ANTIHYPERTENSIVE MEDICATIONS
Drugs Used to Treat Hypertension made easy: A B C D
A= Ace Inhibitors/ARB
The “prils” & “sartans”
Used for: Diabetes (helps the kidneys)
CHF (improves EF, HF, L. vent dysfunction
Post MI (improves survival)
Connective tissue disease (sclerderma)
Effective in young patients
Do not use in renal artery stenosis
Most Common Side Effects: Angioedema, Cough, hyperkalemia, low sodium, hypomagnesium, hyperuricemia, hyperglycemia
These drugs decrease blood pressure, help the kidneys get rid of fluid & remodel the heart
B= Beta Blockers
The “olols”
Only 3 indications to use Beta Blockers: CHF
Post MI
Angina
Effective in young patients
Do Not Use in ASTHSMA, HEART BLOCK (blocks sympathetic nervous system), COPD, DM & PATIENTS WITH HIGH K LEVELS
A diabetic could have SEVERE HYPOGLYCEMIA with no signs and symptoms if treated with a Beta Blocker
Teach patient not to push themselves to extremes when taking a Beta Blocker
Most Common Side Effects: decrease heart rate, depression, asthsma, copd, bronchospasm, increase k level, nightmares, impotence & masking of hypoglycemic symptoms
C= Calcium Channel Blockers
Effective in African Americans & elderly
Has not shown to improve survival
2 classes of Ca Channel Blockers:
NONDIHYDROPYRIDINES (Cardizem, Verapamil)
Vasodilates smooth muscle
Decreases heart rate
Decreases impulse conduction through the AV Node
Side Effects: CONSTIPATION (Verapamil causes constipation), HEADACHES (Procardia XL)
ADVOID WITH SEVERE HEART FAILURE
DIHYDROPYRIDINES (Norvasc. Procardia, ADALAT)
Only vasodilates
Do not give to treat arrheamias
Can increase heart rate in response to vasodilation
Side Effects: peripheral edema, increase in heart rate, decrease in heart rate, decrease preload
D= Diuretics
Has not shown to improve survival
Effective in African Americans & elderly
Thiazide diuretics are 1st line therapy for the treatment of HTN
HYDROCHLOROTHIAZIDE
Ascending loop diuretic
Used in uncomplicated HTN
Onset 1-2 Hrs, works 12-24 Hrs, long ½ life
Side Effects: low Na, low K, Low Mg, high glucose, high calcium, high cholesterol, high uric acid (Gout)
With a decrease Cre level, Hydrochlorothiazides become less effective
Can give to patients with Ostioprosis (side effect high calcium)
Cautious use in patients with Gout (increases uric acid levels)
LASIX (LASIX, BUMEX, DEMADEX, ETHACRYNIC ACID)
Loop diuretic
Short acting, quick onset
Fluid volume unloaders
Provide symptomatic relief of pulmonary & peripheral edema
Side Effects; low Na, low K, low Mg, dehydration, elevated Cre levels, ototoxicity
Do not use in patients with renal stones (can increase Ca levels)
More effective for treatment of HTN than Hydrochlorothiazides
Ethacrynic acid can be used with patients that are allergic to sulfonamides
In patients with normal renal function, loop diuretics are less effective than thiazides for treatment of HTN (better to use loop diuretics for patients with renal failure)
POTASSIUM SPARING DIURETICS (ALDACTONE-SPIROLACTONE, INSPRA-EPLERENONE)
Weak diuretic but effective
A mineralocorticoid receptor antagonist
Side Effects: high K, low Na, gynecomastia, menstrual abnormalities, gi disturbances
Used with other diuretics to prevent hypokalemia
Inspra is less likely to cause gynecomastia
References
Harvey, R. A., Clark, M. A., Finkel, R., Rey, J. A., & Whalen, K. (2012). Drugs affecting the cardiovascular system. In Pharmacology (pp. 193-218). Baltimore, MD: Wolters Kluwer/ Lippincott Williams & Wilkins.