Hypertension PNN
Thiazides: SE - ✔️✔️INCREASE CA2+ (opposite of loops)
INCREASE glucose, but monitor K+ for glucose intolerance
INCREASE lipid
INCREASE uric acid
sexual dysfunction
rash, photosensitivity (sulfa)
DOC for ESRD or patients > 75 y/o with CKD - ✔️✔️CCB
thiazides
Methods in reducing BP - ✔️✔️1. decrease volume of fluid in vessels
2. dilate vessels
Calcium disturbances due to diuretics - ✔️✔️Thiazides: increase
Loops: decrease
Drugs that increase BP - ✔️✔️- estrogens
- corticosteroids,
- NSAIDs/COX inhibitors
- Adrenergics (B agonists)
- SNRIs - increase NorEpi: venlafaxine, desvenlafaxine, duloxetine, milnacipran
- Migraine megs - triptans, ergots
- ADHD amphetamines
- OTC/herbs - ephedra, ma huang, licorice, bitter orange, decongestants
- others - epogen, tacrolimus, cyclosporine
DASH diet - ✔️✔️rich in fruits and vegs, K+ and Mg+, Ca2+, protein, fiber, low in
saturated fat
Hypertension + CAD: first line - ✔️✔️BB with ACEi/ARB
Hypertension + CHF: first line - ✔️✔️Low dose BB
ACEi/ARB
Entresto
Aldosterone antagonist
Loops (no effects on morbidity and mortality, but helps with s/sx)
CrCl <30: which diuretics to use - ✔️✔️Loops
Thiazide-like: Metolazone
AHA/ACC BP definitions - ✔️✔️Normal: <120/80 - annual BP checks
,Elevated: SBP 120-129 but DBP is still <80 - lifestyle changes
HTN Stage I: SBP 130-139 or DBP 80-89 - check 10-year CVD risk --> if <10% lifestyle
change and reassess in 3-6 months, if >10% lifestyle change and medication with
monthly follow-ups until normal BP
HTN Stage II: SBP >/= 140 or DBP >/= 90 - lifestyle change and 2 meds with monthly
follow-ups until normal BP
AHA/ACC Goals - ✔️✔️<130/<80 for all
First line antihypertensives - ✔️✔️CCB
thiazides
ACEi/ARBs, especially in presence of albumineria to preserve kidney function
Antihypertensive options for African-Americans - ✔️✔️CCB
Thiazides
If CKD, then ACEi/ARBs
Antihypertensive options for pregnant patients - ✔️✔️methyldopa
nifedipine
labetalol
No ACEi/ARBS/aliskiren
JNC goals - ✔️✔️age >/= 60: <150/90
<60, diabetic, >/= 18YO with CKD: <140/90
Arterial dilators: drugs - ✔️✔️CCB
adrenergic blockers: BB, alpha 1 blockers, alpha 2 agonists, peripheral adrenergic
antagonists
Meds that reduce volume and vasodilate - ✔️✔️RAAS antagonists: ACEi, ARB, DRI
When to recommend BB - ✔️✔️1. angina
2. systolic heart failure
3. post MI
4. CAD
5. Afib
Reason why BB are not recommeneded as first-line for HTN without other comorbidities
- ✔️✔️BB don't work as well to prevent stroke and cardiac events in patients without
heart disease
Drugs that have sulfa - ✔️✔️Bactrim
Thiazides
Loops (except ethacrynic acid)
, Carbonic anhydrase
Thiazide: drug interactions - ✔️✔️Risk of lithium toxicity
Risk of digoxin toxicity
Risk of allopurinol hypersensitivity
Lithium considerations - ✔️✔️- Sensitive to Na+ - goes in opposite direction of Na+
- Lithium is excreted through renal system - compete with NSAID at the same site
Hydrochlorothiazide: brand - ✔️✔️Microzide
Metolazone: brand - ✔️✔️Zaroxolyn
Indapamide: brand - ✔️✔️Lozol
Chlorthalidone advantage over hydrochlorothiazide - ✔️✔️Longer acting and more
potent than hydrochlorothiazide
Loops: indications - ✔️✔️- edema
- HTN (mostly in renal patients)
- hypercalcemia
Loops: drugs - ✔️✔️bumetanide
ethacrynic acid
furosemide
torsemide
Torsemide: brand - ✔️✔️Demadex
Which loop causes the most ototoxicity? - ✔️✔️Ethacrynic acid
Bumex : lasix conversion - ✔️✔️1 mg : 40 mg
Torsemide: max dose - ✔️✔️100 mg/day
Potassium-sparing diuretics: drugs - ✔️✔️amiloride
triamterene
spironolactone
eplerenone
Amiloride: brand - ✔️✔️Midamor
Triamterene: brand - ✔️✔️Dyrenium
Thiazides: SE - ✔️✔️INCREASE CA2+ (opposite of loops)
INCREASE glucose, but monitor K+ for glucose intolerance
INCREASE lipid
INCREASE uric acid
sexual dysfunction
rash, photosensitivity (sulfa)
DOC for ESRD or patients > 75 y/o with CKD - ✔️✔️CCB
thiazides
Methods in reducing BP - ✔️✔️1. decrease volume of fluid in vessels
2. dilate vessels
Calcium disturbances due to diuretics - ✔️✔️Thiazides: increase
Loops: decrease
Drugs that increase BP - ✔️✔️- estrogens
- corticosteroids,
- NSAIDs/COX inhibitors
- Adrenergics (B agonists)
- SNRIs - increase NorEpi: venlafaxine, desvenlafaxine, duloxetine, milnacipran
- Migraine megs - triptans, ergots
- ADHD amphetamines
- OTC/herbs - ephedra, ma huang, licorice, bitter orange, decongestants
- others - epogen, tacrolimus, cyclosporine
DASH diet - ✔️✔️rich in fruits and vegs, K+ and Mg+, Ca2+, protein, fiber, low in
saturated fat
Hypertension + CAD: first line - ✔️✔️BB with ACEi/ARB
Hypertension + CHF: first line - ✔️✔️Low dose BB
ACEi/ARB
Entresto
Aldosterone antagonist
Loops (no effects on morbidity and mortality, but helps with s/sx)
CrCl <30: which diuretics to use - ✔️✔️Loops
Thiazide-like: Metolazone
AHA/ACC BP definitions - ✔️✔️Normal: <120/80 - annual BP checks
,Elevated: SBP 120-129 but DBP is still <80 - lifestyle changes
HTN Stage I: SBP 130-139 or DBP 80-89 - check 10-year CVD risk --> if <10% lifestyle
change and reassess in 3-6 months, if >10% lifestyle change and medication with
monthly follow-ups until normal BP
HTN Stage II: SBP >/= 140 or DBP >/= 90 - lifestyle change and 2 meds with monthly
follow-ups until normal BP
AHA/ACC Goals - ✔️✔️<130/<80 for all
First line antihypertensives - ✔️✔️CCB
thiazides
ACEi/ARBs, especially in presence of albumineria to preserve kidney function
Antihypertensive options for African-Americans - ✔️✔️CCB
Thiazides
If CKD, then ACEi/ARBs
Antihypertensive options for pregnant patients - ✔️✔️methyldopa
nifedipine
labetalol
No ACEi/ARBS/aliskiren
JNC goals - ✔️✔️age >/= 60: <150/90
<60, diabetic, >/= 18YO with CKD: <140/90
Arterial dilators: drugs - ✔️✔️CCB
adrenergic blockers: BB, alpha 1 blockers, alpha 2 agonists, peripheral adrenergic
antagonists
Meds that reduce volume and vasodilate - ✔️✔️RAAS antagonists: ACEi, ARB, DRI
When to recommend BB - ✔️✔️1. angina
2. systolic heart failure
3. post MI
4. CAD
5. Afib
Reason why BB are not recommeneded as first-line for HTN without other comorbidities
- ✔️✔️BB don't work as well to prevent stroke and cardiac events in patients without
heart disease
Drugs that have sulfa - ✔️✔️Bactrim
Thiazides
Loops (except ethacrynic acid)
, Carbonic anhydrase
Thiazide: drug interactions - ✔️✔️Risk of lithium toxicity
Risk of digoxin toxicity
Risk of allopurinol hypersensitivity
Lithium considerations - ✔️✔️- Sensitive to Na+ - goes in opposite direction of Na+
- Lithium is excreted through renal system - compete with NSAID at the same site
Hydrochlorothiazide: brand - ✔️✔️Microzide
Metolazone: brand - ✔️✔️Zaroxolyn
Indapamide: brand - ✔️✔️Lozol
Chlorthalidone advantage over hydrochlorothiazide - ✔️✔️Longer acting and more
potent than hydrochlorothiazide
Loops: indications - ✔️✔️- edema
- HTN (mostly in renal patients)
- hypercalcemia
Loops: drugs - ✔️✔️bumetanide
ethacrynic acid
furosemide
torsemide
Torsemide: brand - ✔️✔️Demadex
Which loop causes the most ototoxicity? - ✔️✔️Ethacrynic acid
Bumex : lasix conversion - ✔️✔️1 mg : 40 mg
Torsemide: max dose - ✔️✔️100 mg/day
Potassium-sparing diuretics: drugs - ✔️✔️amiloride
triamterene
spironolactone
eplerenone
Amiloride: brand - ✔️✔️Midamor
Triamterene: brand - ✔️✔️Dyrenium
