HTN and miscellaneous antihypertensive medication

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Author:
jaime.davenport
ID:
240123
Filename:
HTN and miscellaneous antihypertensive medication
Updated:
2013-10-12 19:04:48
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HTN meds
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Description:
pharm midterm fall 2013
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  1. Drugs that may increase BP are
    • Oral contraceptives
    • steroids
    • appetite suppressants
    • trycyclics
    • cyclosporines
    • NSAIDS
    • decongestants
    • Some SSRI's -Effexor, and zoloft
  2. Normal HTN
    Pre HTN
    HTN
    2nd Stage HTN
    • 120/80
    • 120-139/80-89
    • 140-159/90-99
    • 160/100
  3. DASH diet lifestyle modification for HTN

    Can reduce SBP by _____?
    • Diet rich in fruits, vegetables, and low fat dairy.
    • Reduce saturated and total fat.
    • Can reduce SBP by 8-20 mmHg
  4. Renin inhibitors for controlling HTN
    Drug:
    aliskiren (tecturna)

    • Do not decrease Renin!!!
    • Increase Renin but inhibit the ability of angiotensin I (vasoconstriction)
  5. Renin
    mediates ECF volume and arterial constriction
  6. DOC for HTN and pregnancy
    Methyldopa
  7. BB not as effective for treatment in HTN in African Americans as ______?
    CCB
  8. _____% of HTN is idopathic
    90

    May not be able to identify cause
  9. Clinical Evaluation of patients with HTN!!
    Continually ______ and _______ treatment!!
    monitor and modify
  10. Central acting alpha agonist such as clonidine and methyldopa act through stimulation of ?

    Inhibit what?
    central inhibitory alpha adrenergic receptors

    • THIS INHIBITS THE SYMPATHETIC NERVOUS SYSTEM
    • ( INHIBITS CARDIOACCELERATION AND VASOCONTRICTOR CENTERS)
    • Result in decreased PVR, HR, and BP
  11. DOC for stage I and II HTN
    • Thiazides
    • Stage one - for most
    • Stage 2- Thiazide with another medication (ACEI or ARB, BB, or CCB)
  12. Thiazides MOA
    • Increase urinary excretion of sodium and chloride in equal amounts.
    • Inhibit reabsorption of Na and CL in ascending limb of loop of Henle.
    • Increases K+ and bicarbonate excretion and decrease Ca+ excretion.
  13. Thiazides increase _______ retention, which may cause ________?
    • uric acid retention
    • cramping
  14. May not want to use thiazides in ______ adults with ______ kidney function because it can cause _______?
    • young
    • normal
    • hypovolemia
  15. Thiazide diuretics and loop diuretics contradicted with patients with _______ allergy
    Suflonamides

    or with decreased renal function
  16. ADR of thiazide diuretics
    • electrolyte imbalance
    • hypokalemia, hypomagnesemia
    • hypercalcemia, hyperuricemia, hyperglycemia.
  17. Diuretics are feared with diabetics because they cause_____
    hyperlipidemia due to increased insulin resistance.
  18. Dosage of Thiazide Diuretics
    • 12.5 mg to 100 mg per day
    • Don't have them take at night, they will be up all night going to bathroom
    • -can cause cramping.
    • Don't use high doses with gout, hyperlipidemia, and diabetes
  19. # 1 thing to monitor with patient on diuretics!!
    Electrolyte balance
  20. What is the most common form of target organ damage associated with HTN
    Ischemic heart disease


    Kidney is second
  21. DOC for stable angina
    • BB
    • followed by CCB
  22. DOC HTN and diabetes

    What medication is feared in diabetics!!
    ACEI and ARBs- seem to work best with diminishing peripheral neuropathies

    ALL DIABETICS NEED TO BE ON ACE AND ARB EVEN IF THEY DO NOT HAVE HTN BECAUSE ACEI ARE REANL PROTECTIVE

    Diuretics are feared in diabetics, it is feared to cause hyperlipidemia.
  23. What are the most renal protective BP meds
    ACEI and ARB's
  24. Stage 2 HTN
    Begin combination therapy
    Second drug should be......
    a drug from another class!!! Two drugs from the same class will not help HTN.
  25. Any unexplained fever with HTN meds always check
    LFT's
  26. Follow up _____ month interval after starting treatment
    • 1
    • more frequent if uncontrolled.
  27. Clonidine
    Don't use much because it is short acting and patients have to take it frequently

    Use caution with severe coronary insufficiency, conduction disturbances, recent MI, and chronic renal failure
  28. Common adverse effect of Clonidine
    Sedation-very common

    Rebound HTN- if abrupt withdrawal

    Orthostatic Hypotension
  29. Geriatrics and BP meds
    Study showed that BP can be reduced in elderly with low sodium diet and weight loss.

    Diuretics and BB are effective in elderly and are shown to reduce morbidity and mortality.

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