Flashcards in Hypertension Deck (83):
losartan + HCTZ
lisinopril + HCTZ
olmesartan + HCTZ
valsartan + HCTZ
azilsartan + chlorthalidone
benazepril + HCTZ
candesartan + HCTZ
irbesartan + HCTZ
quinapril + HCTZ
telmisartan + HCTZ
benazepril + amlodipine
valsartan + amlodipine
aliskiren + HCTZ
clonidine + chlorthalidone
atenolol + chlorthalidone
bisoprolol + HCTZ
nebivolol + valsartan
triamterene + HCTZ
olmesartan + amlodipine + HCTZ
Which HTN meds are contraindicated in pregnancy?
ACEi, ARB, DRI
What are the recommended first line agents to treat HTN during pregnancy?
nifedipine extended release
Where and how do thiazide diuretics work?
Distal convoluted tubule
Inhibit Na+ reabsorption
Cause increased excretion of Na+, Cl, and water
Side effects of thiazide diuretics
Dihydropyridine CCBs MOA
Inhibit Ca ions from entering vascular smooth muscle and myocardial cells.
Causes peripheral arterial vasodilation, decreases stroke volume and blood pressure and coronary artery vasodilation.
Causes reflex tachycardia, headache, flushing, and peripheral edema.
IV DHP CCBs
DHP CCB Warnings and side effects
*immediate release nicardipine is not for chronic hypertension and sould not be used for acute BP reduction*
peripheral edema, dizziness, flushing, headache, palpitations/tachycardia, gingival hyperplasia
Which DHP CCBs are considered the safest if a CCB must be used for heart failure with reduced ejection fraction?
amlodipine and felodipine
Storage and administration requirement for Cardene IV
Must be protected from light
lipid emulsion 2kcal/mL
milky white color
maximum time of use after vial puncture is 12 hours
Non-dihydropyridine CCBS MOA
Used to control heart rate in certain arrhythmias and sometimes used for HTN and angina.
Inhibit Ca ions from entering vascular smooth muscle and myocardial cells, but are more selective for myocardium. They decrease blood pressure through negative inotropic and chronotropic effects.
Inotropic = force
Chronotropic = rate
Side effects and warnings for DHP CCBs
sinus bradycardia, AV block, hypotension, heart failure.
edema, headache, dizziness, constipation, gingival hyperplasia
All CCBs are major substrates of _______.
____________ and ____________ are substrates of P-gp and moderate inhibitors of 3A4.
diltiazem and verapamil
Action of aldosterone
Increases blood volume thus blood pressure through Na+ and water retention.
Can patient be rechallenged with RAAS inhibitor if they develop angioedema?
NO. Angioedema can be fatal. If any patient develops angioedema with any RAAS inhibitor other agents in this class are contraindicated.
ACE inhibitor MOA
Block conversion of Ang I to Ang II resulting in decreased vasoconstriction and decreased aldosterone secretion.
Also block degradation of bradykinin
ACE inhibitors have been shown to slow the progression of _________ disease.
kidney disease in patients with albuminuria due to diabetes, hypertension, or other causes of CKD.
Ang II constricts the __________ arterioles to a greater extent than the _______ arterioles causing _________________.
Constricts the efferent arteriole constriction more than afferent arteriole constriction causing increased perfusion pressure (workload) in the glomerulus.
How do ACE inhibitors protect the kidneys?
By blocking vasoconstriction of efferent arteriole caused by Ang II resulting in decreased glomerular filtration pressure (workload).
How do ACE inhibitors work in heart failure?
Protect the myocardium from remodeling effects of Ang II.
Boxed warning for ACE inhibitors and ARBs
Injury and death to developing fetus when used in 2nd and 3rd trimesters.
Discontinue as soon as pregnancy is detected
Contraindications for ACE inhibitors and ARBs
History of angioedema
Use with aliskiren in patients with diabetes (ACE inhibitors)
Warnings for ACE inhibitors
**Avoid use in bilateral renal artery stenosis**
Monitoring for ACE inhibitors and ARBs
signs/symptoms of angioedema
Warnings for ARBs
Olmesartan: sprue-like enteropathy (severe chronic diarrhea with substantial weight loss can occur months to years after drug initiation).
enalapril oral solution
lisinopril oral solution
Block Ang II from binding to Angiotensin II type-1 (AT1) receptor on vascular smooth muscle, preventing vasoconstriction.
Shown to slow the progression of renal disease and heart failure for similar reasons as ACE inhibitors.
RAAS Drug Interactions
Hyperkalemia - look for other drugs that can increase K+
Use of aliskiren in combination with a RAAS agent is specifically contraindicated in patients with diabetes and should be avoided with eGFR <60mL/min
Can decrease lithium renal clearance and increase risk of lithium toxicity.
Potassium-sparing diuretics traditionally used in combination with ___________ to counteract the _________ losses seen with ________ diuretics.
Non-selective aldosterone receptor blocker
Also blocks androgen
Selective aldosterone receptor blocker that does NOT exhibit endocrine side effects.
Potassium-sparing diuretics MOA
Compete with aldosterone at receptor sites in distal convoluted tubule and collecting ducts to increase Na+ and water excretion while conserving K+ and H+ ions.
25-100mg in 1-2 divided doses
Heart failure: 12.5-25mg daily, MDD 50mg
50mg daily or BID
Heart failure: 25-50mg daily
triamterene + HCTZ
Side effects of spironolactone
Monitoring for Potassium sparing diuretics
Check potassium before initiating and frequently thereafter
Diuretics can ________ lithium renal clearance and _______ risk of lithium toxicity.
Increase risk of toxicity
Eplerenone is a major substrate of ____. Use with strong _____ inhibitors is contraindicated.
Strong 3A4 inhibitors
Beta blockers are no longer recommended as _______ line agents for uncomplicated hypertension unless the patient has a comorbid condition for which beta-blockers are recommended first-line including ___, __________, and ______.
No longer recommended as first line agents.
stable ischemic heart disease
Beta blocker MOA
Decrease blood pressure by competitively blocking beta-1 and beta-2 adrenergic receptors resulting in decreases in heart rate and myocardial contractility.
Alpha-1 blocking properties....
Decreases peripheral vasoconstriction