Lab 3 - Hypertension Flashcards
Hydrochlorothiazide - MoA
Thiazide diuretic. Inhibit Na+, Cl- symporter and increase sodium excretion
Hydrochlorothiazide - Dose and route
12,5 mg orally
Hydrochlorothiazide - Adverse effects
Hyponatremia Hypokalemia and metabolic alkalosis Hypomagnesemia Hypercalcemia Hyperuricemia Hypertrigyceridemia Hyperglycemia
Hydrochlorothiazide - Contraindications
Liver and kidney failure Diabetes Gout Allergy to sulfonamides Obs in pts with urinary issues (overactive bladder, BPH, especially in elderly)
Hydrochlorothiazide - Interactions
- ACE inhibitors have opposite effect on potassium
- Increase serum levels of lithium by increasing reabsorption
- Hypotensive effect decreased by NSAIDs and augumented by ACE inhibitors
Captopril - Dose and route
12,5 mg X 2 PO
Propanolol - Dose and route
40 mg orally. Increase dose to not more than 160mg x 2
Amlodipine - MoA
Dihydropyridine calcium channel blocker. Arteriolar vasodilation
Amlodipine - Dose and route
5 mg orally
Amlodipine - Adverse effects
Hypotension and reflex tachycardia Dizziness Flushing Headache Peripheral edema Gingival hyperplasia Constipation
Amlodipine - Contraindications
Severe hypotension
Cardiogenic shock
Acute MI
Aortastenosis
Amlodipine - Interactions
Serum levels increased by azole antifungal agents and cimetidine
Methyldopa - MoA
alpha 2 agonist. converted to methylnorepinephrine which activated a2
Methyldopa - Dose and route
125mg x 2 orally
Methyldopa - Adverse effects
Sedation
Orthostatic hypotension
Dry mouth
Headache
Immunologic effects including;
coombs positive hemolytic anemia, autoimmune hepatitis, other organ dysfunction.
Lupus-like syndrome
Methyldopa - Contraindications
Sick sinus syndrome Acute hepatitis Cirrhosis Pheochromocytoma MAO inhibitors
Methyldopa - Interactions
- Hypotensive effect decreased with tricyclic antidepressants
- Hypotensive effect increased with levodopa
- Sedative effect increased by CNS depressants
- Can cause hypertensive crisis with MAO inhibitors
Nitroprusside - MoA
Release nitric oxide and causes vasodilation
Nitroprusside - Dose and route
0.3 mcg/kg/min IV infusion
Nitroprusside - Adverse effects
Hypotension Dizziness Headache Increased intracranial pressure Methemoglobinemia Thiocyanate and cyanide toxicity
Nitroprusside - Contraindications
Vitamin B12 deficiency
Anemia
Severe renal disease
Hypovolaemia
Nitroprusside - Interactions
Increased hypotensive effect with other hypotensive drugs
HTN - Diagnosis
1) Staging BP
2) Cardiovascular risk (DM, LV hypertrophy, chronic renal disease)
3) Secondary causes of HTN + identify cardiovascular consequences)
Physical Exam: retinal arteriolar changes (narrowing), left ventricular lift, A2, S4, abdominal bruit, delayed femoral pulse etc.
Lab:
- Renal: urinalysis, albumin excretion, BUN, creatinine
- Endocrine: Na, K, Ca, TSH
- Metabolic: fasting blood glucose, total cholesterol, triglycerides
Other: Hb (anemia, polycythemia), CBC, Gamma- glutamyltransferase (chronic alcoholism), CXR (identification of distal aortic arch in coarctation of aorta), ECG/Echo
Renal artery stenosis - MR angiography
Cushing syndrome: dexamethasone suppression test, Adrenal CT
Pheochromocytoma: 24-h urine collection of catecholamines, plasma metanephrine + Adrenal CT
Primary hyperaldosteronism: depressed plasma renin + hyper secretion of aldosterone
Metoprolol - Dose and Route
Preferred in what kind of pts?
50 mg PO
Young ptw with hyperkinetic circulation
DM with CAD
Bilateral adrenal hyperplasia - treatment + dose
Aldosterone antagonist- Eplerenone: 50 mg PO
HTN in black pt (stage 1)
CCB or thiazide –> if needed combine them or add ACE-inh
HTN <60 y old (stage 1)
ACE - inh –> CCB or thiazide –> combine all
HTN >60 y old (stage 1)
CCB or thiazide –> ACE-inh –> combine all
Stage 2 HTN
start with 2 drugs; ACE-inh + CCB/thiazide
HTN with HF
ACE-inh + Thiazide + Beta- blocker
HTN and DM (+ CAD)
ACE- inh
DM + CAD: Beta-blockers
DOC for chronic HTN in pregnancy and preeclampsia
chronic HTN in pregnancy: Methyldopa
preeclampsia: Hydralazine
Hydralazine - Dose and route
12,5 mg bid
BP Goal
Clinic, Ambulatory, CM, Proteinuria/renal failure, elderly
Clinic: <140/90 Ambulatory: <130/80 DM: <140/80 Proteinuria/renal failure<130 Elderly<150/90
BP in hypertensive emergency and urgency
Emergency: >220/140
Urgency >180/120
