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NURS 572 Pharm Ch46

Pharm HTN drugs

what is essential HTN = EHT 90% of all pts have EHT, which is HTN with no identifiable cause
what drug categories are PROVEN to decrease premature death from HT and its complications diuretics---Beta Blockers---ACEIs
what are consequences of HTN CAD/MI---HF/CHF---CVA---kidney dx/RF---blindness
normal bp values <120----<80
preHTN bp values 120-139----------80-89
Stage 1 HTN values 140-159----------90-99
Stage 2 HTN values >160------------->100
what is goal for HTN tx - normal pts goal is < 140/90
goal HTN tx - kidney disease, diabetic pts goal is <130/80
majority of patients require how many drugs to acheive goal most require 2 drugs
What are the compelling indications in the tx of HTN (require specialized drug regimes) HF-----post-MI-----high-risk CVD-----diabetes----chronic renal disease----recurrent stroke prevention
how do we tx normal or pre-HTN no drug indications - encourage lifestyle modification
what lifestyle modification results in a 5-20 mm Hg/10kg bp decrease weight reduction, the most important lifestyle modification
what lifestyle modification results in an 8-14 mmHg bp decrease DASH eating plan, the second most impactful lifestyle modification
what is the third most impactful lifestyle modification to reduce HTN aerobic exercise lowers bp 4-9 mmHg
what TWO lifestyle modifications reduce bp 2-4 mmHG reduce dietary Na----moderate ETOH consumption
Stage 1 HTN - first line drug class thiazides are first line ---stage 1 HTN
name 4 thiazide diuretics chlorothiazide---hydrochlorothiazide---chlorothalidone----metolozone
Stage 1 HTN - other drug classes that may be considered after thiazides may consider ACEIs----ARBs----BB---CCB---or combination thereof
Names of ACEIs that may be considered for Stage 1 tx The 'prils, who have ADR of cough/angioedema---benzapril, catopril, lisonopril and anything else ending in pril
Name the ARBs that may be considered for stage 1 tx the sartan family with less cough ADR---losartan, valsartan, olmesartant---any anything ending in sartan
can we use renin-blocker aliskiren as a consideration for Stage 1 HTN tx yes, we may consider it as it works upstream of ACEIs and ARBs
Stage 1 HTN consider selective B-1 blockers (3) atenolol---metoprolol---nebivolol----'amen'
Stage 1 HTN consider non-selective B-1 B-2 blocker (1) propanolol
stage 1 HTN consider non-selective B-1 B-2 with smypathomimetic activity pindolol
stage 1 HTN consider combined A-1, B-1,B-2 blockers carvedilol----labetalol
What alpha-1 blockers can be used (3) doxazosin---prazosin---tarazosin
What centrally-acting Alpha-2 blockers can be used (4) clonidine---methyldopa---guanfacine---guanabenz
Stage 2 HTN class of drugs, usually given in combination (but not within class) thiazide diuretic---ACEI---ARB---BB---CCB
name 4 K-sparing antidiuretics that can be used Aldosterone blockers = spironolactone, eplerenone------Na/K pump blockers= triamterene, amiloride
what CCBs can be used verapamil, diltiazem-----and the DHP dihydropyridine family----amlodipine, felodipine, nicardipine and anything else ending in 'dipine
combining rules---if first drug used WAS a diuretic that gave inadqueate response--- keep it in regime, add a second drug (not in same class)
if first drug WAS NOT a diuretic and gave an inadequate response second drug ALMOST ALWAYS a diuretic----take note of potentiating effect on other drugs
when adding drugs from a DIFFERENT class, you cannot combine these classes do not combine ACEIs/ARBs - same MOA-----do not combine BBs/CCBs - coupled MOA yields same result
can we combine 2 diuretics? yes, provided one is loop/thiazide and the other is K sparing
patient is already on lisinopril. what drug should be given next a thiazide diuretic. go ahead, name them -----chlorothiazide, hydrochlorothiazide, chlorothalidone, metolazone
what centrally acting Alpha-2 blockers (4) could be used to tx HTN clinidine, methyldopa, guanabenz, guanfacine
what renin inhibitor could be used to tx HTN aliskiren
what drug would we add to hydrochlorothiazide and atenolol check the answers to make sure you are not combining within class---nor are you combining BBs/CCBs or ACEIs/ARBS
just for the fun of it, what are two combinations that MUST be avoided avoid BBs/CCBs-----avoid ACEIs/ARBs
what is 1 DHP that you must watch for to make sure he doesn't slip it in because it CANNOT be used for HTN nimopidine CANNOT be used for HTN tx ---ONLY indicated for subarachnoid hemorr stroke
Created by: lorrelaws