Flashcards in Second line HTN meds Deck (66):
Give some examples of loop diuretics that you dose BID
Who are loop diuretics usually reserved for?
CrCl < 30 mL/min
How do you avoid nocturnal diuresis with loop diuretics?
Give BID doses in AM and afternoon
Avoid HS administration
Are potassium sparing diuretics strong anti-HTN meds?
No, they are weak
When do you use potassium sparring diuretics?
For an additive effect in combo w/ a thiazide or loop
When are potassium sparing diuretics useful?
In pts w/ low serum K
What might potassium sparing diuretics cause in what specific poupulation?
Hyperkalemia in pts w/ CKD/DM
What are some examples of potassium sparing diuretics?
What are the examples of triamterene with HCTZ?
What are examples of aldosterone antagonist diuretics?
Spironolactone (w/ or w/o HCTZ)
What is a side effect of aldosterone antagonist diuretics?
Give some examples of beta blockers.
What is the standard dosing for beta blockers?
Q 24 hours
What are beta blockers w/ intrinsic sympathomimetic activity useful for?
Useful if beta blockers cause bradycardia
What are direct renin inhibitors contraindicated with??
ACEIs and ARBs
When are alpha 1 blockers used?
In pts w/ BPH
What is Doxazosin and how many times per day is it dosed?
Alpha 1 blocker
When do you instruct pts to take their first dose of alpha 1 blockers? Why?
Take first dose before bedtime
Minimizes dizziness and postural hypotension
How can you give out clonidine?
Transdermal patches (replaced weekly)
How quick is the onset of clonidine? And is it long or short acting?
Fast onset (20-60 mins)
When is clonidine usually used?
What are the SEs of clonidine?
Significant anticholinergic SEs
What happens if you abruptly cease clonidine? How do you avoid this?
Possible rebound HTN
Taper doses gradually as DCing
What is the first line agent for pregnancy induced HTN?
Is methyldopa used for much more than pregnancy induced HTN?
In what forms do we give methyldopa?
What is hydralazine?
A direct vasodilator
What do you use hydralazine with and why?
Diuretics and beta blockers to minimize water retention and reflex tachycardia
What are some SEs of hydralazine and why?
Lupus like syndrome at high doses
What is minoxidil?
A direct vasodilator
What do you takes minoxidil with?
Take w/ loop diuretic and bet blocker w/ hydralazine
What are two popular vasodilators?
What is nitroprusside the mainstay tx for?
Most HTN emergencies
What is a precaution with nitroprusside?
What is nitroprusside metabolized to?
What is a problem with renal insufficiency and nitroprusside?
Cyanide is converted to thiocyanate and this accumulates w/ renal insufficiency
What do you need to do to monitor pts with renal issues and nitroprusside?
Need to monitor levels if used for > 4 days
What do you add to the IVBP if using nitroprusside? And at what point?
@ 2nd bag
What does sodium do for nitroprusside?
accelerates enzyme degradation of cyanide to thiocyanate making it much less toxic
What do you use nitroglycerine for?
Acute myocardial infarction
What are some precautions for nitroglycerine? How do you deal with that?
Development of tolerance
Increase IV administration rate
When is nitroglycerine contraindicated?
Concurrent use of phosphodiesterase 5 inhibitors
What is epinephrine?
Pressor of last resort
What is a possible issue with epinephrine?
What is norepinephrine used for?
What is a possible issue with norepinephrine?
What is the low dose of dopamine?
Mainly DA effects
What is the intermediate dose of dopamine?
DA + beta effects
What is the high dose of dopamine?
> 10 mcg/kg/min
Mainly alpha effects
Do you use dopamine or norepinephrine first?
What is the primary activity of dobutamine?
Mainly beta 1 activity
What does dobutamine do?
Increases cardiac output w/ little vasoconstriction
What is dobutamine?
An inotrope w/ vasodilator properties
What is phenylepherine?
Potent alpha agonist with weak beta agonist activity
Where is phenylepherine vasoconstrictive?
Arterioles and nasal mucosa
When is phenylepherine a useful alternative?
In those unable to tolerate tachycardia from dopamine or norepinephrine
What is the MOA of vasopressin?
Increases water permeability of renal tubule
How does vasopressin increase water permeability of renal tubule?
Increases H2O resorption from tubular lumen
What does the increase H2O resorption from tubular lumen do?
Results in decreased urine volume and increased osmolarity
How do you administer vasopressin?
@ 0.04 units/min
What might greater doses of vasopressin do?
Cause cardiac arrest
When is vasopressin typically used?
Added on in addition to the use of other pressors
Which loop diuretic do you only dose daily?
Which loop diuretic can you dose TID?
What is Prazosin and how many times per day is it dosed?
Alpha 1 blocker