hypertension therapeutics - second half

name the loop diuretics

bumetanide, furosemide, torsemide

adverse effects of loop diuretics

-dehydration

-hypotension

-decreased Na, K, Mg, Cl

-increased glucose, uric acid, LDL-C, TG

contraindications of loop diuretics

-anuria

-caution with sulfa allergies (not ethacrynic acid)

loop diuretics monitoring

-BP

-electrolytes

-renal function

-fluid status

-glucose

-uric acid

loop diuretics drug interactions

NSAIDs

name the potassium sparing diuretics

-amiloride

-triamterene

-eplerenone

-spirnoloactone

adverse effects of potassium spring diuretics

-dehydration

-hyperkalemia

-hyponatremia

-dizziness

adverse effects of spironolactone

-gynecomastia

-breast tenderness

-irregular menses

contraindications of potassium sparing diuretics

-hyperkalemia

-anuria

-renal impairment

-concurrent use of potassium sparing diuretics of potassium supplementation

potassium sparing diuretics monitoring

-BP

-electrolytes

-renal function

-fluid status

potassium sparing diuretics drug interactions

strong CYP3A4 inhibitor

name the cardioselective beta 1 blockers

-atenolol

-betaxolol

-bisoprolol

-esmolol

-metoprolol tartrate

-metoprolol succinate

name the cardioselective and vasodilatory beta blockers

Nebivolol

name the non-cardioselective beta-1 and beta-2 blockers

-nadolol

-propranolol IR

-propranolol LA

name the intrinsic sympathomimetic activity beta blockers

-acebutolol

-carteolol

-penbutolol

-pindolol

name the non-cardioselective beta blocker and alpha-1 blocker

-carvedilol

-carvedilol phosphate

-labetalol

adverse effects of beta blockers

-bradycardia

-hypotension

-fatigue

-dizziness

-depression

-decreased libido

-mask symptoms of hypoglycemia

-rebound hypertension if abrupt discontinuation

contraindications of beta blockers

-severe bradycardia

-2nd or 3rd degree AV block

-cardiogenic shock

beta blockers monitoring

HR, BP, ECG

beta blockers drug interactions

other drugs that decrease heart rate

what are the direct renin inhibitors

aliskiren

adverse effects of direct renin inhibitors

-angioedema

-hyperkalemia

-hypotension

-renal dysfunction

-diarrhea

contraindications of direct renin inhibitors

-use with ACE or ARBs in patients with diabetes

-bilateral renal artery stenosis

-pregnancy

direct renin inhibitors monitoring

-BP

-potassium

-renal function

direct renin inhibitors drug interactions

RAAS inhibitors

name the alpha 1 blockers

-doxazosin

-prazosin

-terazosin

adverse effects of alpha 1 blockers

-orthostatic hypotension

-syncope

-fatigue

-dizziness

-headache

-edema

contraindications of alpha 1 blockers

hypersensitivity to drug

monitoring of alpha 1 blockers

BP

drug interactions of alpha 1 blockers

caution with other drugs that decrease BP, PDE-5 inhibitors

name the centrally acting alpha 2 agonists

-clonidine oral and patch

-guanfacine IR

-methyldopa

adverse effects of centrally acting alpha 2 agonists

-bradycardia

-hypotension

-dry mouth

-headache

-fatigue

-dizziness

-depression

-constipation

-rebound hypertension if abrupt discontinuation

-drug induced lupus

contraindication of centrally acting alpha 2 agonists

methyldopa - active liver disease, concurrent use either MAO inhibitors

centrally acting alpha 2 agonists monitoring

BP, HR, mental status

centrally acting alpha 2 agonists drug interactions

beta blockers

name the direct vasodilators

hydralazine, minoxidil

adverse effects of hydralazine

-headache

-hypotension

-reflex tachycardia

-palpitations

-drug induced lupus

adverse effects of minoxidil

-fluid retention

-tachycardia

-hair growth

contraindications of hydralazine

-mitral valve rheumatic heart disease

-coronary artery disease

contraindications of minoxidil

pheochromocytoma

direct vasodilators monitors

BP, HR, antinuclear antibody titer

direct vasodilators drug interactions

caution with other drugs that decrease BP

what three antihypertensive therapies are preferred in pregnancy

methyldopa, labetalol, nifedipine ER

what drugs are contraindicated in therapy

ACE-I, ARB, direct renin inhibitor

what is considered a hypertensive emergency

severe elevations in BP (>180/120) associated with evidence of new or worsening organ damage

how should BP be lowered in a hypertensive emergency

decrease BP by no more than 25% within the first hour, if stable decrease to 160/100 within the next two hours, then decrease to normal over next 24-48 hours

treatment of a hypertensive emergency

initiate IV hypertensive therapy

what IV hypertensive therapies can be initiated during a hypertensive emergency

esmolol, labetalol, hydralazine, nicardipine, nitroglycerin, nitroprusside

what is the definition of a hypertensive urgency

severe elevations in BP (> 180/120) without acute target organ damage

how should BP be lowered in a hypertensive urgency

decrease BP gradually over 24-48 hours

treatment of a hypertensive urgency

reinitiate or intensify oral antihypertensive drug therapy