When to use Flashcards
Which antihypertensive classes increase K
Potassium sparing diuretics, aldosterone antagonist, ACEIs, ARBs, aliskirne
Which antihypertensive classes decrease K
Thiazides, Loop diuretics
What is the biggest difference between the effects thiazides and loops have on electrolytes
Thiazides increase Ca while Loops Decrease it
A patient currently taking Lithium is to placed on antihypertensive therapy. Which of the following will NOT affect his lithium levels?
a. potassium sparing diuretics
b. thiazides
c. loops
d. aldosterone antagonists
D ONLY.
What effect to diuretics have on lithium?
Thiazides, loops & K-sparing all increase the level of lithium
Aldosterone antagonists have no effect
A pt is admitted with a history of metabolic syndrome, and diabetes. what 2 classes should be avoided in this patient and why?
Loop diuretics and Thiazide diuretics as these increase TG levels
What is the diuretic of choice for young, non-african american, white, pts without renal impairment?
thiazides
In what other condition, may a thiazide diuretic be a great option?
osteoporosis
A patient comes in with a CrCl of <30 and hypertensive. The doctor would like to start a thiazide diuretic what are his options and why?
The only agent that could be used is metolazone (Zaroxolyn) a thiazide-like diuretic that is not affected by poor renal function.
Diuril or ______ 500mg, is the only form of _____ in this class
Chlorothiazide/ injectable/ thiazide class
Anuria is a contraindication for what antihypertensive classes, and what 2 classes are of the most significance?
Diuretics/ loops & thiazides
In what patient would loop diuretics be the diuretic of choice?
Patients with:
- renal disease or insufficiency (CrCl2.5)
- CHF
- severe edema
Due to the increase in K, Potassium sparing diuretics, aldosterone antagonist, ACEIs, ARBs, and aliskirne should be greatly monitored when taken with medications that may cause this.
Torsade (class IA & III antiarrhythmics in particular)
Which loop diuretic can be used even if a patient has a sulfa allergy, and at what cost?
Edrecin (ethacrynic acid) can be used, but it does have a higher risk of hyperkalemia.
When are K-sparing antihypertensives most appropriate?
They should be reserved for pts that developed hypokalemia while on diuretic treatment without renal or hepatic disease or at risk for torsades.
Potassium sparing diuretics are contraindicated under which circumstance?
- pt with hyperkalemia or on other k-sparing agents
- pts with renal or hepatic impairment
- anuria
Aldoseterone antagonists are contraindicated under what circumstances
acute renal insufficiency
hyperkalemia
Inspra & Aldactone are best used in patients with:
- moderate to severe HF
- pt w/ NYHA class 2 HF & decreased LVF
At doses > 100mg, this medication should not be used due to increased risk of hyperkalemia but no additional benefits.
Inspra (eplerinone)
What are the contraindications for Serpasil (reserpine)?
- Hx of depression
- pheochromocytoma
- peptic ulceration
- parkinsonism
What are the side effects if Reserpine and which is the most common/ significant?
Nasal congestion is the most significant side effect of Serpasil, others include: sedation, lethargy, memory impairment, sleep disturbances & weight gain
Non-selective alpha-1 blockers, may be of benefit & should be used if a patient presents with what condition(s)?
BPH
Dyslipidemia
How many hours must be allowed between a dose of Cardura (doxazosin) & Viagra and why?
non selective alpha-1 blockers & PDE5-I must be separated by 4-6 hours do avoid worst syncope, orthostasis & palpitations.
Which alpha-1 blocker is ONLY approved for BPH
Cardura XL
