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Risk factors for Heart Disease
- High BP
- Smoking
- Dyslipidemia
- Diabetes
- Family history
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Management of HTN
- 1. Lifestyle changes
- 2. Diuretics, Beta blockers
- 3. Angiotensin
- 4. Ca2+ channel blocker
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3 classes of diuretics
- Thiazide
- Loop
- Potassium Sparing
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Side effects of Diuretics
- Dizziness
- Muscle cramps
- N/V
- Preg Cat B
- CI: renal dysfunction
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Thiazide Diuretics (3)
- Hydrochlorothiazide - Microzide
- Polythiazide - Renese
- Indapamide - Lozol
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Thiazide Diuretics MOA
- Inhibition of Na/Cl tubules in kidney, causing increases urinary excretion.
- Lower cariac output and lower BP
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Thiazide Diuretics Counseling points
- Take in AM
- Can take days to work
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Loop Diuretics
- Furosemide - Lasix
- Bumetanide - Bumex
- Toresmide - Demadex
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Loop Diuretic MOA
- Inhibit reabsorption of Na/Cl in ascending loop
- INcreased urine output lowers cardiac output lowers BP
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Loop Diuretics Counseling Points
- Don't take at bedtime
- May need additional potassium in diet (hypokalemia)
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Potassium Sparing Diuretic (2)
- Triamterene - Dyrenium
- Amiloride - Midamor
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K-sparing diuretic MOA
- Competitively inhibit aldosterone binding. Increases Na/Cl/H2O excretion.
- Not K+/H+ excretion
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Beta Blockers (5)
- Atenolol - Tenormin
- Labetelol - Normodyne
- Metroprolol Succinate - Toprol XL
- Metroprolol Tartate - Lopressor
- Propranolol - Inderal
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Beta blockers indications
HTN, heart failure, MI, arrhythmias, angina
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Beta blocker MOA
- competitively blocks B adrenergic receptors
- decreases heart rate, BP and contractility
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Beta Blocker Counseling points
- SE: Bradycardia
- Effect can take 2 or more weeks
- do not DC abruptly
- Preg Cat C
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ACE inhibitors (5)
- Lisinopril - Zestril
- Ramipril - Altace
- Captopril - Capoten
- Benazepril - Lotensin
- Enalapril - Vasotec
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ACE Inhibitor Indications
- HTN
- CHF
- Acute MI
- Prevention of MI
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ACE Inhib MOA
- supress renin-angiotensin-aldosterone system (RAAS)
- Inhibit ACE enzyme, prevents conversion of angiotensin 1 to angiotensin 2 to decrease vasoconstriction
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ACE inhib Counseling points
- SE: dry cough or edema in face (rare emergency medical condition)
- Preg Cat D
- Can cause hyperalkemia
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Angiotensin 2 Receptor Blockers (ARBS)
- Valsartan - Diovan
- Losartan - Cozaar
- Irbesartan - Avapro
- Candesartan - Atacand
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ARBS MOA
- inhibit RAAS by blocking binding of angiotensin 2
- decrease vasoconstriction
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ARBS Counseling points
- SE: HA, drowsiness
- May take weeks to work
- Preg Cat C
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Ca channel blockers (4)
- Amlopidine - Norvasc
- Nifedipidine - Procarida
- Diltiazem - Cardizem
- Verapamil - Calan
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Ca channel blockers MOA:
- Blocks Ca channels
- relaxation of coronary smooth muscle, vasodilation
- decreased cardiac workload and lower BP
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Ca channel blockers counseling points
- SE: Edema, constipation, flushing
- Don't DC abruptly
- No grapefruit juice (cyp3A4)
- Preg Cat C
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