pulmonary edema, hypercalcemia, acute renal failure, anion overdose
loop diuretic
types of loop diuretic
Furosemide
Bumetanide
Torsemide
Ethacrynic acid (phenoxyacetic acid derivative)
side effect of loop diuretics
dehydration ototoxicity sulfa allergy (EXCEPT ethacrynic acid) hyperuricemia nephritis
CNS sympathetic outflow blocker
activates alpha 2 adrenergic receptors –> decreases central sympathetic outflow
used for hypertension
side effect: rebound hypertension
clonidine
dose limit for clonidine
900 mcg
antidote for rebound hypertension
phentolamine
CNS sympathetic outflow blocker
activates alpha 2 adrenergic receptors –> decreases central sympathetic outflow
used for pre-eclampsia
side effect: hemolytic anemia (POSITIVE COOMBS TEST)
Methyldopa
ganglion blocker
competitively blocks Nn nicotinic Ach receptors
used for hypertension (obsolete), hypertensive emergencies
side effect: POSTURAL HYPERTENSION, dry mouth, blurred vision, constipation, sexual dysfunction
Hexamethonium
nerve terminal blocker
irreversibly blocks vesicular monoamine transporter (VMAT)
used for hypertension (obsolete)
side effects: sedation, severe psychaitric depression, suicidal ideation
reserpine
nerve terminal blocker
inhibits vesicular release of NE from presynaptic neuron
used for hypertension (obsolete)
side effects: sedation, severe psychiatric depression, suicidal ideation
guanethidine
guanadrel
which part of the nephron is acted on: carbonic anhydrase inhibitors? loop diuretics? thiazide diuretics? potassium-sparing diuretics? osmotic diuretics?
carbonic anhydrase inhibitors: PCT
loop diuretics: Na/K/2Cl transporter in thick ascending limb of LoH
thiazide diuretics: Na/Cl transporter in DCT
potassium-sparing diuretics: collecting duct
osmotic diuretics: all parts, ESPECIALLY PCT
primary site for calcium absorption due to Na-Ca changer
loop of henle
potassium escape mechanism located in which part of nephron?
thick ascending limb of loop of henle
adrenergic blocker
alpha 1 selective antagonist
used for benign prostatic hyperplasia, hypertension
side effects: FIRST DOSE –> ORTHOSTATIC HYPOTENSION, less chance of reflex tachycardia
Prazosin
Doxazosin, Terazosin, Tamsulosin, Silodosin, Alfuzosin
most selective for prostatic smooth muscle
Tamsulosin
adrenergic blocker
non-selective beta blocker
blocks sympathetic effects on heart and BP
reduces renin release
used for prophylaxis and hypertension
side effects: bronchospasm, AV block, heart failure, CNS sedation, erectile dysfunction
masks symptoms of hypoglycemia in diabetics
Propranolol, Pindolol, Timolol, Labetalol, Carvedilol, Nadolol, Levobunolol, Metapranolol
has combined alpha and beta blockade (may be used in pheochromocytoma)
Carvedilol and Labetalol
what drugs are used to control BP in pheochromocytoma?
Phenoxybenzamine
Phentolamine
or Labetalol
older oral vasodilator
alters intracellular Ca++ metabolism
relaxes arteriolar smooth muscle –> vasodilation –> decreases afterload
used for hypertension
side effects: REFLEX TACHYCARDIA, DRUG-INDUCED LUPUS
Hydralazine
older oral vasodilator
opens K+ channels in vascular smooth muscle –> hyperpolarization –> muscle relaxation and vasodilation
used for hypertension, alopecia
side effects: REFLEX TACHYCARDIA, HYPERTRICHOSIS
Minoxidil
Diazoxide
older oral vasodilator specific for arterioles
decreases afterload
Minoxidil
Diazoxide
Medications that cause drug induced lupus?
Hydralazine
Isoniazid
Procainamide
Penicillamine
how does minoxidil cause hypertrichosis?
minoxidil stimulates hair follicles (telogen phase) to differentiate into growth follicles (anagen phase)
calcium channel blocker
non-dihydropyridine CCB
block voltage-gated L-type Ca channels (cardiac > vascular –> more for arrhythmias since cardioselective)
used for supraventricular tachycardia (OPD setting)
side effects: CONSTIPATION, pretibial edema, GINGIVAL HYPERPLASIA, heart failure, AV block, sinus node depression
verapamil
diltiazem
dihydropyridine CCB
block voltage-gated L-type Ca channels (vascular > cardiac)
used for angina, hypertension
side effects: PRETIBIAL EDEMA, FLUSHING, CONSTIPATION
Nifedipine
amlodipine, felodipine, nicardipine, nisoldipine, clevidipine, isradipine
parenteral vasodilator relaxes venous and arteriolar smooth muscle by increasing cGMP (preload unloader) decreases both preload and afterload used for hypertensive emergency side effect: CYANIDE TOXICITY light sensitive
Nitroprusside
parenteral vasodilator dopamine agonist (D1 receptor) causes arteriolar vasodilation of afferent and efferent arterioles increases renal blood flow used for hypertensive emergency side effects: HYPOKALEMIA short half life
Fenoldopam
angiotensin antagonist
ACE inhibitor
inhibits ACE and formation of angiotensin II
decreases aldosterone secretion
used for hypertension, heart failure, post-MI, diabetic nephropathy
side effects: COUGH, TERATOGEN, HYPERKALEMIA
captopril
enalapril, benazepril, fosinopril, lisinopril, quinapril, ramipril, trandolapril, moexipril, perindopril
why use ACE inhibitors in patients with diabetic nephropathy?
ACE inhibitors decrease albumin excretion and slow progression from micro- to macro-albuminuria
(renoprotective effect)
angiotensin receptor blockers
blocks angiotensin (AT1 receptors) in vascular smooth muscle and adrenal cortex
decreases aldosterone secretion
used for hypertension, heart failure, diabetic nephropathy
side effects: HYPERKALEMIA
losartan
candesartan, valsartan, irbesartan, erprosartan, telmisartan, azilsartan, olmesartan, valsartan
slows ventricular remodeling and increases survival in heart failure
delays progression of diabetic nephropathy
ACE inhibitors
captopril
enalapril, benazepril, fosinopril, lisinopril, quinapril, ramipril, trandolapril, moexipril, perindopril
ARBs
losartan
candesartan, valsartan, irbesartan, erprosartan, telmisartan, azilsartan, olmesartan, valsartan
combination treatment with ISDN for heart failure more effective than ACE-Is in blacks
hydralazine
older oral vasodilator
how do ARBs/ACE-Is cause hyperkalemia?
ACE-Is/ARBs reduce aldosterone levels –> potassium retention
renin antagonist
inhibits renin
prevents conversion of angiotensinogen to angiotensin I
used for hypertension
aliskerin
management for malignant hypertension
accelerated form of severe hypertension associated with rising BP and rapidly progressing end-organ damage
powerful vasodilators (nitroprusside, fenoldopam, diazoxide) combined with diuretics (furosemide) and beta blockers to lower BP to 140-160/90-110
