Wolff Hypertension Flashcards
What Thiazide diuretic is preferred to treat hypertension based on prolonged half life and proved trial reduction of CVD?
What needs to be monitored with this medication?
Chlorthalidone
Monitor hyponatremia and hypokalemia, as well as uric acid and calcium levels
Patients with what disease should be cautioned about using thiazide diuretics such as chlorthalidone, hydrochlorothiazide, or metolazone?
Gout unless they are on uric acid lowering therapy
What class of medication should not be used with ARBs or direct renin inhibitors?
ACEI
What are primary agents to treat hypertension?
- Thiazide
- ACEI
- ARBs
- CCB’s
CWhat are the secondary agents for hypertension? (12 classes)
- Loop diuretics
- K sparing diuretics
- Aldosterone antagonists
- Cardioselective Beta blockers
- Cardioselective & vasodilatory Beta blockers (nebivolol)
- Noncardioselective beta blockers (propranolol, nadolol)
- Intrinisic sympathomimetic activity Beta blockers (pindolol, acebutolol)
- Combined alpha and beta receptor blocker (carvedilol, labetalol)
- Direct renin inhibitor (aliskiren)
- Alpha 1 blockers ( prazosin, doxazosin, terazosin)
- Centrral alpha 2 agonist (clonidine, methyldopa)
- Direct vasodilators (hydralazine, minoxidil)
What beta blocker is preferred in patients with HFrEF?
Carvedilol
Thiazide MOA? What tends to be lost in greater amounts compared to loop diuretics?
- block Na Cl co transporter in distal convoluted tubule
- Mg
How does Amiloride work? Toxicity?
- blocks epithelial Na channel in collecting duct
- K sparing diuretic
- Hyperkalemia is the black box warning
How does Spironolactone work?
- Blocks aldosterone receptor in collecting duct
- K sparing diuretic and it also antagonizes profibrotic effects of aldosterone
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Clinical use of spironolactone?
- Counteracts K loss induced by other diuretics in tx of Htn and HF
- Reduces fibrosis in HFrEF and post MI HF
Captopril MOA, use, and toxicities?
- Competitive inhibitor of ACE
- Cough
- Angioedema
- Can be used in acute htn urgency & HFrEF
Enalapril (enalaprilat)?
ACEI prodrug available for IV
Benazepril & lisinopril significance ?
widely used ACEI with a long half life and 1x dosing
Aliskiren MOA, use, AE’s?
- direct renin inhibitor blocking angiotensinogen conversion to angiotensin I
- hypertension treatment
- skin rash, diarrhea, increase creatinine phosphokinase, BUN, hyperkalemia, cough
- New expensive and no obvious benefit
How do drugs interfering with Angiotensin II impact the kidneys?
- decrease efferent tone
- Can precipitate renal failure in patients with bilateral renal stenosis
Nifedipine MOA and use?
- Dihydropyridine CCB
- Frequency independent- not cardioactive
- manage stable or vasospastic angina and tx htn
- Hypertensive emergency in pregnancy off label
Nifedipine toxicities?
- Flushing
- Peripheral edema
- HA
- Palpitations
- Gingival hyperplasia
Verapamil class, effects, use, AE?
- Cardioactive non dihydropyridine CCB
- slows automaticity of AV node and is frequency dependent, decreases contractility
- PSVT (IV)
- Primary htn, angina pectoris,
- HA gingival hyperplasia and constipation
Key difference between nifedipine and verapamil?
- nifedipine at therapuetic doses exerts smaller direct inotropic effects on myocardium and no chornotropic effects, but large vasodilatory effects, HR and CO are increased bc of SNS activation
Adverse effects of Phentolamine?
- non selective alpha blocker
- prolonged hypotensive episodes
- Orthostatic hypotension
- Tachycardia
- Cardiac arrhythmia
- Nasal stuffiness
- diarrhea
Prazosin effects, use, & AE’s?
- Vasodilates veins and arterioles to decrease TPR
- Late choice bc it shows likelihood of stroke and CHF with doxazosin in comparison to chlorthalidone
- retrograde ejaculation and orthostatic hypotension
Clonidine toxicities?
- drowsiness
- xerostomia
- rebound hypertension if missed dose
alpha methyldopa use & AE?
- Gestational hypertension (Pregnancy induced hypertension)
- SLE like syndrome
- Positive coombs test
Why are beta blockers contraindicated with Peripheral vascular disease?
Cold extremities is an AE
Hydralazine MOA use?
- Direct vasodilator of arterioles, decreasing systemic resitance
- Used for hypertensive emergency in pregnancy
- HFrEF
Hydralazine AE?
- CV
- hypotension, palpitations
- Drug induced lupus like syndrome
- Dermatologic
- GI
- Hematologic
- Neuromuscular
- Ocular
- Respiratory
Nitroprusside MOA use?
Venous and arteriolar vasodilator
Used for htn crises
Minoxidil AE?
- Profound vasodilation leading to weight gain, edema, pericardial effusion with tamponade,
If you have htn and proteinuria what drugs should be used?
ACEI or ARBS
In a patient with A. Fib and Htn what should be used for the hypertension?
ARB
In a patient with aortic disease and htn what should be used?
Beta blocker
What medications should be used for a pregnant woman?
- Methyldopa
- Nifedipine
- Labetalol
What CCB’s are used for Htn emergencies?
- Nicardipine
- contraindicated in adv aortic stenosis
- Clevidipine
- contraindicated with soy egg allergies
What Vasodilators are used for htn emergency?
- Sodium Nitroprusside
- Nitroglycerine
- don’t use in volume depleted patients
Direct vasodilators used for htn emergency?
Hydralazine
alpha 1 selective and non selective beta blocker used for htn emergency?
Labetaol
- dont use with heart blocks or bradycardia
Adrenergic non selective alpha blocker used for htn emergency?
Phentolamine
Dopamine 1 receptor agonist for htn emergency?
Fenoldopam
Aortic dissection medications?
- Esmolol or labetalol
