Uses for antihypertensives Flashcards
Estimated GFR
Chronic kidney disease
New elevation in serum creatinine, marked elevation in serum creatinine with ACE inhibitor or ARB, drug-resistant hypertension, flash pulmonary edema, abdominal or flank bruit
Renovascular disease
Arm pulses > leg pulses, arm BP > leg BP, chest bruits, rib notching on chest radiography
Coarctation of the aorta
Hypokalemia, drug-resistant hypertension
Primary aldosteronism
Truncal obesity, wide and blanching purple striae, muscle weakness
Cushing syndrome
Paroxysms of hypertension, palpitations, perspiration, and pallor; diabetes
Pheochromocytoma
Obstructive sleep apnea
Loud snoring, large neck, obesity, somnolence
Thiazide contraindication
Gout
Side effects:
- Insulin resistance, onset type 2 diabetes
- Hypokalemia, hyponatremia
- Hypertriglyceridemia
- Hyperuricemia, precipitation of gout
- Erectile dysfunction
- Potentiate nondepolarizing muscle relaxants
- Photosensitivity dermatitis
Loop diuretics contraindication
Hepatic coma
Side effects- interstitial nephritis hypokalemia potentiate succinylcholine potentiate aminoglycoside ototoxicity
ACE inhibitor contraindication
- B/l renal artery stenosis
- Hyperkalemia
Side effects:
- Cough
- Hyperkalemia
- Angioedema
- Leukopenia
- Fetal toxicity
- Chloestatic jaundice- rare fulminant hepatic necrosis if the drug is not discontinued
Dihydropyridine CCB contraindications
As monotherapy in chronic kidney disease with proteinuria
Side effects:
- Headaches
- Flushing
- Ankle edema
- Heart failure
- Gingival hyperplasia
- Esophageal reflux
Nondihydropyridine CCB contraindications
- Heart block
- Systolic heart failure
Side effects: - Bradycardia - Constipation above seen with verapamil - Worsening of systolic function, heart failure - Gingival edema or hypertrophy - Increase cyclosporine blood levels - Esophageal reflux
ARB and DRI contraindications
- Pregnancy
- B/l renal artery stenosis
- Hyperkalemia
Side effects:
- Hyperkalemia
- Angioedema
- Fetal toxicity
b blocker contraindications
- Heart block
- Asthma
- Depression
- Cocain and methamphetamine abuse
Side effects:
- Heart block
- Acute decompensated heart failure
- Bronchospasm
- Depression, nightmares, fatigue
- Cold extremities
- Stevens-Johnson syndrome
- Agranulocytosis
a blocker contraindications
- Orthostatic hypotension
- Systolic heart failure
- Left ventricular dysfunction
Side effects:
- orthostatic hypertension
- Drug tolerance
- Ankle edema
- Heart failure
- First dose effect
- Potentiate hypotension
central sympatholytic contraindications
- Orthostatic hypotension
Side effects
- Depression, dry mouth, lethargy
- Erectile dysfunction
- Rebound hypertension w clonidine withdrawal
- Coombs test + –> hemolytic anemia and elevated liver enzymes with methyldopa
Direct vasodilators contraindications
- Orthostatic hypotension
Side effects:
- Reflex tachycardia
- Fluid retention
- Hirsutism, pericardial effusion with minoxidil
- Lupus with hydralazine
What drug?
hypertensive crisis w retinopathy, microangiopathy, or acute renal insufficiency
Labetalol
Alternative therapy:
- Nitroprusside
- Nicardipine
- Urapadil
What drug?
hypertensive encephalopathy
Labetalol
Alternative therapy:
- Nicardipine
- Nitroprusside
What drug?
acute aortic dissection
Nitroprusside + metropolol
Alternative therapy:
Labetalol
What drug?
acute pulmonary edema
Nitroprusside with loop diuretic
Alternative therapy:
- Nitroglycerine
- Urapadil w loop
What drug?
Acute coronary syndrome
Nitroglycerine
Alternative therapy:
- Labetalol
What drug?
Acute ischemic stroke and BP > 220/120
Labetalol
Alternative therapy:
- nicardipine
- nitroprusside
What drug?
cerebral hemorrhage and systolic BP >180 or MAP > 139
Labetalol
Alternative therapy:
- Nicardipine
- Nitroprusside
What drug?
Acute ischemic stroke with indication for throbolytic therapy and BP > 185/110
Phentolamine (after benzodiazephines)
Alternative therapy:
nitroprusside
What drug?
Pheochromocytoma crisis
Phentolamine
Alternative therapy:
nitroprusside
urapadil
What drug?
Perioperative hypertension during or after CABG
Nicardipine
Alternative therapy:
- Urapadil
- Nitroglycerine
What drug?
During or after craniotomy
Nicardipine
Alternative therapy:
labetalol
What drug?
severe preeclampsia/eclampsia
Labetalol + MgSO4 and oral antihypertensive medication such as nifedipine w or w/ out methyldopa
Alternative therapy:
- Ketanserin
- NIcardipine
-zosin
alpha blockers
Combinations to avoid
- ACE inhibitors, ARBs, and renin inhibitors
- Beta blockers and non dihydropyrine
- Potassium sparing diuretics and ACE inhibitors
Most effective parenteral drug for hypertensive emergencies
Sodium nitroprusside- vasodilator
Potential for cyanide toxicity limits prolonged use
Less antihypertensive efficacy than other agents for HTN emergencies; useful adjunct in pts with cardiac ischemia or after coronary bypass surgery
Nitroglycerin-vasodilator
DHP-CCB with longer onset of action and longer elimination half life, but good safey profile
Nicardipine-vasodilator
Ultra short-acting DHP-CCB is approved only for hypertensive emergencies
Clevidipine-vasodilator
Rarely used due to slow onset and long duration of action; hypotensive response is unpredictable and dependent on plasma volume and plasma renin activity
Enalaprilat-vasodilator
Maintains or increases renal perfusion by dilating renal arteries; possibly a good choice for patients with renal dysfunction; avoid in glaucoma
Fenoldopam-vasodilator
Use of parenteral form limited by prolonged and unpredictable hypotensive effect; considered safe in pregnant patients
hydralazine-vasodilator
Acute management of severe hypertension in pregnancy
- Labetalol
- Hydralazine- only used if preeclampsia
- CCB- nifedipine or nicardipine
- Nitroglycerin- good when HTN is associated w pulmonary edema
Long term oral therapy for HTN in pregnancy
- Methyldopa
- Labetalol
- Nifedipine
- Hydralazine
- Thiazide
