diuretics/antihypertensives

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Pharmacology
Chapters 38, 39
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1

thiazide diuretics

  • hydrochlorothiazide

MOA: pull Na, K, H2O off, dilates arterioles

USE: increase urine output, HTN, edema, HF, nephrotic syndrome, ascites

AE/SE: orthostatic hypotension, hyponatremia, hypokalemia, SJS, renal failure

contraindication in renal failure. ceiling threshold

2

loop diuretic

  • furosemide

MOA: inhibits reabsorption of Na, K, H2O

USE: HF, renal dysfunction, HTN, nephrotic syndrome, acute pulmonary/peripheral edema

SE/AE: electrolyte imbalances, orthostatic hypotension, hyperglycemia, SJS

ADMIN: IV over 1-2mins, infusion @ 4mg/min

3

potassium-sparing diuretics

  • spironolactone

MOA: promotes Na H2O excretion and K retention. can be used with furosemide

USE: peripheral/pulmonary edema, fluid overload, HTN, ascites, hypokalemia

SE/AE: hyperkalemia, SJS, hepatotoxicity, deepening of voice, gynecomastia, menstrual irregularity

ADMIN: given @ same time each day, preferably morning

4

beta-adrenergic blockers

  • metoprolol

MOA: promotes BP reduction by blocking Beta 1 receptors

USE: HTN, AMI, HF, angina

SE/AE: bradycardia, hypotension, bronchospasm, erectile dysfunction

abrupt withdrawal can lead to exacerbation in angina, MI, ventricular dysrhythmias

5

alpha-adrenergic blockers

  • prazosin hydrochloride

MOA: dilates peripheral blood vessels by blocking alpha-adrenergic receptors

USE: control HTN

SE/AE: pancreatitis, elevated liver enzymes, orthostatic hypotension

first dose phenomenon -> orthostatic hypotension, palpitations, dizziness, syncope

6

ACE inhibitors

  • lisinopril

MOA: blocks release of aldosterone

USE: HTN, MI, HF

SE/AE: hypotension, headache, dizziness, hyperkalemia, dry hacking cough

7

ARB inhibitors

  • losartan

MOA: blocks angiotension II from binding to receptor sites

USE: HTN, diabetic nephropathy, proteinurea

SE/AE: weakness, dizziness, cough, hypotension, anemia, angioedema

8

calcium channel blocker

  • diltiazem

MOA: promotes vasodilation

USE: HTN, angina, dysrhythmia

SE/AE: peripheral edema, dizziness, dyspepsia, bradycardia, hypotension

9

cultural response to antihypertensive agents

AAs respond best to diuretics.

asians respond best to beta blockers

10

physiological risk factors

  • excessive saturated fat and simple carbs
  • alcohol increase renin secretion
  • obesity increases CO, stroke volume, left ventricular filling