Diamox

CA inhibitor

Osmitrol

Osmotic Diuretic

Lasix

20-80 mg/day BID

Loop Diuretic

Torsemide

Bumetanide

Demadex

Bumex

12.5-25 mg/day QD

THZ diuretic

Lozol 

1.25-2.5 mg/day

THZ diuretic

Chlorthalidone

Metolazone

Metolazone = Zaroxyln

THZ diuretic

1 -Spironolactone

2- Eplerenone

 1- Aldactone

25-50 mg/day

2- Inspra

Aldosterone Antagonist

(K+ Sparing)

 1st - ACE w/ diuretic (loop usually)

2nd-  Beta blocker

can add:

 - ARB

OR

- Aldosterone Antagonst

1- Amiloride

2- Triamterine

1 - Midamor

2- Dyrenium

50-100 mg/day

Na+ Channel Inhibitor

(K+ Sparing)

 HYPOkalemia   (K)

HYPOmagnesemia (Mg)

 HYPERcalcemia (Ca)

HYPERglycemia 

HYPERlipidemia

HYPERuricemia --> gout

Orthostatic Hypotension

Less common:

Sexual dysfxn

gynomastia (ald. antagonists)

hypersensitivity

photosensitivity

nephtotoxicity

rash/sulfonamide cross-allergy (THZ, Loop)

CrCl < 30 = loop

CrCl >30 = THZ

CrCl > 50 = K+ Sparing

1 - K+ Sparing + KCl supplements

2- ACE and ARB 

3 - Digoxin

4- Lithium

5- Bile Acid Resins

Hydralazine 

Side Effects

1 ) flushing, dizziness, nausea, h/a

2) EDEMA and Na RETENTION (use diuretic)

3) TACHYCARDIA (use BB)

4) ANGINA

5) LUPUS

Minoxidil 

MOA

activates K+ channels

leads to outflow of K+ 

leads to less Ca+ in cell (less contraction)

Minoxidil

Side Effects

1) Dizziness, nausea, H/a, 

2) tachycardia

3) edema and Na+ retention

4) angina

5) Hirutism (topical helps with hair baldness)

Sodium Nitroprusside

MOA

IV Only

degrades into nitric oxide that goes directly to smooth muscle cells

nitric oxide converts GTP --> cGMP 

cGMP relaxes smooth muscle

Sodium Nitroprusside

Side Effects

DOES NOT CAUSE ANGINA

1) excessive vasodilation/hypotension

2) cyanide intoxication

(if have liver dysfxn)

Non DHP CCB

MOA and Side Effects

(Verapamil, Diltazem)

blocks type L Ca+ channels

1) decreases HR  (bradycardia)

2) constipation = verapamil

3) nausea, GERD, H/a, dizziness, flushing (less than DHP)

Calan SR

Isoptin SR

Verlan

Covera HS (ER)

80-480 mg/day 

NON DHP CCB

Cardizem SR/CD/LA (ER)

Dilacor XR

Tiazac

Cartia XR

180-360 mg/day

NON DHP CCB

more potent than Non-DHP

REFLEX TACHYCARDIA

edema

less likely to cause GI upset, nausea, GERD, Etc

do not use IR

Adelat CC

ProcardiaXL

30-90 mg/day

DHP CCB

Norvasc

2.5-10 mg/day

DHP CCB

CCB 

Warnings

BETA BLOCKER

w/ non-dhp (add on to negative inotropic effects)

preexisting cardiac conduction problems

DHP w/ migrane 

GI obstrutction

norvasc - liver

diltazem - kidney

verapamil and nifefipine - kidney and liver

CCB 

Drug interactions

3A4 = verapmil, diltiazem, nifedepine 

erythromycin

digoxin

grapefruit juice

ginseng/ginkgo

1)  DECREASE GFR

2) INCREASE Na+ reabsorption in proximal and loop

(Direct)

3) INCREASE Na+ reabsorption in late distal/collecting

(Indirect)

Zestril

Prinvil

5-40 mg/day

Vasotec

2.5-20 mg/day

(half of lisinopril)

Fosinopril

Monopril

10-40 mg QD

Quinapril

Accupril

5-80 mg QD

Altace

1.25-20 mg day

(1/4 of quinapril)

Zestoric

Prinzide

REDUCES degradation of bradykinin

(increase in bradykinin = vasodilation)

ACEi 

Side effects

1) Dry Cough

2) Hypotension/dizziness

3) HYPERkalemia (K+)

4) Fetal defects

5) Elevated ScR

(d/c if >35%)

LESS COMMON:

6) nephrotoxicity

7) Rash (captopril > enalapril)

8) Angiodema (increased vascular perm>

9) neutropenia

10) hepatoxicity

ACEi

Warnings

risk - hyperkalemia

avoid - dehydration, hypotension

avoid - angiodema

d/c - ScR > 35%

elderly on diuretic, renal dz, CHF- start low dose

DO NOT GIVE IF PREGNANT

ACEi

Drug interactions

1) lithium

2) K+ Sparing Diuretics (hyperkalemia)

3) NSAIDs

4)Loop/THZ diuretics

Cozaar

25-100 mg QD or BID

Diovan

80-320 mg QD

Avapro

150-300 mg QD

Atacand

8-32 mg QD or BID

ARBs

MOA

1)  do NOT effect bradykinin (no cough)

2) inhibit actions of ATII derived from ACE AND other pathways

3) inhibit actions of ATII on AT1 receptors only

(ACE inhibitors may also inhibit some actions of ATII on AT2 receptors)

ARB

Side Effect

NO COUGH

1) hypotension/dizziness

2) hyperkalemia

3) Fetal Defects

4) headache

5) Fatigue

Rare:

- neutropenia

-nephrotoxicity

-Angiodema

ARB

Warnings

-Angiodema

-DO NOT USE IF PREGNANT

hypotension/dehydrated

hepatic/renal failure

hyperkalemic

severe heart failure

renal artery stenosis

ARB 

Drug Interactions

K+ Sparing

KCl supplements

2C9/3A4 = losartan

Micardis w/ Digoxin

NSAIDS

Alpha 1 Antagonists

MOA

competes with Norepinephrine to bind to alpha-1 receptor

decrease peripheral resistance

increase vasodilation (arteries/veins)

alpha-1 antagonist

side effect

1) orthostatic hypotension

**most likely will faint when given 1st dose so advise to give at bedtime**

2) CNS Sedation

3) Edema

* combo with BB and diuretic will help

4) Sexual dysfxn and priapism

Can be used to help BPH

does NOT cause tachycardia

Toprol XL

Lopressor

50-200 mg QD  (BID for lopressor)

Tenormin

25-100 mg QD

Bystolic 

new drug

NON SELECTIVE b1/b2

Inderal

160-480 mg BID

NON SELECTIVE b1/b2

Corgard

40-240 mg QD

alpha-1/ beta

Normodyne

Trandate

200-800 mg BID

alpha-1/ beta

12.5-50 mg BID

ISA (partial agonist)

Visken

less likely to cause bradycardia

heart

kidney

lungs

liver

pancreas (think about insulin/glucose)

arteriole smooth muscle

BB

Side Effect

1) Dizziness/Orthostasis

2) Bronchospasm

**avoid in asthma/COPD patients**

3) Bradycardia ( HR <60)

4) Dyslipidemia

**although - Can DECREASE dyslipidema with B-1 selective or ISA**

**can avoid changes with alpha/beta **

5) Hyperglycemia

less common:

- sexual dysfx

-fatigue

-cold extremities

-weight gain

- AV conduction abnormalities

-Heart Failure 

(esp high doses with LVD patient)

BB

Warnings

TAPER OVER 14 DAY PERIOD

do not abruptly d/c (upregulation)

Asthma/COPD

cardiac conduction abnormalities

PAD

Dyslipidemia 

non-selective > selective

Kidney Imparment

(atenolol, nadolol)

1st pass metabolism (Liver) with propranolol and metoprolol

uncontrolled DM

Guanethidine

MOA and Side effects

half life = 5 days

blocks release of Norepinephrine 

DOES NOT CROSS BBB

Side effects: due to blockade of PERIPHERAL synapses

1) Postural hypotension

2) Diarrhea

3) Delayed ejaculation

Reserpine

MOA and Side Effects

half life = 1-2 day

 blocks norepinephrine storage in secretory vessels

CROSSES THE BBB

Side effects: due to blockade of CENTRAL synapses

1) Sedation

2) Depression

3) parkinsons like symptoms

decrases sympathetic/increases parasympathetic so....

nasal stuffiness

bradycardia

increases gastric acid secretion

diarrhea

alpha-2 agonists

MOA and Side effects

Clonidine  (need to taper down if d/c)

Methyldopa (pregnancy 1st line tx)

Guanfacine

ACTIVATES ALPHA-2 RECEPTOR IN BRAIN TO DECREASE NOREPINEPHRINE EXCRETION

Side effects:

1) Anticholinergic : dry mouth, GI disturbances, sedation, fatigue, dizziness

2) depression

rare hepatic dysfxn, lupus (m-dopa)

Tekturna (new)

MOA: selectivly binds to renin to block angiotensinogen --> AT I

side effects:

1) cough

2) edema

3) hyperkalemia

> 180/120

WITHOUT target organ injury

goal: reduce to stage 1 

over period of hours -days

reevaluate w/i 7 days (usually 1-3)

do not be overly aggressive

 > 180/120

WITH acute/progressing target organ injury

- encephalopathy

-intracranial hemmorage

-acute LVD w/ pulmonary edema

-dissecting aortic anuerism

-unstable angina

-eclampsia / HTN during pregnancy

Goal: mean arterial pressure drop of 25%

sodium nitroprusside is likely used here

Loop

MOA

inhibits Na/K/2Cl symporter on lumen side

(ascending loop of henle)

lack of K+ decreases potential so Mg and Ca stay there and do not get reabsorbed into blood

*leads to lack of Ca and Mg in blood*

cannot make concentrated urine

THZ

MOA/Side effect

inhibit Na/Cl symport on lumen side

(early distal tubule)

decreases Na+ in cell with increase Ca/Na antiporter 

* leads to increased Ca in blood * 

(this can help kidney stones)

hypokalemic alkalosis =b/c of increase of excreted K+ and H+ 

Uric acid retention --> leads to Gout

37.5/25   = maxzide 25

75/50 = dyazide  or maxzide

K+ Sparing

MOA/Side effecgt

blocks aldosterone

or blocks Na+ Channels

hyperkalemia

acidosis

gynomastia

impotence

menstrual irregularites

1st - Beta blocker    

(non dhp ccb if can't use)

2nd- ACE/ARB

can add on

- Aldosterone antagonist

1st - ACE/ARB

can add on

- diuretic

-BB, CCB

1st- ACE/ARB

can add on

- diuretic

-BB, CCB

CrCl <30 = loop

CrCl > 30 = THZ

CrCl > 50 = K+ Sparing

1st - ACE w/ diuretic (usually THZ)

OR

ARB

1st - BB

 (non DHP CCB if can't use)

2nd - ACE/ARB

can add on

-CCB, diuretic (THZ)