Hypertension Drugs CI, SE, & clinical pearls

IDK if this is anything you need to know, but its everything bolded on the slides

Main thiazide diuretic side effect

hypokalemia

When should a thiazide diuretic be taken and why

at night to prevent nocturia

What is the CrCl cutoff for thiazide effectiveness

CrCl<30 ml/min

Main loop diuretic side effects

hypokalemia

Monitoring paramaters while on loop diuretics

potassium and magnesium

When is a loop diuretic preffered over thiazide

when CrCl < 30 mL/min

Potassium-Sparing Diuretics contraindication

K > 5.5 mEq/L

Potassium-Sparing Diuretics side effects

hyperkalemia

which drugs can increase hyperkalemia when taken with a potassium sparing diuretic

ACE-I, ARB, K supplements, and/or NSAIDs

Monitoring parameters when taking potassium-sparing diuretics

Electrolytes (potassium) and renal function

Potassium Sparing Diuretic MOA

Competes with aldosterone for receptor sites in distal renal tubules

ACE-I contraindication

History of angioedema & bilateral renal artery stenosis (narrowing of renal arteries)

ACE-I side effects

dry cough & Hyperkalemia

ACEI monitoring

Drug Interactions: K+ sparing diuretics, K+ supplements,

Renal function

ACEI Clinical Pearl

SCr may increase upon initiation secondary to angiotensin II vasodilation of efferent arterioles

• OK to continue unless SCr increases 30% above baseline

Which meds should you not use alongisde ACEIs

ARB or direct renin inhibitor

which meds are typically used alongside ACEIs and why

Calcium channel blockers due to the reduction in peripheral edema incidence

ARB contraindication

pregnancy box warning & bilateral renal artery stenosis

Which drugs can you not use in combination with ARBs

ACEI or direct renin inhibitor

ARBs Clinical Pearl

SCr may increase upon initiation secondary to angiotensin II

vasodilation of efferent arterioles

• OK to continue unless SCr increases 30% above baseline

ARB clinical pearl: Losartan

Losartan is the cheapest, but not the best. Consider ones that

last all day (telmisartan, olmesartan, irbesartan)

Direct Renin Inhibitor contraindications

Concomitant use of ACEI or ARB. Pregnancy black box warning

Direct renin inhibitor side effects

Hyperkalemia

CCBs Dihydropyridine contraindications

Nicardipine: aortic stenosis, Nifedipine: cardiogenic shock

CCB Dihydropyridine side effects

Peripheral edema: diuretics won’t help

ACEi/ARB can

CCB Non-dihydropyridine contraindications

Afib with accessory bypass tract, cardiogenic shock, HFrEF, 2nd or 3rd degree AV

block

CCB Non-dihydropyridine side effects

Bradycardia, AV block Anorexia , nausea

• Verapamil: constipation

CCB monitoring (both)

HR, angina

S/sx peripheral edema

Dihydropyridines are most effective in which kind of patients

elderly (solated systolic HTN), Raynaud’s syndrome

Non-DHP should be avoided in what patients and why

heart failure ( strong affect on heart can potentially worsen cardiac output and heart failure symptoms.)

Beta Blockers contraindications

BB with Intrinsic sympathetic activity in post-MI patients

Beta Blocker Monitoring

potential masked hypoglycemia in DM patients

Beta Blockers: Clinical Pearl for Diabetes/Hypoglycemia

Counsel patient w/ diabetes to look for sweating as sign of

hypoglycemia

Beta Blockers: Clinical Pearl general

Less effective at controlling blood pressure and preventing events

α1 Receptor Blockers side effects

1st dose phenomenon: syncope, dizziness, fainting, palpitations

Central α2 – Agonists: MOA

reduction in sympathetic outflow from brain

Central α2 – Agonists side effects

Clonidine: anticholinergic effects (blurred vision, dry mouth, sedation, constipation)
Clinidine & Methyldopa: Rebound hypertension (rapid rise in BP when stopped suddenly secondary to compensatory incr. in NE)

What population is methyldopa good for

used in pregnancy