Therapeutics Hypertension

kaciteto's version from 2015-09-05 19:23

Section 1

Question Answer
HydrocholorthiazideThiazide diuretic
chlorthalidoneThiazide diuretic
indapamidethiazide diuretic
metolazonethiazide diuretic
"pril" suffix drugsACE inhibitor
"sartan" suffix drugsARB
"dipine" suffix drugsCCB dihydropyridines
DiltiazemCCB non Dihydropyridines
VerapamilCCB non dihydropyridines
propranololnon cardioselective
carvedilolnon cardioselective
nadololnon cardioselective
labetalolnon cardioselective
aliskianrenin inhibitor
"zosin" suffix drugsAlpha1 blockers
triamterenepotassium sparing diuretics
amiloridepotassium sparing diuretics
spironolactonealdosterone antagonists
eplerenonealdosterone antagonists
clonidinecentral alpha 2 agonist
mehyldopacentral alpha 2 agonist
guanfacinecentral alpha 2 agonist
hydralazinedirect vasodilators
minoxidildirect vasodilators

Section 2

Question Answer
Thiazide diureticsreduce Na reabsortion in distal convoluted tubule of kidney.
ACEIsPrevent conversion of angiotensin I to angiotensin II. Increase bradykinin availability by inhibiting its breakdown.
ARBs selective competitie angiotensin II receptor antagonists
CCB dihydropiridinerelax smooth muscle on arterial wall. decreasing peripheral resistance.
CCB non dihydropiridineact as a potent vasodilator of coronary vessels. decreases heart rate by depression of AV node
Beta blockersSelective angents block beta 1 adrenergic receptor in the heart with little effect on beta 2 receptors. higher doses lose selectivity
renin inhibitorsdecrease plasma renin activity and inhibits conversion of angioensinogen to angiotensin I
Alpha blockersselctive alpha 1 antagonist. blocks action of adrenaline on smooth muscle.
potassium sparing diureticsblock epithelial sodium channel on the lumen side of the kidney collecting tubule
aldosterone antagonist inhibits effect of aldosterone by competing for intracellular aldosterone receptors in the cortical collecting duct decrease resabsorption of sodium and water while decreasing secretion of potasium
central alpha 2 agonistreduce sympathetic outflow from the central nervous system
direct vasodilaotrs direct acting smooth muscle relaxant that acts as a vasodilator primarily in the arteries and arterioles

Section 3

Question Answer
Thiazide diureticshypokalemia, hyponatremia, hypomagnesemia, hyperuricemia
ACEIsdry cough lasts 1 to 4 weeks after cessation but may last up to 3 months , ^ Scr rise 30% above base line, hyperkalemia, angioedema more common in black population
ARBsCough less than ACEI, angioedema less than ACEI( need 4 week wash out), ^ SCr 30%, hyperkalemia
CCB dihydropyridinesperipheral edema
CCB non dihyrdropyridinesbradycardia, heart block, constipation
Beta blockersbradycardia, heart block, potentially worsens bronchospastic disease, mask symptoms of hypoglycemia and associated with hyperglycemia, exercise intolerance, fatigue, sexual dysfunction
renin inhibitorsangioedema, hyperkalemia
Alpha blockersdizziness, orthostatic hypotension
potassium sparing dirueticshyperkalemia, avoid in px with CrCl less than 10 ml/min
aldosterone antagonisthyperkalemia, gynecomastia and sexual dysfucntion
Central alhpa 2 agonistsdizziness and orthostatic hypotension, drowsiness, dry mouth
direct vasodilatorstachycardia, fluid retention

Section 4

Question Answer
thiazide diureticsSCr, NA, K 7 to 10 days after initation and titration, thiazide causes calcium retention, HCTZ and chlorthalidone are ineffective in px with CrCl < 30 ml/min
ACEIsScr and K 7-14 days after therapy initiated avoid in pregnancy esp. in 2nd and 3rd trimester, do not combine with ARB or renin I
ARBssame as with ACEI
CCB dihyrdopiridinesOption as first line therapy with most patients with HTN. amlodipine most common
CCB non dihydropiridinespotent CYP 450 enzyme inhibitors, do not use with reduced ejection HF
Beta blockersmonitor HR and BP. still recommended in Px with a HX of cornoary arter disease/post MI
Renin inhibitorsK+ and renal function should be monitored similar to ACEI, avoid in preg. do not combine with ACEI and ARBs
alpha blockersconsidered 4th or 5th line for HTN, generally reserved for HTN with cocmitant BPH
Potassiums sparing diureticsSCr and K+ 7-10 days after initiation, typically used in combo with thiazide diuretic to maintain K+ balance
aldosterone antagonistsSCr and K+ 7-10 days after initiation , (CI in: anuria, acute renal insufficiency, hyperkalemia, or CrCl < 30)
central alhpa 2 agonistsrebound HTN possible if withdrawn too quickly, especially when used with beta blockers, avoid in patients with HF, Methyldopa is often used to treat pg associated HTN
direct vasodilatorshydralazine can cause a lupus like syndrome, minoxidil associated with hirsutism