Hypertension/HF Flashcards
1st line for htn
non black
thiazide
dhp ccb
ace or arb
1st line for htn
thiazide or dhp ccb
1st line for htn
ckd stage 3 or albumineria
ace or arb
when 2 start 2 drugs in htn
if stage 2 htn AND BP?20/10 above goal
meds that can worsen htn
amphetamine and adhd
cocaine
decongestants(pseudofed)
erythropoiesis-stimulating agents (by increasing blood viscosity)
immunosupprents (e.g cyclosporine)
nsaids
steroids
Lisinopril/hctz brand name
Zestoretic
Losartan/ hctz
Hyzaar
olmesartan/ hctz
Benicar HCT
valsartan/hctz
Diovan HCT
benazepril/amlodipine
Lotrel
valsartan/amlodipine
exforge
Highlights for thiazides
contraindicated w. sulfa allergy
side effects: decrease K, Na, Mg
increase ca, ua, bg, ldl/tg
dosing: start at 12.5 mg daily
MDD: Chlorthalidone 25mg daily, hctz 50 mg daily
not effective if Crcl<30 ml/min
DDI: nsaids, lithium
DHP CCBS
vasodilatory effects
minimal cardiac effect
**amlodipine safest dhp ccb for bp control in pt w dhp
NIFEDIPINE ir NOT USED IN HTN
can cause gingival hyperplasia
cyp3a4 substrates (ex: clevidipine)
non dhp ccbs
bradycardia
constipation
do not use in heart failure
can cause gingival hyperplasia
clevidipine
dhp ccb in a lipid emulsion
provides 2kcal/mL
hyperTG
si w soybean, soy , or egg allergy
change bottle and tubing q12h due to risk of bacterial growth in lipid emulsions
IV
ACE ARB
CI: pregnancy
angioedema
bilateral renal artery stenosis
-356 hour of entresto
cough, Increase potassium, renail impairment
drugs: lithium
olmesartan SE
DIARRRHEA and weightloss
beta blockers
not first line unless compeling indication
common side effects: decreased hr, fatigue, dizziness, depression
additive risk of bradycardia w. non dhp ccb, digoxin, amiodarone, clonidine
metoprolol notes:
metoprolol and labetalol must be taken w food or immediately after eating
10 mg iv metoprolol =25 mg PO metoprolol
drugs that cause drug induced lupus DILE
methyldopa
hydralizine
other drug classes
a2- agonists
decrease sympathetic outflow
clonidine (catapress)-
change patch q7days
can cause rebound htn if taken off abruptly
Clonidine (Kapvay not for htn)
Hypertensive crisis
hypertensive urgency vs emergency
emergency: target organ damage
ex: stroke, MI, flash pulmonaryedema, damage to kidneys, encephalopathy
treatment of hyperensive urgency
decrease bp gradually over 1-2 days
PO: captopril, labetalol, clonidine, hydralizine
treatment of hypertensive emergency
kidneys/heart/brian failinng
decrese bp by 25% in the first hour. then gradual lowering
IV: clevedipine, nitroprusside (cyanide toxzicity),
ntg (mi)
nicardipine, labetalol (stroke)
drugs that can cause worsen of HF
ddp4 inhibitors (alogliptin)
immunosupressants (tnf inhibitors like infklixamab)
non chb ccb
antiarrythmics (less risk w. amiodarone. Class 1)
tzd’s (pioglitazone)
itraconazole
anthracyclines
nsaids
hfpef EF aka diastolic hf
IMPAIRD VENTRICULAR RELAXATION AND FILLING DURING DIASTOLE
>/50%
hfmref EF
40-50%
mized systolic and diastolic dysfunction
Hfref ef
aka systolic dysfunction
impaired ability to eject blood during systole
which drugs have a motarlity benefit in HF
BB (carvedilol, bisoprolol, metoprolol)
ACE/ARBS/arni
ARA
sglt2
BIDIL( isosorbide nirate/ hydralazine) not 1st line
which drugs can be used in hf but dont have mortality benefit
digoxin
loop diuretics
loop diuretics in hf
dont decrease mortality
sulfa allergy- choose ethacrynic acid
ototoxicity
furosemide iv:po 1:2
20 mg iv=40 mg PO furosemide
Target doses of ace in HF
most aCE is 40 mg FOR hf
*ENALAPRIL 20 MG bid
RAMIPRIL 10 mg
target does of arbs in HF
losartan -50-150 mg daily
valsartan 150 mg bid
ARAS RISKS
do not use if K>5 or Crcl<30
BIDIL
isosorbide nirate/ hydralazine) not 1st line
only use in black pts.
meds decreases hospitalizations in hf
ivabridine (should be in normal sinus rhythm, hr atlest 70 bpm and should be on a beta blocker target dose
digoxin- therepeutic range 0.5-0.9 in HF( higher levels increase rate of mortality
increases contractility
renally cleared
toxicity-n/v, decreased appetite, decreased hr, yellow green vision, arrythmias
antidoite: digifab
electrolyte imbalances that increase risk for digoxin toxicity
hypokalemia
hypomagnesemia
hypercalcemia
target doses in hf for BB
metoprolol xl: 200 mg/day
carvedilol 25 mg bid (in pts who weigh <85 kg
zestril is brand name for
lisinopril
Coozar is brand name for
losartan
olmesartan is generic for
benicar
