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Antihypertensives Cheat Sheet by

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
**once daily medication
 

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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