Esmolol
250-500mcg/kg
Onest: 1min
DOA: 20min
Labetalol 20mg
Onset: 5min
DOA: 6hrs
Early DCT Diuretics
Thiazides
Chlorothiazide
Hydrochorothiazide
Chlorthalidone
Metolazone
Thiazides produce ? natriuresis and diuresis by blocking the
? symporter
Thiazides produce MODEST natriuresis and diuresis by blocking the
Na+/Cl- symporter
Loop Diuretics
Furosemide
Bumetanide
Ethacrynic acid
Torsemide
Loop Diuretics produce ? natriuresis and diuresis by blocking the ?symporter on the apical membrane of the ascending limb of the loop of Henle;
produce MARKED natriuresis and diuresis by blocking the Na+/K+/2Cl-
promote PGE2 mediated venodilation and renal tubular sodium excretion
Late DCT-CD Diuretics
K+-sparing diuretics
ENaC Inhibitors( Triamterene
Amiloride)
and
Aldosterone Antagonists
Sympatholytics
BETA BLOCKER-BLOCK JG RENIN CELLS
ALPHA 2 AGOINIST
Vasodilators- CO
non-HDP(VERAPAMIL, DILTIZEM
CCBs (NIEFIPINE)
Vasodilators- TPR
ALPHA1-Blockers
Neuronal blockers
CCBs
VSM vasodilators
Agents that affect Adrenergic Function (Sympatholytics)
Non-selective BETA 1/2 antagonist
Propranolol
Selective BETA 1-antagonist
Atenolol
Metoprolol
Non-selective BETA 1/2 and
? antagonist
Carvedilol
(HF ok!)
Neuronal Blockers?
**AE: ?
Reserpine
Guanethedine
AE: Sever depressive disorder
CNS Alpha-2 agonists
Clonidine
Selective ALPHA-1 adrenoceptor
antagonists
Prazosin
Terazosin
Block cardiac 1 receptors decreases HR, CF and cardiac output
Block renal 1 receptors **decreases ???
plasma renin, ANG II and TPR (afterload)
Use -blocker if MI; Benefits: Antiarrythmic, Anti-ischemic
Antiatherogenic, Reverses cardiac remodeling
**CAUTION: Not routinely used for treatment of hypertension in elderly due to marked CNS effects (sedation, confusion) and orthostatic hypertension
CNS ALPHA-2 AGONIST
Decrease in sympathetic outflow decreases HR, TPR and MAP while producing diuresis and natriuresis
Selective ALPHA-1 adrenoceptor antagonists
**ADVERSE EFFECT:
reflex tachycardia, orthostatic hypotension
Calcium Channel Blockers (CCBs)
Nifedipine (a Dihydropyridine)
Amlodipine (a Dihydropyridine)
Diltiazem
Verapamil
CCB **ADVERSE EFFECTS:
reflex tachycardia;
ankle edema due to selective arterial vasodilation,
constipation,
headache
CCB**DRUG INTERACTIONS: may precipitate
AV block with other
drugs that decrease AV node conduction (e.g., -blockers)
CCBs ?affect plasma renin activity, GFR, salt and water excretion or body fluid composition
DO NOT
Direct Acting Vasodilator Agents
Hydralazine
Minoxidil (ROGAINE)
Sodium Nitroprusside (i.v. formulation only)
Direct Acting Vasodilator Agents
**Adverse Effects:
Reflex tachycardia
Monoxidil - hirsutism (hair growth), ankle edema
Sodium Nitroprusside - cyanide toxicity with increased dose/duration of use.
Angiotensin Converting
Enzyme inhibitors (ACEIs)
PRILS
captopril (Capoten)
enalapril (Vasotec)
lisinopril (Zestril)
ramipril (Altace)
Angiotensin AT1 Receptor Blockers (ARBs)
SARTANS
losartan (Cozaar) irbesartan (Avapro)
valsartan(Diovan) candesartan (Atacand)
azilsartan (Edarbi)
**Adverse effects: ACE inhibitor-induced
coughing and angioedema do to elevated plasma bradykinin levels
THE RELEASE OF RENIN FROM CELLS JG APPARATUS IS TRIGGERED BY WHICH OF THE FOLLOWING
INCREASED SNS OUTFLOW TO KIDNEYS
DURING THE WORKUP PT HTN HYPOKALEMIA DX OF RENIN SECRETING TUMOR
LAB RESULTS
HIGH ALDOSTERONE
HIGH RENIN (ANGIOTENSIN 2 X ACEI )
LAB RESULTS WITH PRIMARY ALDOSTERONISM (CONN SYNDROME)
HIGH ALDOSTERONE
LOW RENIN-
HTN
PRA RATION: A/R -
HIGH # 23 ABOVE
PRIMARY AND SECONDARY HAVE HIGH
HIGH ALDOSTERONE
SECONDARY-HIGH RENIN-
HTN HYOPKALEMIA WITH PRIMARY ALDOSTERONISM
MEDICATIONS?
SPRIONALACTONE
24hr urine collection on 3 people.
10gm sodium diet for the week prior
what is expected?
high urine sodium
low urinary aldosterone
BMP/ANP increase
152/92 46yo AA
first line medication
Chlorthalidone
hydrazine/minoxidil
DM
HTN
HTN
ACE-I
ARB
(NEVER WITH RENIN INHIBITOR)
HTN
HF
CAVEDILOL
46YO Male ON THIAZIDE
HTN
low K
labs?
high urinary sodium
high urinary aldosterone-
+ ENaC inhibitor
30yo female HA diaphoretic 'panic attacks'
212/114
128/78
fractionated metanephrines level
pheochromocytoma
Alpha Antagonist first line-
then beta blocker
phenoxebenzamine long term
In addition, an antihypertensive agent such as ? ? ? ? may be preemptively administered.
esmolol,
labetalol,
metoprolol or
clonidine
Metoclopramide
Also has prokinetic properties for esophagial clearance and gastric emptying
Not effective alone in preventing PONV - often given with dexamethasone IV
Droperidol
FDA BLACK BOX WARNING for prolonged QT syndrome
Requires ECG monitoring for 2
Dopamine D2 Receptor Antagonists
Dopamine D2 Receptor Antagonists
SEs
These drugs are neuroleptics (typical antipsychotics)
Extrapyramidal effects - Tardive dyskinesia (long term treatment)
Sedation
Hypotension
5-HT3 Receptor Antagonists
Ondensetron
Granisetron
Palonosetron
Dolasetron*
Cannabinoid
Dronabinol
Indirect 5-HT3
Muscarinic M1 Receptor Antagonist
Scopolomine
Vestibular
Muscarinic M1 Receptor Antagonist
Contraindications
Kidney or liver disease
Enlarged prostate
Difficulty in urination / bladder problems
Heart Disease
Glaucoma
Neurokinin NK1 Receptor Antagonist
"Substance P antagonist" or SPA
Aprepitant
24hr duration
Aprepitant
Patients should be monitored for:
Headache; elevated liver enzymes; hypotension
Glucocorticoids
Dexamethasone
SEs:
Acute = flushing, general itching, hyperglycemia
Long term = adrenal suppression, fluid retention
Histamine H1 Receptor Antagonist
Diphenhydramine
Diphenhydranate
vestibular