Hypertention II Flashcards
Benazepril Captopril Enalapril Fosinopril Lisinopril Quinapril Ramipril
Ace inhibitors
1FIrst drug of choice for HT
Decrease conversion of AT1 to ATII, decrease aldosterone secretion -> good for diabetic neuropathy ,CAD, MI, dilated cardiomyopathy, cardiac failure,chronic kidney disease !!first drug of choice
-salt must be restricted
a.E.- dry cough, angioedema** switch to ARBs , blacks
- don’t use in bilateral renal stenosis=decreased GFR
No use in pregnancy (use methyl dopa or hydralazine)
-enhance diuretic treatment (a.e. If excess sodium loss- hypotension reactions )
-Reduce after load
Prevent ATII induced remodeling
Aliskiren
Renin inhibitor- decrease increase of renin when on ACE inhibitors or ARBS
Reactive risk , increase cough
Ace inhibitors angioedema
Switch to ARB
Candesartan Irbesartan Losartan** Olmesteran Telmistartan Valsartan
Angiotensin receptor blockers ARBS #1in HT
Competitive inhibitors
Same efficacy
a.E. Low cough , low angioedema, hyperkalemia ,
Not for people with renal stones or pregnant
Do not use ACE inhibitors and ARBs together
Losartan
ARBs
Urosuric so also useful in goUt
Reduce vascular smooth muscle tone
Diuretic -especially thiazides
Calcium channel blockers
Vasodilators ( hydralazine) ( open k channels- minoxidil) , ( liberate NO sodium nitroprusside) ( activating k/atpase channel- diazoxide)
For mild hypertension
Thiazides
For severe hypertension
Loop diuretics
Chlorothiazide
Longer duration of action, Na/cl channel blocker
Thiazide
Lower bp
Ace inhibitor enhances
Efficacy of diuretics
Resistant hypertension
Aldosterone antagonist use
Diuretics
In small dose Can be combined with other drugs Don't give too high or bad very low bp -reduce CV death -increase glucose when combined with b blockers(hypokalemia) -unmask latent diabetes -thiazides
Calcium channel blockers act on
L channel smooth muscles. Used in Angina and HT
A.e. Sa nodal inhibition -Brady cardia or sa node arrest
Don’t use on patients with congestive cardiac failure or sa , av
nodal abnormalities
-good for mono therapy use
Verapamil Diltiazam Nifedipine Isradipine Nicardipine Feiodipine Amlodipine
The dihydropyridines
Calcium channel blockers for angina
Verapamil
Diltiazem
Calcium channel block
Displayed dialate vessels and affects cardiac contraction
-no RACE importance
Good for HT and angina
Not good for cardiac failure - because reduce conduction
–verapamil most used a.e. Constipation
-diltiazem -reduce work of heart
Bradycardia, decrease myocardial contraction,
** give to patients who cannot tolerate beta blockers
Hydralazine
Minoxidil
Vasodilators - most often combined with propranolol and diuretics
-barco reflex mediated
A.e. Angina,sodium water retention , vertigo nausea,yacht
Minoxodil
Vasodilator- k channels
Direct relaxation of arterial smooth muscle
Severe hypertension( renovascular disease, transplant rejection, renal failure ) - combine with beta blocker
Helps in hair loss
A.e. Can cause hypertrichosis - hairy face
Sodium nitroprusside
For hypertension crisis ***
Direct acting NO , relaxation of arterial and venous vascular smooth muscle
- IV, maintain dose
- interact with oxyhemoglobin-methemoglobin, cyanide -NO increase gyanylyl cyclase- no calcium entry ^ Ca uptake store
- use bloodless surgery
- good brain perfusion
- short half life
- for emergency reduction of after load, chf, , preclampsia, eclampsia
Diazoxide
Vasodilator -Involves activation of ATP sensitive K channels- activate hypotension agent
As. Salt and water retention, hyperglycemia, inhibit insulin release to treat insulinomas**
Amlodopine
Nifedipine
Calcium channel blocks that decrease TpR but no effect on conduction - unless reflex
-reduce after load and vasodilate
- use for angina and hypertension
- long term basis
Diuretic thiazides
Loop diuretics
For mild HT- do not use in gout .increases uric acid *
For severe BP
Enhanced by ACE inhibitors
Unmask DM
Reduce glucose tolerance as well - thiazides
Hydralazine
-hydralazine-dialate arterioles but not venous side
-greater effect in diastolic bp
- renin activity increased so sodium wAter retention. - give diuretics
** slow acetylators- drug induced SLE
S.e. Increased hr, Increased 02 demand - angina
Isosorbide mononitrate
Oral nitrate for prevention of angina
Atenolol
Bisprolol
Metoprolol
Nevibolol
Cardio selective beta blockers good for angina
Pindolol - partial agonist not good for angina
Ranolazine
Alters Slow Na current hence prevents Ca
- increase qt interval
- inhibit cyp2d6
Ivabradine
Selective Ifunny sodium channel blocker
- slows cardiac rate
- anti angina
What drugs are good for black people that have hypertension
Thiazides
CCB
