HTN drugs

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Author:
xinchen3
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196242
Filename:
HTN drugs
Updated:
2013-01-29 20:06:10
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HTN drugs
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HTN drugs
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  1. Hydralazine - MoA
    stimulates NO release
  2. Hydralazine - Adverse Effects
    • Hypotensive reactions
    • activation of RAAS (low pressure)
  3. Minoxidil - MoA
    • opens K channels
    • (hyperpolarize the cell membrane, inhibits depolarization & contraction)
  4. Minoxidil - Use
    • anti-HTN
    • male pattern baldness
  5. Minoxidil - Adverse Effect
    • Hypotensive reactions
    • activation of RAAS
  6. what are the HYPOtensive reactions
    • Headache, dizzy, anxiety, nausea, vomiting, diarrhea, anemia, dyspnea, edema, nasal congestion (think what happens when you dilates all the bv in your body?)
    • reflex tachycardia can occur if Beta-receptors are not blocked or heart conductions are not suppressed
  7. Nitroprusside
    Nitroglycerin
    Diazoxide
    • activates guanylate cyclase => increase NO
    • parenteral drug
  8. Nitroglycerine - Adverse Effects
    • Postural hypotensiosn, tachycardia, headache
    • Tolerance may develop with prolonged use
    • **sudden withdrawal can cause MI**
  9. Nifedipine
    • Dihydropyridine (-dipine)
    • Ca2+ channel blocker
  10. Amlodipine
    • Dihydropyridine (-dipine)
    • Ca2+ channel blocker
  11. Nicardipine
    • Dihydropyridine (-dipine)
    • Ca2+ channel blocker
    • more action on coronary vessels
  12. Nimodipine
    • Dihydropyridine (-dipine)
    • Ca2+ channel blocker
    • more action on cerebral vessels
  13. Nisoldipine
    • Dihydropyridine (-dipine)
    • Ca2+ channel blocker
    • more action on coronary vessels
  14. Dihydropyridine - Use
    Most effective anti-HTN drug
  15. Dihydropyridine - Adverse Effects
    • reflex tachycardia
    • peripheral edema
    • headache, constipation
  16. Phenylalkylamines - MoA
    - Verapamil
    • Ca2+ channel blocker
    • most potent in coronary vessel
  17. Benzothiazepine - MoA
    - Diltiazem
    • Ca2+ channel blocker
    • most potent in coronary vessel
  18. Phenylalkylamines - Use
    - Verapamil
    HTN & arrhythmia
  19. Benzothiazepines - Use
    - Diltiazem
    HTN & arrhythmia
  20. Phenylalkylamines - Adverse Effects
    • cardiac conduction disturbance
    • headache, constipation
  21. Benzothiazepines - Adverse Effects
    - Diltiazem
    • Cardiac conduction disturbance
    • headache, constipation
  22. Clonidine
    alpha-2 agonist
  23. Guanabenze
    alpha-2 agonist
  24. Guanfacine
    alpha-2 agonist
  25. Methyldopa
    • alpha-2 agonist
    • pro-drug (need convert in body to methyl-NE)
  26. Prazosin
    Alpha-1 Blocker
  27. Terazosin
    Alpha-1 Blocker
  28. Doxazosin
    Alpha-1 Blocker
  29. Alpha-2 agonist - MoA
    - Clonidine, Guanabenze, Guanfacine
    - Methyldopa (prodrug)
    Stimulates alpha-2 => inhibits pre-synaptic neurotransmitter release
  30. Alpha-2 agonist - Adverse Effects
    - Clonidine, Guanabenze, Guanfacine
    - Methyldopa (prodrug)
    • Sedation
    • Orthostatic Hypotension
  31. Alpha-1 blocker - MoA
    - Prazosin, Terazosin, Doxazosin
    block alpha-1 => systemic vasodilation
  32. Alpha-1 blocker - Adverse Effects
    - Prazosin, Terazosin, Doxazosin
    • orthostatic hypotension, syncope
    • nasal congestion
    • headache, palpitation, blurred vision
  33. Propranolol - MoA
    • Beta-1 & Beta-2 blocker
    • decrease sympathetic tone
    • decrease HR, CO, RAAS
  34. Propranolol - Adverse Effect
    • bradycardia
    • rebound HTN
    • percipitates CHF
    • Bronchoconstriction (COPD, asthma)
  35. Metoprolol - MoA
    • Beta-1 blocker
    • decrease HR, CO
    • preferred in diabetics
  36. Metoprolol - Adverse Effect
    Worsens Asthma
  37. Labetalol, Carvedilol - MoA
    • Beta-1, Beta-2, & alpha-1 blocker
    • decrease BP
    • best drug for CHF
  38. Labetalol, Carvedilol - Adverse Effects
    Orthostatic hypotension
  39. Beta blocker - Use
    • HTN, stable angina, CHF, MI
    • thyrotoxicosis, pheochromacytoma (Epi)
    • migraine
    • not for variable angina
  40. Beta blocker - Adverse Effect
    • A/V block, acute heart failure (in suppressed heart)
    • Abrupt withdrawal of BB can lead to HTN, angina, MI & sudden death
    • (chronic inhibition leads to increase beta-receptor sensitivity)
  41. ACE inhibitors (-prils) - MoA
    • inhibits ACE => decrease AT => vasodilation & decrease sympathetic tone
    • also inhibits bradykinin degradation => cough & angioedema
    • decrease Pre-load, After-load, RAAS & cardiac remodeling
  42. ACE inhibitors (-prils) - Use
    • HTN, MI, CHF, cardio hypertrophy
    • nephropathy
  43. ACE inhibitors (-prils) - Adverse Effects
    • Dry Cough
    • angioedema
    • Hyperkalemia
    • Fetal deformity (teratogen)
    • decrease renal functions - avoid in bilateral renal stenosis (dec. renal blood flow)
  44. Captopril
    ACE inhibitor
  45. Enalapril
    ACE inhibitor
  46. Lisinopril
    ACE inhibitor
  47. Ramipril
    ACE inhibitor
  48. Quinapril
    ACE inhibitor
  49. Angiotensin Receptor (AT-1) Blocker (-sartans) - MoA
    • blocks AT-1 receptors
    • vasodilates, decrease sympathetic tone
    • less side effect than ACEi (no bradykinin effects - cough)
  50. Angiotensin Receptor (AT-1) Blocker (-sartans) - Use
    HTN, MI, CHF, cardiac hypertrophy
  51. Angiotensin Receptor (AT-1) Blocker (-sartans) - Adverse effects
    • Hyperkalemia
    • fetal deformity (teratogen)
    • skin rash
    • all the same AE as ACEi except for cough & angioedema
  52. Losartan
    Angiotensin Receptor (AT-1) Blocker
  53. Candesartan
    Angiotensin Receptor (AT-1) Blocker
  54. Ibersartan
    Angiotensin Receptor (AT-1) Blocker
  55. Telmisartan
    Angiotensin Receptor (AT-1) Blocker
  56. Valsartan
    Angiotensin Receptor (AT-1) Blocker
  57. Aliskiren - MoA
    • inhibits renin
    • lowers BP
    • Renal protective effects
  58. Aliskiren - Use
    • renal protection in HTN & DM-HTN
    • combine with thiazide diuretics
  59. Aliskiren - Adverse effects
    • Hypotension
    • stroke
    • angioedema
    • hyperkalemia
  60. If a patient doesn't not respond well to ACEi & ARB, what do you do next?
    • use ACEi & ARBs +diuretics
    • commonly seen in some black populations
  61. Therapy for HTN
    • Diuretics (Thiazide, Loop +K-sparing)
    • Vasodilators (Hydralazine, Minoxidil, NG)
    • CCB
    • ACE inhibitor or ARB
    • Alpha & Beta blockers
  62. Therapy for Stable Angina
    • Nitroglycerin
    • Beta-blockers
    • CCB
  63. Combination Therapy for Angina
    • NG + BB
    • NG + CCB
    • NG + BB + CCB
  64. Therapy for CHF
    • ACE inhibitor
    • Beta blocker
    • Diuretics
    • Digoxin
    • vasodilators
  65. Therapy for Stage A CHF
    ACE inhibitor
  66. Therapy for Stage B CHF
    ACE inhibitor + Beta blocker
  67. Therapy for Stage C CHF
    • ACE inhibitor + Beta Blocker + Diuretics
    • other drugs if indicated: digoxin, vasodilators, ARBs
  68. Therapy for Stage D CHF
    • continue stage C therapy with inotropes
    • wait for heart transplant
  69. Stage A CHF criteria
    high risk, no symptoms
  70. Stage B CHF criteria
    cardiac remodeling, no symptoms
  71. Stage C CHF criteria
    CHF symptoms
  72. Stage D CHF criteria
    refractory
  73. Therapy for MI
    • NG + Beta Blocker
    • CCB can make MI worse
  74. Therapy for unstable angina
    • NG, CCB
    • Beta blocker in unstable angina can make it worse (block beta-2)
  75. Digoxin - MoA
    • Na/K ATPase inhibitor
    • increase intracellular Ca2+ & Na
    • increase contractility but not HR
    • improve CHF symptoms but doesn't decrease mortality
  76. Digoxin - Use
    • CHF
    • first-line drug for CHF with Atrial Fibrillation
  77. Digoxin - Adverse Effect
    • small therapeutic index
    • vomiting & nausea
    • visual disturbances
    • AV block & bradycardia
    • gynecomastia, delirium
  78. Digoxin - Contraindications
    • Quinidine, amiodarone, verapamil (increase digoxin conc.)
    • Hypokalemia enhances toxicity
  79. Treatment of Digoxin toxicity
    • mild toxicity - Potassium
    • digoxin induced arrhythmia - Lidocaine
    • Life threatening toxicity - Digibind
  80. Digibind
    • monoclonal antibody for digoxin
    • used in life threatening toxicity
  81. Digitoxin
    • same drug as digoxin, except it's LIVER excretion
    • used in renal failure patients
  82. Acute Heart Failure Therapy
    Dobutamine
  83. Dobutamine - MoA
    • Beta-1 agonist
    • increase contractility but not HR
  84. Dobutamine - Use
    #1 drug in Acute Heart Failure
  85. Dobutamine - Adverse Effect
    tolerance
  86. Dopamine
    • dopamine, B1, a1 receptor agonist
    • used to maintain hemodynamic in shock
  87. Phophodiesterase III inhibitor
    - Inamrinone, Milrinone
    positive inotropic & vasodilator
  88. Nesiritide
    • synthetic BNP
    • vasodilator & diuretic

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