HTN (Part 2: Drugs)
Pharmaceutical Sciences Phpr 3823 with Mc Cluggage at Lipscomb University
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Created: 2011-10-27
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What is the initial BP drop from diuretics caused by
Reduction in plasma and stroke volume
What is the long-term BP effect of diuretics due to
Vasodilation
Which class of diuretics should you think of first due to vasodilatory effects
Thiazides
Examples of Thiazides
Chlorthalidone
HCTZ
Indapamide
Metolazone
AEs of Thiazide Diuretics
Hypokalemia
Hypomagnesemia
Hypercalcemia
Hyperuricemia
Hyperglycemia
Hyperlipidemia
Sexual disfunction
When do you dose Diuretics
In the morning to avoid nocturnal diuresis
What comorbidities do you see Loop Diuretics used for in HTN
HF
Impaired renal fxn (Low CrCl)
Global Edema
Examples of Loop Diuretics
Bumetanide
Furosemide
Torsemide
AEs of Loop Diuretics
HYPOkalemia
HYPOmagnesemia
HYPOcalcemia (notice hypo)
Hyperuricemia
Hyperuricemia
Why are Potassium-Sparing Diuretics used in Combination with a Thiazide?
To minimize Hypokalemia
AEs of Potassium-Sparing Diuretics
Hyperkalemia (esp in combo with ACE-I)
CI/Precaution for Potassium-Sparing Diuretics
CKD
DM
Examples of Potassium-Sparing Diuretics
Amiloride
Triamterene
CI of Eplerenone
CrCl <50ml/min
T2DM with Proteinuria
AEs of Aldosterone Antagonists
Hyperkalemia (esp in combo with ACE-I)
Gynecomastia
CI/Precaution for Aldosterone Antagonists
CKD
DM
Examples of Aldosterone Antagonists
Eplerenone
Spironolactone
MOA of ACE-I
Block antiotensin I to angiotensin II conversion
Block bradykinin degradation
Monitoring with ACE-I
K+ and SCr within 4 weeks of initiation/dose increase
AEs of ACE-I
Cough (due to inc bradykinin)
Angioedema
Hyperkalemia
Neutropenia, agranulocytosis
Proteinuria, glomerulonephritis, acute renal failure
Dysgusea (metallic taste)
Suffix for ACE-I
-pril
MOA of ARBs
Directly blocks angiotensin II receptors
AEs of ARBs
Orthostatic Hypotension
Renal Insufficency
Hyperkalemia
Which patient populations do you reduce stating dose of an ACE-I/ARB by 50% due to hypotension risk?
Patients taking diuretics
Volume depletion
Elderly Patients
Which patient population do you worry about HYPERkalemia with an ACE-I/ARB?
CKD patients
Patients on other K-sparing medications
Pregnancy Category of ACE-I/ARBs
Pregnancy category C in 1st trimester
Pregnancy category D in 2nd/3rd trimester
1st FDA approved Renin Inhibitor
Aliskiren
AEs of Renin Inhibitors
Orthostatic Hypotension
Hyperkalemia
MOA of Beta Blockers in HTN
1. Weak association with anti-HTN effects by inhibiting Renin Release
2. Negative Chronotropic and Inotropic Cardiac Effects (reduce CO)
3. Membrane-Stabilizing Action on Cardiac Cells at HD
AEs of Beta Blockers
Bradycardia
AV conduction abnormalities
Acute HF
Masking HYPOglycemia
Rebound HTN (abrupt DC)
Bronchospastic (nonspecific)
May aggrevate intermittent claudication
Location of Beta-1 Receptors
Heart
Kidneys
Action of Beta-1 Stimulation
Increase HR
Increase Contractility
Inhibit Renin Release
Location of Beta-2
Lungs
Liver
Pancreas
Arteriolar SM
Action of Beta-2 Stimulation
Bronchodilation
Vasodilation
Insulin secretion
Glycogenolysis
Examples of Cardioselective BBs
B. MEAN
B Betaxolol, Bisoprolol
M Metoprolol
E Esmolol
A Atenolol
N Nebivolol
Nonselective BBs
Nadolol
Propranolol
Timolol
Additional benefits of Nonselective BBs
Essential Tremor
Migraine HA
Thyrotoxicosis
BBs with ISA
Acebutolol
Carteolol
Penbutolol
Pindolol
Mixed alpha/beta blockers
Carvedilol
Labetolol
Addition effects of alpha/beta blockers
· Carvedilol reduces mortality in HF concomitant with ACE-I/Diuretic
· More Orthostatic Hypotension
Suffix for DHP CCBs
-dipine
Examples of DHP CCBs
Amlodipine
Felodipine
Isradipine
Nicardipine
Nifedipine
Nisoldipine
Clevidipine
Main effect of DHP CCBs
Reduce BP through blood vessels
Examples of non-DHP CCBs
Diltiazem
Verapamil
Main effect of non-DHP CCBs
Reduce BP through effects on heart
AEs of non-DHP CCBs
Bradycardia
AV block
Systolic HF
Which subgroup of CCBs shows a baroreceptor-mediated reflex tachycardia
DHP
due to potent vasodilating effects
Which non-DHP CCBs are preferred in HTN
ER products
Which DHP CCBs do you avoid in HTN
Short-Acting
Particularly IR Nifedipine and Nicardipine
Which DHP CCB has a negative inotropic effect
Nifedepine
Counterbalanced by reflex tachycardia
MOA of Alpha-1 Blockers
Inhibit SM catecholamine uptake in peripheral vasculature (vasodilation/BP lowering)
Place in HTN Tx of Alpha-1 Blockers
Comorbidity of BPH
Used with Diuretics to min edema
AEs of Alpha-1 Blockers
Orthostatic Hypotension
1st Dose phenomenon
Precaution of Alpha-1 Blockers
Caution in Elderly Patients
Dose at BedtimeMOA of Central Alpha-2 Agonist
· Reduces sympathetic outflow from the brain’s vasomotor center (increases vagal tone)
· Peripheral stimulation of presynaptic receptors may ruther reduce sympathetic tone
AEs of Central Alpha-2 Agonists
Sodium/Water Retention
Rebound HTN (abrupt DC)
Depression
Orthostatic Hypotension
Dizziness
Additional AEs associated with Clonidine
Anticholinergic AEs
When is Methyldopa Used
Central Alpha-2 Agonist used for HTN in Pregnancy
Examples of Central Alpha-2 Agonists
Clonidine
Methyldopa
AEs of Direct Arterial Vasocilators
Na+/Water Retention
Angina
Lupus-like syndrome (Hydralazine)
Hypertrichosis (Minoxidil)
Place in HTN Tx of Direct Arterial Vasodilators
Use with Diuretic (Thiazide) and BB to reduce fluid retention and reflex tachycardia
MOA of Reserpine
Reduces NE release in synapse
Depletes catecholamine from brain & myocardium
AEs of Reserpine
Sedation
Depression
Decreased CO
Na+/H2O retention
Increased gastric Acid secretion
Diarrhea
Bradycardia
Place in HTN Tx of Reserpine
Use with diuretic (Thiazide) to avoid fluid retention
About this deck
Created: 2011-10-27
Size: 64 flashcards
Views: 9
About StudyBlue
Naj