Hypertension Drug Chart
| DRUG NAME | MOA | ACTIONS | THERAPEUTIC USES | SIDE EFFECTS |
|---|---|---|---|---|
| Thiazides “AZIDE” Hydrochlorothiazide Chlorthalidone Indapamide Esldrix metolazone | ↓ BP by ↓ blood volume Acts mainly in the distal tubule to ↓ the reabsorbtion on NA+ ; inhibit reabsorption of Na+ and Cl- in the distal convoluted tubule, resulting the retention of water ↓ SERUM Na+ concentration (hypernatremia | ↑ EXCRETION OF Na+ AND Cl- (Hyperosmolar urine) ↑LOSS OF K+ due to the increase in Na+ in the filtrate arriving at the dital tubule, ↑ in exchange of K+ for Na+ (can result in hypokalemia) ↑LOSS OF Mg2+ can occur in elderly ↓URINARY CALCIUM EXCRETION (↓Ca+ content of urine by promoting reabsorption of Ca+) REDUCED PERIPHEAL VASCULAR RESISTANCE ↓in BP results from a ↓ in blood volume = ↓CO ↑BLOOD GLUCOSE ↑LIPID LEVELS ↓URATE EXCRETION | HTN HEART FAILURE HYPERCALCIURIA DIABETES INSIPIDUS DOC FOR MILD HTN AND ELDERLY Combine with another drug for severe HTN | Idiosyncratic rxn (rash, photosensentivity, purpura) ↑plasma renin Hyponatremia Hypokalemia Hypomagnesaemia Hyperuricemia (gout) Hyperglycemia Hypercalcemia (esp. hyperparathryroid pt) hypercholesterolemia |
| LOOP DIURETICS Bumetanide Furosemide Torsemide Ethacrynic Acid Demadex | Inhibit the cotransport of Na+/K+/Cl- in the luminal membrane in the ascending limb of the loop of Henle. ↓ SERUMN Ca+ = ↑ Ca+ in URINE (kidney stones) | ↑Ca+ in urine ↑K+ excretion Hypomagnesemia Hyperuricemia ↓renal vascular resistance and ↑ renal blood flow ↑prostaglandid synthesis (NSAIDS can interfere with prostaglandid synthesis and ↓ diuretic action) RISK FOR DEHYDRATION (>4 L urine/24h) If given with Li+ (thymoprofylatic) ↓Na+ reabsorption can led to ↑Li reabsorption (TOXICITY) | Acute pulmonary edema Severe renal failure Severe HTN CHF Hypercalcemia hyperkalemia DOC for ↓ acute pulmonary edema of heart failure | Ototoxicity Hyperuricemia Acute hypovolemia Hypokalemic Alkalosis (Potassium depletion) Hypomagnesemia |
| Ace Inhibitors “PRIL” Captopril Enalapril Quinapril Lisinopril Perindopril Ramipril Spirapril | ↓BP by ↓PVR without ↑CO, HR, or contractility BLOCKS ACE (Angiotensin I can’t form to Angiotensin II) ↑ BRADYKININ (b/c blocks ace which is responsible for breakdown of bradykinin) ↓secretion of aldosterone Blocks Ace=↓Angiotensin II=↓secretion of Aldosterone= ↓Na & H2O retention | HTN (white & young) CHF MI (started 24 hours after MI) Diabetic nephropathy ↓Albuminuria Combined with a diuretic they have the same effectiveness with African Am pts | C- Cough, ↑levels of bradykinin A- Angioedema (black/female); Agranulocytosis P- Proteinuria; ↑K+ levels T- Taste Change O- Orthostatic changes P- Pregnancy contraindications; Pancreatitis R- Renal Failure (renal artery stenosis); Rash I – Indomethacin inhibition (NSAIDS block prostaglandins in kidneys) L- Liver toxicity (metabolized in the liver); Leukopenia |
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| Angiotensin II Receptor Antagonist (ARB) “SARTAN” Losartan (Cozaar) Valsartan Candesartan Telmisartan | They produce vasodilation and block Aldosterone secretion= ↓BP & ↓Na+ H2O retention BLOCKS ALDOSTERONE (does not inhibit ACE) Do Not Effect Bradykinin Levels | ↓ Nephrotoxicity of DM Similar uses as ACE inhibitors | C- Cough A- ↓Angioedema; Agranulocytosis P- Proteinuria; ↑K+ levels T- Taste Change O- Orthostatic changes P- Pregnancy contraindications; Pancreatitis R- Renal Failure (renal artery stenosis); Rash I – Indomethacin inhibition (NSAIDS block prostaglandins in kidneys) L- Liver toxicity (metabolized in the liver); Leukopenia Similar Adverse rxn as ACE except cough and angioedema are ↓ bc no effect on Bradykinin |
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| Calcium Channel Blockers Nondihydropyridines Verapamil Diltiazem Dihydropyridines Nifidipine Amlodipine Felodipine Isradipine Nicardipine nisoldipine | Nondihydropyridines Actions on peripheral vasculature and heart Vasodilate (smooth muscle relaxation >↓TPR) ↓Cardiac Depression= ↓HR ↓SV ↓impulse conduction (may cause AV BLOCK Dihydropyridines Calcium channel antagonist block the movement of Ca+ by binding to L-type Calcium channels in heart/smooth muscle of heart/peripheral vasculature=smooth muscle relaxation and dilatation of arterioles | Asthma, DM, Angina, PVD, Migraines Works well with African Am | Constipation (↑GERD) Avoid in severe HF – heart depressant (make CHF worse) |
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| BETA BLOCKER “OLOL” Nonselective B Antagonist: act at both B1 (heart) and B2 (lungs) receptors Propranolol Timolol Nadolol Carvdilol (B1, B2, and α1) Labetalol (B1, B2, and α1) Cardio selective B Antagonist: Block only B1 (heart) receptors Acebutolol Atenolol Metoprolol Esmolol | Nonselective B Antagonist Cardio: ↓ CO, ↓Cardiac work, ↓O2 consumption by blockade of B1 receptors Peripheral Vasoconstriction: ↓CO=↓Blood flow to periphery Bronchoconstriction: blocking B2=contraction of bronchiolar SM ↑Na+ Retention: ↓BP= ↓renal perfusion=↑Na+ retention and plasma volume Disturbances in Glucose Metabolism: B-blockade =↓glycogenolysis and ↓glucagon secretion Blocked action of isoproterenol ↓Renin Secretion Cardio selective B Antagonist: ↓BP in HTN and ↑exercise tolerance Little effect on pulmonary fxn, peripheral resistance, and carbohydrate metabolism | HTN (by ↓CO) Glaucoma (by ↓ICP) Migraine (Propranolol DOC) Hyperthyroidism Angina Pectoris (↓o2 requirement of heart muscle) MI (given during will reduce infarct size and ↑recovery) | A- Asthma B- heart block C-COPD D-Diabetes mellitus E- Electrolytes (↑K+) |
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| Vasodilators Hydralazine (Apresoline) Minoxidil Rogaine | Produce relaxation of vascular smooth muscle= ↓resistance = ↓BP Produce reflex stimulation of the heart= ↑myocardial contractility, ↑HR, ↑O2 consumption=these actions prompt angina, MI, or CHF in predisposed ↑plasma renin concentration=Na+ H2O retention | Hydralazine- ∗ Moderately severe HTN ∗ Hydralazine-given w/ B-blocker or CCB and diuretic (↓CO↓PV↓PVR) ∗ Safe in pregnancy Minoxidil- ∗ Severe to malignant HTN Very potent vasodilator | Hydralazine- ∗ Moderately severe HTN ∗ Hydralazine-given w/ B-blocker or CCB and diuretic (↓CO↓PV↓PVR) ∗ Safe in pregnancy Minoxidil- ∗ Severe to malignant HTN Very potent vasodilator Hydralazine- ∗ Moderately severe HTN ∗ Hydralazine-given w/ B-blocker or CCB and diuretic (↓CO↓PV↓PVR) ∗ Safe in pregnancy Minoxidil- ∗ Severe to malignant HTN Very potent vasodilator |
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| Central a-Agonist Clonidine (Catapress) Methyldopa (Aldomet) | Acts in the CNS Stimulates a-receptors in the CV control center of the brain=↓SNS activity= ↓vasoconstriction, ↓HR, ↓SV=↓BP | Mild to Moderate HTN that does not respond to diuretics alone HTN in renal pt (bc does not ↓renal blood flow) Used to treat BPH (Hytrin & Doxazosin{Cardura}) | Causes Na+ and H2O retention (give with diuretic) REBOUND HTN “Clonidine Rebound” Sedation Drying of nasal mucosa |