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Diuretics, ACEI, ARBs, Direct Vasodilators, CCB, BB, AB

to treat intracranial/intraocular pressure mannitol
to treat acute renal failure mannitol, furosemide (loop)
side effect: hypovolemic hypernatremia mannitol
side effect: hyperchloremic metabolic acidosis acetazolamide (CAI)
side effect: kidney stones acetazolamide (CAI), triamterene (K-sparing)
to treat open angle glaucoma dorzolamide (CAI)
to treat edema patients with metabolic alkalosis acetazolamide (CAI)
to treat acute mountain sickness acetazolamide (CAI)
increases calcium excretion furosemide (loop)
inhibits Na-K-2Cl cotransport furosemide (loop)
to treat edema furosemide (loop), hydrochlorothiazide (thiazides) - in combo with loops, acetazolamide (CAI)
to treat hypercalcemia furosemide (loop)
side effects: ototoxicity ethacrynic acid > furosemide
side effects: hypokalemia acetazolamide (CAI), furosemide (loop), hydrochlorothiazide (thiazide)
side effects: hypokalemia, hyponatremia, hypomagnasemia, hypocalcemia furosemide (loop)
side effects: hypokalemia, hyponatremia, hypomagnasemia, HYPERcalcemia thiazide
classify: indapamide thiazide
classify: metolazone thiazide
classify: methclothiazide thiazide
classify: chlorthialidone thiazide
classify: torsemide loop
classify: bumetanide loop
classify: brinzolamide CAI
classify: methazolamide CAI
alpha blockers used prazosin, terazosin, doxazosin
classify: hydralazine direct vasodilator
classify: minoxidil direct vasodilator
non-DHPs verapamil, diltiazem
to treat ascites spironolactone, maybe combo w/ loop
side effect: hyponatremia, HYPERkalemia K-sparing
side effect: hypokalemic metabolic alkalosis loop & thiazide diuretics
side effect: metabolic acidosis K-sparing, mannitol
side effect: dehydration, allergy, gout, hyperglycemia furosemide (loop)
If patient has allergies to fuorsemide, what do you use instead? ethacrynic acid
to treat hypertension & osteoporosis thiazide
to treat nephrolithiasis thiazide
to treat nephrogenic diabetes insipidus & hypertension thiazide
If GFR is < 30-40 ml/min, what thiazide can you use? metolazone
side effect: gynecomastia spironolactone
to treat hirsutism/acne/polycystic ovary syndrome spironolactone
to treat primary & secondary aldosteronism K-sparing
MOA for treating aldosteronism K-sparing: too much aldosterone can cause vessel injury, cardiac remodeling, CV dz, etc. K-sparing helps prevent that.
Drug for hypertensive pregnant women methyldopa (alpha-2 blocker)
Classify: methyldopa alpha-2 agonist
classify: clonidine alpha-2 agonist
Drug for hypertension & raynaud's syndrome calcium channel blocker
Drug for prostatism & hypertension tamsulosin, alfuzosin (alpha-1 blocker)
Drug for hypertension & migraines beta-blocker
Drug for essential tremor & hypertension beta-blocker
Drugs for acute/post MI & hypertension ACE inhibitor, beta blocker
Drug for aortic dissection & hypertension beta-blocker
Drug for hypertension & pheochromocytoma non-selective alpha-blocker?
Preferred drug for african americans with hypertension diuretic 1st, then CCB
Drug for hypertension & atrial tachyarrhythmia or atrial fibrillation beta-blocker
Drug for cerebrovascular disease or stroke ACE inhibitor, thiazide diuretic
Drug for hypertension and thyrotoxicosis beta blocker
Drugs for hypertensive urgencies/emergencies beta blocker: propranolol, esmolol ACE inhibitor: enalapril CCB (DHP): nicardipine, clevidipine alpha blocker: phentolamine lebetalol clonidine hydralazine nitroprusside
1st line drugs for hypertension diuretics beta antagonists calcium channel blockers ACE inhibitors Angiotensin II Receptor blockers renin inhibitor
2nd line drugs for hypertension alpha antagonists alpha/beta antagonists centrally acting alpha-2 agonists adrenergic neuron blocking agents direct vasodilators
1st line therapy for hypertension thiazide diuretics
acute effect of diuretics increase Na, H2O excretion --> decrease blood vol --> decrease CO
chronic effect of diuretics decrease Na in smooth muscle cells --> decrease PVR (CO returns to normal)
Drug for reduced renal function or sever hypertension when drugs that retain Na are being used loop diuretics
disadvantage to loops short half life
Drugs to avoid in patients with gout thiazides, loops
Drugs to avoid in patients with asthma beta blockers, labetalol
Drugs to avoid in patients with AV block beta blocker
Drugs to avoid in patients with acute CHF beta blocker, CCB, ACEI, ARBs
Drugs to avoid in patients with history of angioedema ACE inhibitors
Drugs to avoid in patients with renal artery stenosis ACE inhibitors, ARBs (no constriction of efferent arteriole --> decrease GFR even more)
Drugs to avoid in patients with pheochromocytoma beta blockers
Drugs to avoid in patients using cocaine beta blockers
Drugs to avoid in pregnant women & sexually active teens ACE inhibitors, ARBs
Will esmolol be used to treat chronic hypertension? NO! short half life, IV drug (can use in htn emergencies)
MOA: beta blockers block beta-1 on heart --> decrease HR, decrease contractility --> decrease CO block beta-1 on kidney --> decrease renin, ang II, aldosterone --> decrease BP block beta receptors on CNS --> decrease sympathetic discharge
Will esmolol be used to treat chronic hypertension? NO! short half life, IV drug (can use in htn emergencies)
MOA: beta blockers block beta-1 on heart --> decrease HR, decrease contractility --> decrease CO block beta-1 on kidney --> decrease renin, ang II, aldosterone --> decrease BP block beta receptors on CNS --> decrease sympathetic discharge
side effects: bronchospasm beta blocker
side effect: rebound hypertension beta blocker, clonidine
side effect: constipation verapamil
Drugs causing peripheral edema alpha blockers, CCB, alpha2 agonist, direct vasodilators
side effect: reflex tachycardia/palpitations alpha blocker, DHP CCD, vasodilator
Use for K-sparing counter K lost from thiazide/loop diuretic use
Why does verapamil/diltiazem not cause reflex tachycardia? These are non-DHPs that block receptors on the heart and vascular smooth muscles. On smooth muscle: relax blood vessels --> vasodilate --> decrease PVR On the heart: decrease HR, conduction, force of contraction --> decrease CO.
Which of verapamil, diltiazem & DHPs cause adverse cardiac effects like sinus bradycardia, AV block, etc verapamil > diltiazem >>>>DHP
side effects: flushing, headache, dizziness, peripheral edema calcium channel blockers
Which will cause more peripheral edema, DHPs, or Non-DHPs? DHPs (nifedipine)
What would be useful to counter peripheral edema? ACE inhibitors
Actions of Angiotensin II 1. release aldosterone from adrenal gland --> increase Na/H2O retension--> increase BP 2. vasoconstrict arterioles > venules 3. facilitates sympathetic activity in brain also: helps regulate GFR!, stimulates thirst, ADH release
Ways to block Ang II effects: renin inhibitor, ACE inhibitor, ARBs
MOA of ACE inhibitors inhibits Ang II production, inhibits bradykinin breakdown --> dilates arterioles --> decrease PVR also, modest drop in aldosterone & small effect on HR, CO, blood volume
68 yo male, severe chest pain, pale gray, sweating, BP= 90/50, pulse = 110, ST elevation. Would you prescribe an ACE inhibitor? NO, bc low BP, wait for BP to increase.
Drug for hypertension & diabetic/nondiabetic nephropathy ACE inhibitor/ ARBs (renoprotective)
Why are ACE inhibitors renoprotective? decrease BP, dilates efferent arteriole --> decrease intraglomerular hydrostatic pressure --> decrease proteinuria
side effect: hyperkalemia ACE inhibitor, ARBs, renin inhibitor, K-sparing diuretics
side effect: loss of taste, metallic taste, skin rash captopril
side effect: anemia, hypotension, neutropenia ACE inhibitor, ARBs
side effect: angioedema, cough ACE inhibitor (use ARBs instead)
74 yo male, BP 150/94, pulse 58bpm, type 2 diabetes, MI 6 months ago, aspirin qd, low Na diet, slight ankle edema, normal Na, K, Cl, creatine. What is the most useful drug for this patient? ACE inhibitor (post MI: use beta blocker or ACEI, no beta blocker bc low pulse, ACEI helps with diabetes, no thiazide b/c kidney & diabetes & post MI are compelling indications for other drugs)
MOA: alpha antagonist prazosin blocks alpha1 on arteries & veins --> vasodilation --> decrease PVR, decrease venous return
Compensatory response activated by prazosin? reflex tachycardia, reflex renin release (due to decrease in BP)
side effect: orthostatic hypotension alpha blockers, lebetalol
MOA: labetalol block alpha1, partial agonist of beta 2 on vessels --> vasodilation --> decrease PVR block beta1 on heart --> small effect on HR & CO
side effect: sexual dysfunction alpha/beta blockers, beta blockers
MOA: decrease sympathetic outflow (decrease PVR, decrease HR, CO) clonidine
What drugs are lipid soluble & works in the CNS because they cross the BBB? clonidine, methyldopa (alpha 2 agonists)
side effects: sedation, dry mouth, depression, impotense, Na retension, contact dermatitis (if use transdermal patch) centrally acting alpha 2 agonists (clonidine)
What drug would require monitoring hemaocrit & show positive Coombs test? methyldopa
side effect: cyanide toxicity nitroprusside
MOA of hydralazine/minoxidil vs nitroprusside hydralazine/minoxidil --> vasodilate arteries --> decrease PVR, decrease BP nitroprusside --> release nitric oxide, increase cGMP, vasodilates arteries & veins
compensatory systems activated with direct vasodilators reflex tachycardia, salt/water retension
Drugs to counter reflex tachycardia & reflex fluid retention? beta blocker, diuretic, respectively
side effect: excessive vasodilation & hypotension hydralazine, minoxidil
side effects: lupus like syndrome (e.g. fever, arthralgia, skin rash) hydralazine
side effect: hypertrichosis minoxidil
Contradindications for labetalol asthma, heart failure
contraindications for captopril renal artery stenosis, hyperkalemia
contraindication for nicardipine acute heart failure
agents for treating hypertension from catecholamine excess phentolamine, nicardipine
characteristics of a drug for hypertensive emergency IV, short half-life (fast-acting)
Created by: cschen38



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