anti- Hypertension Flashcards
Hydrochlorthiazide(HCTZ) / Hydrodiuril
Thiazide, K wasting
Hypertension, edema, hypOcalcemia
MOA: Inhibits Na/Cl reabsorption at the ascending limb and distal convoluted tubule, thereby osmotically pulling out water for excretion into the urine. (Least potent of the diuretics)
SE: “Preferentially keeps Ca, uric acid, and glucose in the tubule –> hypercalcemia, hypotension, hyperuricemia, glucose dysregulation. Hyponatremia, hypokalemia, low magnesium. High cholesterol, high triglycerides.
Be aware of those with sulfa allergies.”
Furosemide / Lasix
LOOP diuretic (strongest) K wasting
“Hypertension, edema, hypERcalcemia (increase Ca excretion)
Used in those with CHF, Renal insufficiency, and nephrotic syndrome.”
MOA: Inhibits the Na/Cl/K co-transporters on the ascending Loop of Henle. (Most+E5+D5
SE: “Hyponatremia, hypokalemia, hypocalcemia, hypomagnesemia. High uric acid.
Use caution with Pt’s prone to hypovolemia. “
“Spironolactone / Aldactone
Amiloride - Midamor
“Potassium-Sparing Diuretic. Least potent Diuretic Effect”
Hypertension, chronic edema, hypERcalcemia, hyper aldosteronism. May also be used in treating hirsutism and PCOS.
MOA: Direct aldosterone antagonist: inhibits Na reabsorption, inhibits K secretion.
SE: “Hyponatremia. Biggest risk is hyperkalemia. Orthostatic hypotension.
Spironolactone inhibits the production of testosterone.
Not for use in renal failure patients. “
Triamterene/ Dyrenium
k+ sparing diuretic
HTN, edema
MOA: Na+ channel blocker
SE: Na,Ca, Folic acid depletion. Ht palpitations, tingling/numbness, fever, chills, sore throat, rash, and back pn. Kidney stones.
Propanolol / Inderal
Non-Specific Beta Blocker
“HTN, angina, MI, tachyarrhythmia, migraine prophylaxis, stage fright/essential tremor
MOA: Non-specific adrenergic blockade of beta receptors (both B-1 and B-2)
CI’s: conduction abnormalities, severe asthma, COPD.”
SE: Weakness, fatigue, lethargy, depression. CNS disturbances. Sexual dysfunction. Bradycardia. May potentiate orthostatic hypotension (esp if mixed with alcohol or narcotic analgesices). Bronchospasm.
Atenolol / Tenormin
Cardiac-Specific B-1 Blocker
HTN, angina, MI, tachyarrhythmia, management of hemodynamically stable patients to reduce risk of CV mortality
MOA: Adrenergic blockade of B1 receptors. Felt to be safer than Propanolol in asthmatics/COPD (although not necessarily at higher doses)
SE: Weakness, fatigue, lethargy, depression. CNS disturbances. Sexual dysfunction. Bradycardia. May potentiate orthostatic hypotension.
Prazosin / Minipress
Alpha-1 Adrenergic Blocker
HTN, BPH
MOA: Blockade of A-1 receptors
SE: Dizziness, headache, orthostatic hypotension, impotence
Rauwolfia Alkaloids / Reserpine
alpha blocker
HTN
MOA: Peripheral adrenergic blockade
SE:Orthostatic hypotension, diarrhea, lethargy, impotence
Verapamil / Isopten
CA channel blocker
Hypertension, angina (esp vasospastic), CHF, cardiac arrhythmia, migraine prophylaxis, Raynaud’s, Printzmetal angina (disappearance with NO or rest)
MOA:Block Ca from entering cardiac cells and smooth muscle cells of BV’s –> dilation of vessels and improved myocardial tone
SE: Hypotension, dizziness, headache. Flushing. Negative inotropic effect (decr cardiac output)
Gingival overgrowth. “
Lisinopril / Prinivil / Zestril
ACE inhibitor
Hypertensive patients with CHF or Diabetes. Diabetic patients that do not have HTN (prophylaxis for nephropathy). Post MI patients.
Drug of choice in treating Diabetic Pt’s with HTN.
MOA:Block Angiotensin I from being converted into Angiotensin II. Relax smooth muscle around renal vasculature .
Bradykinins (build up)–> stimulate the cough reflex at the level of the medulla (dry, irritating cough). May elevate serum potassium. Angioedema (may be life threatening). Fetal pulmonary and developmental abnormalities (CI in pregnancy). Potential hyperkalemia.
In diabetic patients be sure to run microalbunemia.
Do not use in patients with bilateral renal artery stenosis. “
Losartan / Cozaar
ARB
Hypertensive patients with CHF or diabetes, in conjuntion with proteinuria.
MOA:”Blocks the effects of Angiotensin II –> interfere with renin/angiotensin system –> decreases peripheral vasoconstriction
no effect on bradykinins.
SE: Hypotension. Persistent dry cough (less so than with ACEi). Angioedema (less so than with ACEi). CI in pregnancy. Hyperkalemia.
Methyldopa / Aldomet; Clonidine / Catapres; Gunanbenz; Wytensin
central alpha agonist
When a patient’s HTN has not been controlled by 2 or 3 medications concurrently, aniety and panic disorders. Opiate withdrawl symptom alleviator.
MOA: “Reduce peripheral sympathetic nervous activity by stimulating the presynaptic alpha 2 adrenergic receptors in the CNS.
Opens K+ channels in vascular smooth muscle cells”
SE:Marked sedation. Orthostatic hypotension. Fatigue
Minoxidil / Loniten
vasodilator
Severe HTN resistant to previous treatment attempts. Alopecia.
MOA:Open K+ channels in vascular smooth muscle cells –> dilate arteries
SE:Marked sedation. Orthostatic hypotension. Fatigue
Hydrakazine / Apresoline
direct vasodilator
Severe HTN resistant to previous treatment attempts.
MOA:Open K+ channels in vascular smooth muscle cells –> dilate arteries
SE:Drug Induced Lupus Syndrome: SLE-like symptom picture, reversible upon discontinuation of the medication (anti-histone antibodies are seen in 50-70% patients with SLE)
Aliskiren / Tekturna
renin blocker
Severe HTN resistant to previous treatment attempts.
SE:Hypotension, headache, diarrhea, hyperkalemia (rare), angioedema (rare)
