Pharmexam2pt3.txt

BP = CO x PR

• smoking
• dyslipidemia
• DM
• age >60
• male
• postmenopausal women
• family hx of CVD (<65 in mom, <55 in dad)
• chronic kidney disease

CO = SV x HR

• high fiber, low-fat diet
• weight loss
• reduce sodium intake
• decrease alcohol intake
• no tobacco
• excercise
• adequate K, Ca, Mg intake

• hydrochlorothiazide
• chlorthalidone

furosemide

propanolol

• atenolol
• metoprolol

prazosin

clonidine

• hydralazine
• minoxidil

captopril

losartan

• diltiazem
• nifedipine
• verapamil

beta blockers, diuretics, alpha 1 blockers, alpha 2 agonists, vasodilators, ACEIs, ARBs, Ca channel blockers

• use: diuretics, CCB
• avoid: beta blockers

prazosin, terazosin

• use: ACEI and ARBs
• avoid: beta blockers

• block resoption of Na
• more effective than loop diuretics except in pts with renal probs (can still use metolazone and indapamide)
• DECREASE excretion of Ca
• used in all pts with HTN

• block sodium and chloride resorption
• INCREASE renal elimination of Ca

• should be used in all pts with HTN
• can take 2-4 wks to see effects
• toxicities: hypokalemia (treat with KCl), hyperuricemia, hyperglycemia, increased cholesterol and trigs, hypomagnesemia
• (K sparing diuretics are also Mg sparing diuretics)
• pt related variable: digoxin therapy (hypokalemia will increase toxicity), renal dysfunction (treat with loops or metolazone)
• interact with NSAIDS, antagonize antihypertensive effects

• decrease CO and decrease release of renin from kidneys
• best if used with other antihypertensives
• abrupt d/c can increase anginal attacks, taper dose over 2 wks
• toxicity: bronchoconstriction in asthmatics, HF, peripheral vascular insufficiency, prolonation of hypoglycemia, beta blocker blues
• DO NOT administer immediately after d/c clonodine

• not good antihypertensive
• decreases PR
• used with pts who have BPH
• may cause first dose syncope, reflex tachycardia, orthostatic hypotension

• decreases sympathetic response
• rebound HTN may occur after d/c of drug
• oral or patch (do not cut patch)
• toxicity: rebound HTN, orthostatic hypotension, sedation, impotence

• reduce PR by directly dilating arterioles
• reflex tachycardia and aldosterone secretion are common
• use beta blocker to decrease reflex tachycardia and diuretic to prevent edema
• take same time each day with meal
• toxicity: edema, hypertrichosis (increased hair growth), reversible SLE (with hydralazine)

• avoide ACEIs if serum K is >5 or Cr is >3 (indicates renal probs)
• toxicity: precipitous BP drop after first dose, dry cough, angioedema (of face)
• containdications: pregnancy, bilateral renal artery stenosis, h/o angioedema
• renal protective in DM

• cause arterial dilation (decrease afterload)
• verapamil and diltiazem decrease inotropic state of heart
• nifedipine increases vasodilation more than V or D
• always use SR of these drugs for HTN
• toxicity: reflex tachycardia, aggrevation of GERD
• pt related variables: preexisting heart block, concurrent used of beta blockers (V and D), HF, hypovolemia, will interact with grapefruit juice (nifedipine)

spironolactone

• aldosterone antagonist
• causes increased absorption of Na, H2O, and K
• toxicity: hyperkalemia

• severly elevated BP with end organ damage
• lower BP up to 25% (to range of 160/100) in minutes to hours
• use IV agents (NTG, hydralazine, labetalol)

• severely elevated BP without end organ damage
• lower BP over hours
• use PO agents (clonodine, labetalol, captopril)