Therapeutics of Hypertension 4 Flashcards
Direct Aterial Vasodilators
agents: hydralazine, minoxidil
- ___ line for HTN
- reserved for patients with special indications or very difficult to control BP (severe CKD or ___ )
- ___ is more potent than ___
- concomitant therapy with ___ and ___ needed
- last
- hemodialysis
- minoxidil, hydralazine
- diuretic, BB
Direct Arterial Vasodilators
AE
- palpitations, ___cardia, chest pain, GI side effects, headache, hematologic dyscrasias, hepatotoxicity, lupus-like syndrome/rash ( ____ ), fluid retention, hair growth ( ___ )
- tachycardia
- hydralazine
- minoxidil
Direct Arterial Vasodilators Frequency
- hydralazine is taken ____ to ___ times daily
- minoxidil is taken ___ to ___ times daily
- 2-4
- 1-3
Minoxidil Boxed Warning Summary
- may cause ___ and pericardial effusion that may progress to ___
- may increase ___ demand and exacerbate ___ pectoris
- max therapeutic doses of a ___ and ___ other antihypertensives should be used before this drug is ever added.
- should be given with a ___ to minimize fluid gain and a ___
- pericarditis, tamponade
- oxygen, angina
- diuretic, 2
- diuretic, BB
Direct Arterial Vasodilators
Caution with
- CVA
- ___ impairment
- CAD
- ___ disease
- SLE
CVA - ___ vascular accident
SLE = Systemic ___ erythematosus
- renal
- liver
cerebral
lupus
a-1 blockers
agents: doxazosin, prazosin, terazosin
___ considered 1st line for HTN
- 2nd line for patients with concomitant ___
associated with ___ hypotension (especially in ___ )
prazosin can be used for ___ caused by ___
NEVER
- BPH
orthostatic, elderly
nightmares, PTSD
Central a-2 agonists
Agents: clonidine, methyldopa, guanfacine
___line due to adverse effects
- ___ depression, dizziness, fatigue, ___ effects, ___cardia, reflex ___, fluid retention
avoid abrupt ___ due to rebound ___
methyldopa is preferred in ___
last
- CNS, anticholinergic, bradycardia, tachycardia
cessation, HTN
pregnancy
Central a-2 agonists
Clonidine
- PO: usual range ___ - ___ mg taken ___ - ___ times daily (max ___ mg/day)
Transdermal ___ patch: usual range ___- ___ mg/24 hours
- lower risk of ___ HTN and improved ___ with patch
Methyldopa
- usual range ___ - ___ mg ___ daily
Guanfacine
- usual range ___ - ___mg ___ daily
Clonidine
- 0.1-0.2, 2-3, 2.4
- weekly
- 0.1-0.3
- rebound, adherence
Methyldopa
- 250-500, twice
Guanfacine
- 0.5-2, once
Clonidine Clinical Pearls
Titrating off
- slow wean - ___ dose every 2-3 days
- concomitant ___ prescribed
- wean ___ several days prior to clonidine wean
Oral to transdermal patch:
- overlap oral regiment for ___ - ___ days
Patch to oral
- consider starting oral clonidine no sooner than ___hrs after patch removal
- half
- BB
- BB
- 3-4
- 8
Monitoring Summary for common agents
ACE-i/ARBs and aldosterone antagonists
BUN/SCr, potassium
Monitoring Summary for common agents
CCBs (non-dihydropyridine) and BBs
HR
Monitoring Summary for common agents
other diuretics
BUN/SCr, electrolytes (K, Mg, Na), uric acid (thiazides)
What if My Pateint Isn’t at Goal?
- consider ___ dosing of one antihypertensive
- assess ___
- educate on diet, exercise, and smoking cessation
- rule out white coat HTN
- discontinue interfering substances
- patient may have ___ HTN
- nighttime
- adherence
- resistant
Resistant HTN
Definition: failure to attain goal BP while adherent to a regimen that includes at least ___ agents at ___ dose (including diuretic) or when ____ or more agents are needed
- risk factors: older age, obesity, CKD, diabetes, AA
- disease of exclusion: must rule out secondary causes of HTN, nonadherence, and white coat HTN
3, max, 4
AHA Guidelines for Resistant HTN (Steps) 1-3
1) maximize lifestyle interventions and optimize ___-drug regimen (ACEi or ARB, CCB, and diuretic)
2) substitute optimized ___ like diuretic (chlorthalidone, indapamide)
3) add ___ receptor antagonist (spironolactone, eplerenone)
steps 4-6 based on expert opinion
- 3
- thiazide
- mineralocorticoid
