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Flashcards in anti- Hypertension Deck (18):
1

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."

2

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. "

3

"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. "

4

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.

5

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.

6

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.

7

Prazosin / Minipress

Alpha-1 Adrenergic Blocker

HTN, BPH
MOA: Blockade of A-1 receptors
SE: Dizziness, headache, orthostatic hypotension, impotence

8

Rauwolfia Alkaloids / Reserpine

alpha blocker
HTN
MOA: Peripheral adrenergic blockade
SE:Orthostatic hypotension, diarrhea, lethargy, impotence

9

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. "

10

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. "

11

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.

12

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

13

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

14

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)

15

Aliskiren / Tekturna

renin blocker

Severe HTN resistant to previous treatment attempts.

SE:Hypotension, headache, diarrhea, hyperkalemia (rare), angioedema (rare)

16

I.V. Nitroglycerin

emergency HTN
indication: Coronary bypass. Heart failure. Acute MI. Unstable angina pectoris. Acute pulmonary edema
MOA:Nitric Oxide --> Vasodilation of both veins and arteries --> lower preload and afterload

17

I.V. Sodium Nitroprusside

Emergency HTN

IV infusion to quickly lower BP in emergency

MOA: Nitric Ocide --> Vasodilation. Reduces both total peripheral resistance and venous return --> decreases both preload and afterload

18

I.V. Labetalol

emergency HTN A-1 and B adrenergic blocker

Oral form is indicated in Pregnancy-induced hypertension