HTN "Important Points" (from tables in slides)

40, decreased, electrolyte, gout

Thiazide and Thiazide-Like Diuretics

• Chlorthalidone preferred due to long half life (__ hours) and _________ incidence in CV data

  • Good for patients with greater chance of poor adherence

• Monitor for ____________ and metabolic disturbances

• Caution in acute _____ unless patient on uric-acid lowering therapy

heart failure, thiazides

Loop Diuretics

• Preferred in patients with symptomatic _____ _______

• Preferred over __________ in patients with moderate-severe CKD (GFR <30 mL/min)

minimally, thiazide, kalemia, CKD

Potassium-Sparing Diuretics

• _________ effective anti-hypertensive when used alone

• Combination therapy with _________ often considered in patients with hypo________ on thiazide monotherapy

• Avoid in patients with significant ___

  • GFR <45 mL/min

  • patients need relatively good kidneys for this drug

resistant, gynecomastia, impotence, K, renal, BID

Aldosterone Antagonists

• Preferred in primary aldosteronism and ___________ hypertension

• ______________ and ___________ with spironolactone compare to eplerenone

• Avoid with + _ supplements, other K+ sparing diuretics, or significant _____ dysfunction

• Eplerenone often requires ___ dosing for effective BP lowering

not, bronchospastic, HFrEF, abrupt

Cardioselective Beta Blockers

• ___ first line unless CAD or heart failure

• Preferred in patients with ______________ airway disease

• Bisoprolol or metoprolol succinate preferred in _____

• Avoid _______ cessation

nitric oxide, cessation

Cardioselective and Vasodilatory Beta Blockers

• Induces ______ ______ - induced vasodilation

• Avoid abrupt __________

reactive, cessation

Non-cardioselective beta blockers

• Avoid in patients with ________ airway disease

• Avoid abrupt _________

CAD, cessation

ISA Beta Blockers

• Avoid in patients with ___ or heart failure

• Avoid abrupt _________

carvedilol, cessation

Combined alpha + beta-receptor Beta Blockers

• ___________ preferred in patients with HFrEF

• Avoid abrupt _________

ARBs, Renin, hyper, stenosis, angioedema, avoid

ACE Inhibitors

• Do not use in combination with _____ or Direct ______ Inhibitors

• Increased risk of _____kalemia

• May cause acute renal failure in patients with bilateral renal artery ________

• AVOID in patients with __________ ACE-I

• _____ in pregnancy & breastfeeding

ACE, renin, kalemia, renal, angioedema, pregnancy

ARBs

• Do not use in combination with ____ inhibitors or Direct _____ inhibitors

• Increased risk of hyper________ (CKD or K+ supplements or K+ sparing drugs)

• May cause ARF in patients with severe bilateral ______ artery stenosis

• Do not use if history of ___________ with ARBs

• Avoid in ___________

ARBs, long, CKD, stenosis, pregnancy

Direct Renin Inhibitors

• Do not use with ACE inhibitors / ____

• ____ acting

• Increased risk of hyperkalemia in ___ or those on K+ supplements or K+ sparing drugs

• May cause ARF in patients with severe bilateral renal artery ________

• Avoid in __________

Beta blocker, HFrEF, 3A4

CCBs: Non-Dihydropyridines

• Avoid routine use with ____ _______ (bradycardia and heart block)

• Avoid in _____

• Many drug interactions (CYP___ substrate and inhibitor)

edema, MI

CCBs: Dihydropyridines

• Dose-related ______ (avoid in immediate use post __ patients)

orthostatic, second

Adrenergic Blockers

• ___________ hypotension

• _______ line agents in patients with concomitant BPH

last, older, rebound HTN

Central Acting Alpha 2 Agonists

• Reserved ____ line due to increased effects (CNS), especially in ______ adults

• Taper clonidine to avoid ________ ___

Sodium, tachycardia, diuretic, beta, loop

Direct Vasodilators

• Associated with _______ and water retention with reflect ____________

• Use with a _________ and ____ blocker

• Minoxidil requires ____ diuretic