Lisinopril
- category
- trade name
- use
- usual dose
- mechanism
- contraindications/adverse effects
(From Drugs needed to know on Med Review Sheet)
Category
- anti-hypertensive
- ACE inhibitor
Trade name
- Prinivil
- Zestril
Use
-treatment of HTN
Usual dose
-5-40 mg qd
Mechanism
- By inhibiting ACE, they
- Block formation of Angiotensin II (powerfulvasoconstrictor)
- ↓ Aldosterone (↓ Na+ retention)
- Also ↑ Bradykinin (→ vasodilation)
Contraindications
-2-3rd trimester of pregnancy
Adverse effects o Dry cough o Hypotension o Rash o Angioedema o May cause hyperkalemia -Monitor especially if on K supplements or K sparing diuretic o May cause acute renal failure in patients with bilateral renal artery stenosis or severe dehydration
Amlodipine -category -trade name -use -usual dose -mechanism -contraindications/adverse effects (From med review sheet)
category
- Anti-HTN
- Calcium antagonist (CCB)
- Dihydropyridine class
trade name
-Norvasc
use
-treat HTN
usual dose
-2.5-10 mg qd
mechanism
- contractility -
- peripheral vasodilation +++
contraindications
- Hypersensitivity to amlodipine or any of the components
- Pregnancy risk factor C
adverse effects
-may cause tachycardia
Atenolol
- category
- trade name
- use
- usual dose
- mechanism
- contraindications/adverse effects
(from med review sheet)
category
- anti-HTN
- Beta-blocker
- cardioselective class
trade name
-Tenormin
use
-treat HTN by decreasing HR
usual dose
-25-100 mg qd
mechanism
- Cardioselective effects are dose related, so have some beta 2 blocking effects at higher doses.
- Block beta-1 receptors
contraindications
- patients with:
- bradycardia
- heart block
- sinus node disease due to decreased heart rate
- cautioned in patients with uncontrolled heart failure
adverse effects
- May cause:
- fatigue, insomnia, -depression, -nightmares
- Bradycardia and ED
- aggravate peripheral vascular disease
- mask signs of hypoglycemia = important for those with DM
- mildly decrease HDL and mildly increase TG
Diuretics
-different classes
- thaizide
- potassium sparing
- loop diuretics
ACE inhibitors (ACEI)
- function
- common drug
- this class of drugs end in?
Function inhibit ACE by: -block formation of angiotensin II -decrease aldosterone -increase bradykinin
Common drug
-Lisinopril
end in:
-“pril”
Angiotensin-II receptor blockers (ARB)
- function
- common drug
- this class of drugs end in?
function
- block angiotensin II receptor they:
- cause vasodilation
- decreased aldosterone
common drug
-losartan
end in:
“sartan”
Calcium antagonists (CCB)
- function
- different classes
function -dependent on class
Classes
- CCD class effects
- Dihydropyridine class (ends with “dipine”
- Non-Dihydropyridine class
Beta-Blockers (BB)
-function
-this class of drugs end in?
function -dependent on class
ends in:
-“olol”
What lifestyle changes are useful to help reduce hypertension?
- Heart healthy diet
- Med or DASH (fruits, veg, whole grain, low fat dairy, poultry, fish, beans, nuts, non-tropical oils, avoid red meat);
- Limit sugary drinks and sweets
- Limit sat fat and trans fat to 5-6% of calories
- Limit sodium intake to 2400 mg daily (for adults with HTN further reduction to 1500 mg/d recommended) - Exercise regularly (mod-vig aerobic activity for 40 minutes 3-4 times per week)
- Healthy weight (BMI 18.5-24.9)
- Avoid tobacco
What is the blood pressure goal of a person who is age 60 or older and when should you initiate pharmacologic treatment?
Goal: /= 150/90
What is the blood pressure goal of a person who is younger than 60 or who is >/= 18 y.o with chronic kidney disease or with diabetes and when should you initiate pharmacologic treatment?
Goal: /= 140/90
Thiazide diuretics should be cautiously avoided in patients with __?
gout or a history of significant hyponatremia
Beta blockers should be generally avoided in patients with __?
asthma, reactive airways disease, or second or third degree heart block.
ACEIs and ARBs are contraindicated in____?
pregnant women or those likely to become pregnant
ACESIs should not be used in individuals with__?
a history of angioedema.
Aldosterone antagonists and potassium sparing diuretics can cause__?
hyperkalemia
What is the antihypertensive treatment recommended for the population of general nonblack, including those with DM?
thiazide diuretic, CCB, ACEI, or ARB
What is the antihypertensive treatment recommended for the population of general black, including those with DM?
thiazide diuretic or CCB
What is the antihypertensive treatment recommended for the population of age >/= 18 with chronic kidney disease?
ACEI or ARB
What are some strategies for dosing and titrating antihypertensive drugs?
A: start one drug, titrate to maximum dose, and then add a second drug
B: start one drug and then add a second drug before achieving maximum dose of the initial drug.
C: begin with 2 drugs at the same time, either as 2 separate pills or as a single pill combination.
What needs to be monitored when using diuretics for management of hypertension?
bp, potassium and magnesium levels, blood sugar, uric acid levels, creatinine levels.
What needs to be monitored when using aldosterone antagonists for management of hypertension?
bp, potassium and creatinine levels
What needs to be monitored when using ace inhibitors for management of hypertension?
bp, potassium and creatinine levels
What needs to be monitored when using ARBs for management of hypertension?
bp, potassium and creatinine levels
