Primary HTN can be treated with (4):
1. diuretics 2. ACE inhibitors 3. ARBs 4. calcium channel blockers
Treatment for HTN w/ CHF
1. diuretics 2. ACE inhibitors/ARBs 3. beta-blockers 4. aldosterone antagonists
Beta-blockers are contraindicated in...
HTN with diabetes mellitus should be treated with...
1. ACE inhibitors/ARBs 2. calcium channel blockers 3. diuretics 4. beta-blockers 5. alpha-blockers
IN DM, ACE inhibitors and ARBs are protective against...
Dihydropyridine Calcium Channel Blockers
1. Amlodipine 2. Nimodipine 3. Nifedipine
Non-Dihydropyridine Caclium Channel Blockers
1. Diltiazem 2. Verapamil
Calcium Channel Blockers MOA
block voltage-dependent L-type calcium channels of cardiac and smooth muscle, thereby reducing muscle contractility
Calcium channel blockers that have the most effect on vessels are...
amlodipine and nifedipine
Calcium channel blockers that have the most effect on the heart are...
verapamil and diltiazem
Clinical use of Dihydropyridine calcium channel blockers
-HTN -angina -raynaud
Clinical use of Non-dihydropyridine calcium channel blockers
-HTN -angina -atrial fib/flutter
Nimodipine is used for...
subarachnoid hemorrhage to prevent cerebral vasospasm.
Toxicity of Calcium Channel Blockers
-cardiac depression -AV block -peripheral edema -flushing -dizziness -hyperprolactinemia -constipation
-increased cGMP leads to smooth muscle relaxation. It vasodilates arterioles the most leading to afterload reduction.
Clinical use of Hydralazine
-HTN, CHF -HTN in pregnancy (first-line with methyldopa) -frequently w/ beta-blockers to prevent reflex tachycardia
Toxicity of Hydralazine
-compensatory tachycardia -fluid retention -nausea -HA -angina -Lupus like syndrome
Commonly used drugs for hypertensive emergency are...
nitroprusside, nicardipine, clevidipine, labetalol, and fenoldopam.
-increase cGMP via direct release of NO -can cause cyanide toxicity
Fenoldopam is a...
Dopamine D1 agonist that causes coronary, peripheral, renal and splanchnic vasodilation. Decreases BP and increases natriuresis.
MOA of Nitroglycerin, isosorbide dinitrate
vasodilates by increased NO in vascular smooth muscle leading to increase in cGMP and smooth muscle relaxation. Dilates veins the most leading to decreased preload.
Clinical use of Nitroglycerin, isosorbide dinitrate
-angina -acute coronary syndrome -pulmonary edema
Toxicity of Nitroglycerin, isosorbide dinitrate
-reflex tachycardia -hypotension -flushing -headache
Cholestyramine, Colestipol, Colesevelam
bile acid resins
cholesterol absorption blocker
Gemfibrozil, Clofibrate, Bezafibrate, Fenofibrate
Digoxin is a...
MOA of Digoxin
direct inhibition of Na/K ATPase leads to indirect inhibition of Na/Ca exchanger. Increased Ca is positive inotropy which stimulates the vagus nerve and decreases HR.
Clinical use of Digoxin
CHF, a fib
Toxicity of Digoxin
-Cholinergic effects -increased PR, decreased QT, ST scooping, Twave inverion, AV block, arrhythmia