- Decrease preload (fluid volume), SVR and force of cardiac contraction.
- Block cardiovascular response to catecholamines
- Block outflow of catecholamines
Drug class
|
Mechanism
|
Side effects & considerations
|
Thiazide diuretics: HCTZ (hydrodiuril)
|
Promotes H2O & Na+ excretion; reduces SVR. First-line tx.
|
↓K+, ↑ glucose & triglycerides
|
Angiotensin-converting enzyme (ACE)inhibitors
(“-pril” drugs)
|
Blocks formation of angiotensin II; prevents vasoconstriction & Na+/H2O retention
|
Dry persistent cough; angioedema; K+ retention; unsafe in pregnancy; first-dose hypotension
|
Beta-blockers
(“-lol” drugs)
|
Blocks β-1 receptors in heart & vascular smooth muscle
|
Contraindicated in COPD & asthma; hold for bradycardia. Fatigue; bradycardia; depression.
Rebound HTN if DC’d
|
Angiotensin receptor blockers (ARBs) (“-sartan”)
|
Blocks angiotensin II receptors; prevents vasoconstriction & fluid retention
|
Expensive. For people who do not tolerate ACE-I. Unsafe in pregnancy. ↑K+
|
Calcium channel blockers (“-ipine)
|
Blocks influx of calcium ions in cardiac & vascular cells
|
Reflex tachycardia; worsens heart failure; hypotension; heart block; constipation. Hold for bradycardia.
|
Alpha blockers
(“-zosin)
|
Blocks alpha adrenergic receptors on vascular smooth muscle
|
First-dose syncope; orthostatic hypotension & reflex tachycardia
|
Central sympatholytics: clonidine (Catapres)
|
Alpha-2 stimulant; inhibits outflow of catecholamines to heart & vessels; vasodilation, ↓CO
|
Rebound HTN with abrupt DC of med. Sedation possible. Unsafe in pregnancy. Available TD patch.
|
Vasodilators: hydralazine (Apresoline)
|
Acts on peripheral arterioles, causing vasodilation
|
Injectable available. Monitor HR, pulse. Orthostatic hypotension. Do not DC abruptly.
|
Which drugs are appropriate?
PreHypertension: lifestyle modifications
Stage 1: diuretic first, maybe add beta blocker or Ace inhibitor
Stage 2: more aggresive tx. more meds
Heart Failure: no calcium channel blockers; Beta blockers used cautiously
African American: Respond better to diuretics and calcium channel blockers
African American & elderly: More sensitive to effects of sodium in diet
1 comment
I started on COPD Herbal treatment from Ultimate Health Home, the treatment worked incredibly for my lungs condition. I used the herbal treatment for almost 4 months, it reversed my COPD. My severe shortness of breath, dry cough, chest tightness gradually disappeared. Reach Ultimate Health Home via their email at ultimatehealthhome@gmail.com . I can breath much better and It feels comfortable!
Post a Comment