Therapeutics HTN 4
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Body hair growth is most common with what type of diuretic?
Sexual dysfunction is common with what type of diuretic?
Orthostatic hypotension is common with what type of diuretic?
Glucose intolerance is common with what type of diuretic?
Thiazides at a dose of >25 mg
Hyperurecemia caused by a Thiazide can lead to gout, what would you recommend to a patient with Gout?
- Don’t use if having common flare-ups
- Use and monitor for flare-ups if gout is controlled or not having flare-ups commonly
- Glucose intolerance due to a diuretic is often caused by what?
- K < 4
What should you monitor when a patient is on a diuretic?
- renal function (BUN, SCr)
- electrolytes, glucose, uric acid
- Adverse effects (cramps/muscle weakness)
What counseling tips should you tell patients on diuretics?
- Take in AM
- If BID, take 2nd dose early afternoon
- Watch for cramps/muscle weakness
Which ACEI do you not have to reduce the dose with Kidney disease and why?
Fosinipril = because it is metabolized ½ by the Liver and ½ by the Kidney
Do ARBs inhibit the kinase enzyme that breaks down bradykinin?
What is the MOA of ARBs?
Inhibit angiotensin II receptors
Which ARBs are generic?
Which ACEI and ARB side effects are most attributable to Captopril?
What are the major side effects of ARBs and ACEIs?
- Cough (very common)
- Orthostatic Hypotension
- Hypotension (Concurrent Diuretic)
- Decreased renal function (ACEI)
Do ARBs or ACEIs cause more renal function decline?
Under what conditions do ACEIs work as well for Caucasians as African Americans?
If you add a Diuretic
What groups have a morbidity and mortality benefit from ARB and ACEIs?
- Acute coronary syndromes (unstable angina, MI) and post-MI
- Cerebrovascular disease
Which would you adjust the dose in for renal insufficiency: ARB or ACEI?
ACEI (except fosinapril)
Can you take ACEIs or ARBs during pregnancy?
What are the CIs with ARBs and ACEIs?
Pregnancy and Angioededma (later for ACEI)
HTN drugs recommended for Renal Insufficiency (CrCl < 30 ml/min):
ACEI, ARB, loops ± metolazone
Dose adjustment for HTN treatment in Renal Insufficiency (CrCl < 30 ml/min):
↓ doses: ACEI by 50% (except fosinopril), H2O-soluble B-blocker by 50%
Why decrease dose of ACEIs in Renal insufficient patients?
Metabolized by CYP3A4 in the kidneys and liver
HTN drugs Ineffective for Renal Insufficiency (CrCl < 30 ml/min):
Thiazides (except metolazone)
HTN drugs recommended for Tachycardia:
B-blocker = ISA (-) OR Non-dihydropyridine CCB (never both, either/or = together could cause Heart Block)
HTN drugs to caution in GERD:
CCB (Could loosen LES)
HTN drugs recommended for Tremor:
BB (lipid soluble = b/c cross BBB)
HTN drugs recommended for Osteoporosis:
Thiazides (Decrease bone mineralization turnover)
HTN drugs recommended for Migraines:
BB (ISA (-), lipid soluble), Verapamil (Good for migraine prophylaxis)
Recommended treatment for Pre-existing HTN in pregnancy:
Methyldopa (Gold Std), Labetalol
Recommend HTN treatment for Preeclampsia (HTN + proteinuria after week 20):
Hydralazine (Gold Std), labetalol, Sodium nitroprusside (only when others fail)
HTN treatments that are Contraindicated in pregnancy: ACEI, ARB, aliskiren and CCB in 3rd trimester - inhibit uterine contractions
African American Patients
- Recommend TX for HTN in African American Patients
- Thiazide diuretics, CCB - The later is more recommended
African American Patients have a decreased response to what HTN drugs:
BB, ACEI and ARB monotherapy
Recommend Tx for Geriatrics with HTN:
Diuretics, CCB (dihydropyridines) - The later is more recommended
Geriatrics have a decreased response to what HTN drugs:
BB, ACEI, ARB monotherapy
What HTN drugs are not recommended for geriatrics?
Alpha-blockers (unless they have BPH, then use), Alpha -agonists, Reserpine
What should you consider for HTN Tx in young adults?
Most drugs ok; watch impotence with BB or Thiazide
What are the most effective drugs for HTN in children?
ACEI, BB, diuretics (ACEI and diuretics don’t lower HR, but are well tolerated so are a good choice)
How are HTN drugs dosed for children?
Dosed at mg/kg/day
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