| Diuretics (-zide, -mide)
                        
                                                                                    
                                                                                            | Thiazide diuretics | LOOP diuretics | K+ Sparing |  
                                                                                            |  MOA | i.e. Lasix (furosemide) | i.e. spironolactone, triamterene |  
                                                                                            | Inhibits reabsorption of Na, K, Cl resulting is osmotic water loss |  MOA |  MOA |  
                                                                                            | Relaxes arterioles (decrease afterload) | Loss of fluid by inhibition of Na and Cl reabsorption | Blocks reabsorption of Na and water, potassium retained |  
                                                                                            |  Indication | Reduced BP |  Indications |  
                                                                                            | HTN (first line) | Reduced SVR (afterload), reduced CVP (preload), reduced LVEDP | HF |  
                                                                                            | Edematous state d/t HF, liver cirrhosis |  Indications |  Contraindications |  
                                                                                            |  Contraindications | Edema (rt sided HF) | Allergy, kyperkalemia, kidney failure, anuria |  
                                                                                            | Drug allergy, hepatic coma, anuria, kidney failure | Fluid accumulation d/t liver/kidney disease |  Adverse Effects |  
                                                                                            |  Adverse Effects | HTN | Spironolactone- gynecomastia, amenorrhea, irregular menses, etc. |  
                                                                                            | Electrolyte disturbances (decrease K, elevated Ca, lipids, glucose, uric acid) | Pulmonary edema (lt sided HF) | Triamterene- kidney stone d/t reduced folic acid |  
                                                                                            | Dizziness | Crackles/low O2 sats |  
                                                                                            | GI disturbance |  Contraindications |  
                                                                                            | Thrombocytopenia | allergy, hepatic coma, severe electrolyte loss (Na & K), pregnancy/BF, gout |  
                                                                                            | Pancreatitis |  Adverse Effects |  
                                                                                            | Cholecystitis | Electrolye loss/dehydration |  
                                                                                            | Headache | Furosemide- ototoxicity/photosensitivity |  
                                                                                            | Impotence | Orthostatis hypotension |  
                                                                                            |  | Hyperglycemia, hyperuricemia |  *Thiazide diuretics work on distal tubule*Loop diuretics work on ascending loop of Henle
 *K sparing works on collecting duct
 |  | Beta Blockers (-olol)
                        
                                    
                        | i.e. atenolol, metoprolol, bisoprolol, timolol (eye drops), labetalol (IV) MOA
 - blocks SNS stimulation of Beta 1
 - Reduced renin and aldosterone release and fluid balance
 - Vasodilation of aterioles= Decreased PVR and BP
 - Decreased myocardial stimulation
 - Decreased HR
 - Decreased conduction through AV node
 - Prolonged SA node recovery
 - Decreases myocardial O2 demand and contractility
 *reduces the work of the heart
  Indications
 - HTN, angina, dysrhythmias
  Contraindications
 - Allergy
 - Uncompensated HF
 - Cardiogenic shock
 - Heart block
 - Bradycardia
 - Pregnancy
 - Severe pulmonary disease (B2)
 - Raynaud's disease
  Adverse Effects
 - Can worsen angina or cause MI if stopped quickly
 - Symptoms of HF (coughing, SOB, Edema, fatigue)
 - Can mask signs of hypoglycemia
 - CV: AV block, bradycardia, HF, PV insufficiency, hypotension
 - Resp: bronchospasm, bronchoconstriction
 - CNS: dizziness, depression, lethargy
 - GI: nausea, dry mouth, vomiting, constipation, diarrhea
 - Hema: thrombocytopenia
 |  ** Watch for diabetic pts** Monitor closely if given with calcium channel blocker
 ARBs (-sartan)
                        
                                    
                        | i.e. losartan, eprosartan, valsartan, irbesartan, telmisartan MOA
 - blocks binding of angiotensin II to receptors
 - Affects smooth muscle and adrenal gland
 - Blocks vasoconstriction and secretion of aldosterone
  Indications
 - HTN, HF (decrease preload/afterload), decreased mortality after MI
  Contraindications
 - allergy, pregnancy/BF, kidney dysfunction (caution), older adults
  Adverse Effects
 - URI, headache, hypotension, tachycardia, S/S of toxicity
  Interactions
 - Cimetidine, phenobarbital, rifampin, K+ supplements
 |  |  | Calcium Channel Blockers (-pine, -amil)
                        
                                    
                        | i.e. Amlodipine (dihydropyridines), Diltiazem (benzothiazepines), Verapamil (phenylakylamines) MOA
 - Blocks Ca access to cells causing:
 - decreased contractility
 - decreased conductivity of the heart
 - decreased demand for O2
 - dilation of coronary arteries (decreased afterload, increased oxygen supply)
 **decreases work of the heart
  Indications
 - Angina
 - HTN
 - SVT
 - Atrial fib/flutter
 - Migraines
 - Intracranial aneurysm rupture
  Contraindications
 - allergy, acute MI, 2 or 3* heart block, hypotension
  Adverse Effects
 - Hypotension
 - Palpitations
 - Tachycardia or bradycardia
 - HF
 - Constipation
 - Nausea
 - Dermatitis
 - Dyspnea
 - Rash/flushing
 - Peripheral edema
  Interactions
 - beta blocker, digoxin, h2 blockers, cyclosporin
 - grapefruit
 |  **avoid grapefruit**do not take diltiazem with cyclosporin
 ** check liver and renal fx
 ** Weight- check for peripheral edema
 Nitrates (nitroglycerin)
                        
                                    
                        |  MOA- dilation of blood vessels (relaxation of smooth muscle) esp coronary vessels
 - decreased afterload and preload
  Indications
 - Angina (stable, unstable, vasospastic)
  Contraindications
 - allergy, anemia, closed-angle glaucoma, hypotension, head injury
  Adverse Effects
 - headache, tachycardia, postural hypotension, reflex tachycardia, tolerance
  Interactions
 - alcohol, beta blockers, CCB, antipsychotics, erectile dysfunction medications
 |  **light sensitive**check expiration date
 **comes in many forms- sublingual, chewable, oral tabs, capsules, ointments, patches, translingual spray, IV
 **ensure pt is not on erectile dysfunction medication
 **always date and time nitro patches upon application
 ** administer while seated, take BP measure pain, then wait 5 mins and repeat up to 3x
 |  | ACE inhibitors (-pril)
                        
                                    
                        | i.e. ramipril, fosinopril sodium, lisinopril, enalapril, perindopril, captopril MOA
 - Suppresses formation of angiotensin II from the RAAS system
 - Reduces PVR
 - Increases CO
  Indications
 - HTN (decreased afterload, prevents formation of ACE II)
 - HF (prevents Na and water resorption, causes diuresis, decreases preload)
 - Protective effects on kidney (decreases GFR)
  Contraindications
 - History of angioedema, renal artery stenosis, K+ >5mmol/L
  Adverse Effects
 - Hyperkalemia
 - Fatigue, mood changes, dizziness, headache
 - Dry, non-productive cough**
 - Hypotension
 - Angioedema
 - Rash, thrombocytosis, loss of taste, proteinuria, pruritis, anemia, neutropenia
  Interactions
 - NSAIDS
 - Potassium sparing diuretics
 - Lithium and ACE inhibitors
 |  **Do not use during pregnancy/BF | 
            
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