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Clinical use of anti HTN
- HTN CRISIS (EMERGENCY AND URGENCY)
- CONTROLLED HYPOTENSION (SURGERYS WANT LESS BLOOD LOSS)
- HF (LOW AFTERLOAD)
- ISCHEMIC HEART DISEASE (NTG)
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HTN EMERGENCY
- >180/120
- S/S OF ESOD
- TREAT WITH IV
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NITRIC OXIDE
- ENDOGENOUS GAS FROM L-AGRININE
- SELECTIVE RELAXTION OF PUL VASCULATURE
- TX PUL HTN, ARDS
- CARDIO- LOW SHEAR FORCES, REGULATE SVR AND PUL VASC RESISTANCE
- REGULATES CO TO LUNGS AND HEART
- LUNG- BRONCHDILATION AND MEDIATOR FOR V/Q MATCHING
- LEADS TO OVERALL ENHANCEMENT OF ANESTHETIC STATE
- LO COAGUABLITY
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SODIUM NITROPRUSSIDE (SNP)
- DIRECT ACTING ON ART AND VIENS THAT IS FAST AND SHORT ACTING
- USED BE USED ON PUMP AND WITH ART LINE
- 44% CYANIDE AND REST NO
- NO CAUSE INCREASE OF cAMP THAN VASODILAT
- META: CYANIDE CONVERTS TO THIOCYANATE
- ONSET <2 MIN AND STOPS WITH IN 1-10 MIN OF GTT OFF
- T.5 LESS THAN 10 MIN
- THIOCYANATE ELIMINATED KIDNEYS
- DOSE (50MG IN 250ML-1L D5W) START .3-.5 MCG/KG/MIN TO 3 RARELY 4
- MAX IS 10 BUT FOR SHORT TIME
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EFFECT OF SNP
- CARDIO; VASODIL ART VEINS, LO BP, SVR, VEN RETURN, MAY CAUSE TACHYCARDIA AND INCREASE CONTRACTITLY, LO PUL VAS RESISTANCE, R ART PRESSURE (AFTERLOAD). LO RENAL B FLOW (INCREASE RENIN), CORONARY STEAL, CAN USE POST MI, MITRAL OR AORTIC REGURG (BETTER TO NITRO) USED POST BYPASS IN WARMING PHASE
- BRAIN; UP CEREBRAL BLOW FLOW AND ICP (BUT D/T FAST DROP BRAIN CAN'T REGULATE FAST ENOUGH LEADING TO STROKE)**** CAUTION HX BRAIN TRAUMA AND CARTIOD ART STENOSIS
- LOWER PAO2 (V/Q MISMATCH) AND UP BLEEDING TIME
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CYANIDE TOXICITY
- HEALTH ADULT CAN HANDLE CYANDIE PRODUCED FROM SNP RATE OF 2 MC/K
- OVER THAT SULFUR AND METHEMOGLOIN EXHAUSTED
- CYANDIE STOP THE KERBS (OXI PHOSPHORYLATION) LOW ATP PRODUCTION
- S/S TACHYPHALXIS OF SNP, INCREASE O2 IN MIX VENOUS(O2 NOT BEING USED) CNS CHANGES, META ACIDOSIS, UP LATATE ACID LEVELS
- TX; O2, NITRATE, THIOSULFATE(SULFATE DONOR) CONVERTS TO THOICYANTE THEN OUT VIA KIDNEYS
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THIOCYANTE TOXICITY
- 100X LESS TOXIC THAN CYANIDE
- RARE TO HAPPEN IN HEALTHY
- TAKE 7-14 DAY AT SNP RATE OF 2-5 FOR TOXCITY
- CAN HAVE SOON IN ESRD
- S/S FATIGUE, TINNITUS, N/V, CONFUSION, PSYCHOSIS, HYPERFLEXIA, MIOSIS
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NTG
- ROUTE IV, PO(RARE), SL, OINTMENT, BUCCAL, PATCHES
- ORGANIC THAT WORKS ON VEIN(1ST) POOLING BLOOD AND LO CARDIAC VET WALL TENSION(LO HEART O2 DEMAND)
- HIGHER DOSES WORK ON ART
- NOT AS STRONG AT SNP
- PHARM; HIGH FIRST PASS, SHORT T.5 X ISOSORBIDE AND META= METHERMOGLOBIN
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CORONARY STEAL
MED DILATES THE CORN ART IN NON ISCHEMIC AREAS AND SHUNT BLOOD AWAY FROM THE ISCHEMIC AREA
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EFFECT OF NTG
NO CARDIO
- RELAX BRONCHIAL AND GI SMOOTH MUSCLE
- RELAX ODDI
- CEREBRAL VASODILATOR INCREASE ICP
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EFFECT OF NTG ON HEART
- VASO DIL VEINS OVER ART
- LO VENOUS RETURN, CO IN HF, AND R LEDP
- LO BP DEPENDANT ON BLOOD VOL
- MAY CAUSE TACHYCARDIA
- NO CHANGE TO SVR BUT LOPUL VAS RESIS
- NTG DILATES LARGER CORONARY ART VESSELS
- NO CORONARY STEAL
- USE NTG FOR HTN IN CAD PT
- USE NTG OF 60-70%LESION (INCREASE HEART O2), AND VASOSPASMS
- IN CHF RELIEVE PUL HTN, UP CO, LO PUL CONGESTION, LO MYO O2 DEMANDS, SIZE OF MI
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NTG SIDE EFFECTS
- H/A, DIZZNESS, RACH, WEAKNESS, TACHY OR BRADY, CORN ART INSUFF, ARRHYTHMIAS, N/V
- METHHEMOGLOBINEMIA (TX METHYLENE BLUE 1-2 MG/KG IV OVER 5 MIN)
- TOLERANCE- NEED BREAK DT NEED OF THIO COMPOUNDS TO WORK
- CAN HAPPAN WITHIN 24-48 HOURS
- 8-12 OFF (WHY TAKE PATCH OFF AT NIGHT)
-
ISOSRBIDE DINITRATE
- TX ANGINA
- USED TO PREVENT OR ACUTE ATTACKS
- SAME AS NTG BUT LAST LONGER (COST MORE)
- DON'T KNOW IF IT BETTER THAN SL NTG
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ISOSORBIDE MONONITRATE
- TX CHRONIC, STABLE ANGINA
- TX; ACUTE MI AND PUL EDEMA WITH L VENT FAILURE
- NO 1ST PASS EFFECT, LONGER T.5 AND 100% BIOAVAIL
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DIAZOXIDE
- OLD MED
- TX HTN BY RELAX ART SMOOTH MUSCLE
- ONSET IMMEDIATE, PEAK 5-10 MINS, DURATION3-18 HOURS
- DOSE 1-3 MG/KG
- SE; LO BP, WATER RETENSION, HYPERGLYCEMIA (CAN BE USED TO TX HYPO), HYPERURICEMIA
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TRIMETHOPHAN
- OLDER
- BLOCKS SNS AND PNS AT GANGLIA
- LO BP AND CO
- DOSE .5-1MG/MIN OR 10-200 MCG.KG.MIN
- SE TACHYHR, HYPO, CONSTIPATION, URINARY RETENTION, EYE DILATION.
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FENOLDAPAM
- SELECTIVE D1 (RELAX ART TO KIDNEYS) LO BP UP RENAL FLOW
- USED FOR HTN AND REDUCED RENAL FX
- EFFECT PO OK, LO PVR, UP RENAL FLOW, DIURESIS, NATRIURESIS. WORKS AT PROXINAL TUBULES
- DOSE 0.1 MCG/KG/MIN UP AT .05-.1 Q15-20 HIGH IS .3
- SE HYPOTEN, EDEMA, TACHYCARDIA, FLUSHING, AFIB/FLUTTER, HA DIZZY, PORT HTN (IN CIRRHOSIS), N/V
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NESIRTIDE
- B TYPE NATRIURETIC PEPTIDE
- NITRO IS BETTER AND COST LESS
- USED FOR ACUTE DECOM CHF
- UP cGMP THUS DILATION OF VEIN AND ART
- DOSE2 MCG/KG BOLUS (HAVE TO HAVE) THEN .01 MCG/KG/MIN
- NEED SBP>90
- DON'T ADJUST BUT HIGH IS .03
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CONTRAINDICATIONS AND WARNINGS OF NESIRITIDE
- CON- BP LESS THAN 90, CARDIO STOCK
- WARNING- VALVULAR STENOIS, CARDIOMYOPATHY, PERICARDITIS, TAMPONADE, LOW CARDIAC FILLING, AFIB/FLUTTER, LO BP, BAD LIVER OR RENAL, NA RETENTION
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LIST OF ANTI HTN
- SYMPATHOLYTIC (A AND B BLOCKER)
- ACEI
- CCB
- VASODILATORS
- DIURETICS
- ARB
- RENIN BLOCKER
-
CLONIDINE
- A2 LO SNS OUTPUT
- TREAT HTN
- DOES .2 TO .3MG PO OR WEEKLY PATCH
- USE- REFACTORY PAIN, LO MAC AND LESS ANEST MEDS, PROLONG REGIONAL MEDS(BUT UP BRADY AND HYPO), STABLIZE BP AND HR, HTN, WITHDRAWAL OF OPIOIDS AND NICOTINE, SHIVERING, LO HEMO EFFECT OF KETAMINE
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PHARMKEN AND SE OF CLONIDINE
- PHARM
- FAST ABSORBED, T.5 9-12 HRS, NEED 48HR FOR PATCH TO WORK
- SE
- SEDATION, BRADY , LESS MAC NEEDED, FLUID RETENTION, OTHO BP, DRY MOUTH, REBOUND HTN (WHEN TAKING >1.2 MG/DAY)
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ACE
- -PRILS
- FIRST LINE FOR HTN, CHF, M REGURG
- MORE EFFECT AND SAFER FOR DM, LO REMODELING FROM MI
- ACTION BLOCK ANGIO I TO ANGIO II
- DOES NOT CAUSE CHF, BRONCHOSPASM, BRADYCARDIA, META CHANGES, REBOUND HTN,
- SE- #1 COUGH, CONGESTION, BRADYKININS, ANGIOEDEMA, DON'T USE FOR RENAL ART STENOSIS
- OR HIGH RISK OF HYPOTENSION BUT TREAT WITH FLUIDS
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ARB
- -SARTAN
- DIRECTLY BLOCK ANGIOTENSIN 2 RECEPTOR
- BLOCKING VASCON, ALDOSTERONE RELEASE, SNS ACTIVATION, ADH RELEASE
- NO BRADYKININS (USE IF ACEI CAN'T BE USED)
- SE- RENAL INSUFF, HYPERK AND MAG, ANGIOEDEMA, HYPOTENSION, NEUTROPENIA
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HYDRALAZINE
- DIRECT VASODIL OF ART (LITTLE EFFECT ON VIENS)
- FOR HTN CRISIS (PRE AND ECLAMPSIA)
- DOSE 10-20 MG IV 4-6 HR ECLAMPSIA IS 5-10 MG Q 20-30 MIN AS NEEDED
- EFFECT- LO DBP >SBP, LO SVR, UP HR, SV, CO
- SE- UP MYO O2 DEMAND, LUPUS LIKE S/S, N/V, HA, HYPOTENSION,
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MINOXIDIL
- DIRECT RELAXATION OF ARTERIAL (LITTLE VIENS)
- FOR MOST SEVERE HTN (PT ON 3-4 OTHER HTN MEDS)
- CARDIO EFFECT- UP HR CO, UP NE AND RENIN SO MUST GIVE DIURETIC
- SE- PERICARDIAL EFFUSIONS, TAMPONADE
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ALISKIREN
- BLOCK RENIN ACTIVITY (PRA) HENCE NO FORMATION OF ANGIO I
- TX HTN FOR PT THAT CAN USE ACEI
- DOSE 150 MG PO TO 300MG
- SE ANGIOEDEMA, DIARRHEA, GERD, HYPO UP K, NO NO NO TO PREGO, UP BUN AND CR, SEIZURES.
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