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NURS 572 Pharm Ch46
Pharm HTN drugs
Question | Answer |
---|---|
what is essential HTN = EHT | 90% of all pts have EHT, which is HTN with no identifiable cause |
what drug categories are PROVEN to decrease premature death from HT and its complications | diuretics---Beta Blockers---ACEIs |
what are consequences of HTN | CAD/MI---HF/CHF---CVA---kidney dx/RF---blindness |
normal bp values | <120----<80 |
preHTN bp values | 120-139----------80-89 |
Stage 1 HTN values | 140-159----------90-99 |
Stage 2 HTN values | >160------------->100 |
what is goal for HTN tx - normal pts | goal is < 140/90 |
goal HTN tx - kidney disease, diabetic pts | goal is <130/80 |
majority of patients require how many drugs to acheive goal | most require 2 drugs |
What are the compelling indications in the tx of HTN (require specialized drug regimes) | HF-----post-MI-----high-risk CVD-----diabetes----chronic renal disease----recurrent stroke prevention |
how do we tx normal or pre-HTN | no drug indications - encourage lifestyle modification |
what lifestyle modification results in a 5-20 mm Hg/10kg bp decrease | weight reduction, the most important lifestyle modification |
what lifestyle modification results in an 8-14 mmHg bp decrease | DASH eating plan, the second most impactful lifestyle modification |
what is the third most impactful lifestyle modification to reduce HTN | aerobic exercise lowers bp 4-9 mmHg |
what TWO lifestyle modifications reduce bp 2-4 mmHG | reduce dietary Na----moderate ETOH consumption |
Stage 1 HTN - first line drug class | thiazides are first line ---stage 1 HTN |
name 4 thiazide diuretics | chlorothiazide---hydrochlorothiazide---chlorothalidone----metolozone |
Stage 1 HTN - other drug classes that may be considered after thiazides | may consider ACEIs----ARBs----BB---CCB---or combination thereof |
Names of ACEIs that may be considered for Stage 1 tx | The 'prils, who have ADR of cough/angioedema---benzapril, catopril, lisonopril and anything else ending in pril |
Name the ARBs that may be considered for stage 1 tx | the sartan family with less cough ADR---losartan, valsartan, olmesartant---any anything ending in sartan |
can we use renin-blocker aliskiren as a consideration for Stage 1 HTN tx | yes, we may consider it as it works upstream of ACEIs and ARBs |
Stage 1 HTN consider selective B-1 blockers (3) | atenolol---metoprolol---nebivolol----'amen' |
Stage 1 HTN consider non-selective B-1 B-2 blocker (1) | propanolol |
stage 1 HTN consider non-selective B-1 B-2 with smypathomimetic activity | pindolol |
stage 1 HTN consider combined A-1, B-1,B-2 blockers | carvedilol----labetalol |
What alpha-1 blockers can be used (3) | doxazosin---prazosin---tarazosin |
What centrally-acting Alpha-2 blockers can be used (4) | clonidine---methyldopa---guanfacine---guanabenz |
Stage 2 HTN class of drugs, usually given in combination (but not within class) | thiazide diuretic---ACEI---ARB---BB---CCB |
name 4 K-sparing antidiuretics that can be used | Aldosterone blockers = spironolactone, eplerenone------Na/K pump blockers= triamterene, amiloride |
what CCBs can be used | verapamil, diltiazem-----and the DHP dihydropyridine family----amlodipine, felodipine, nicardipine and anything else ending in 'dipine |
combining rules---if first drug used WAS a diuretic that gave inadqueate response--- | keep it in regime, add a second drug (not in same class) |
if first drug WAS NOT a diuretic and gave an inadequate response | second drug ALMOST ALWAYS a diuretic----take note of potentiating effect on other drugs |
when adding drugs from a DIFFERENT class, you cannot combine these classes | do not combine ACEIs/ARBs - same MOA-----do not combine BBs/CCBs - coupled MOA yields same result |
can we combine 2 diuretics? | yes, provided one is loop/thiazide and the other is K sparing |
patient is already on lisinopril. what drug should be given next | a thiazide diuretic. go ahead, name them -----chlorothiazide, hydrochlorothiazide, chlorothalidone, metolazone |
what centrally acting Alpha-2 blockers (4) could be used to tx HTN | clinidine, methyldopa, guanabenz, guanfacine |
what renin inhibitor could be used to tx HTN | aliskiren |
what drug would we add to hydrochlorothiazide and atenolol | check the answers to make sure you are not combining within class---nor are you combining BBs/CCBs or ACEIs/ARBS |
just for the fun of it, what are two combinations that MUST be avoided | avoid BBs/CCBs-----avoid ACEIs/ARBs |
what is 1 DHP that you must watch for to make sure he doesn't slip it in because it CANNOT be used for HTN | nimopidine CANNOT be used for HTN tx ---ONLY indicated for subarachnoid hemorr stroke |