Final study guide
Cardiovascular management:
1. Know Initial treatment choices for HTN
AceI- sartans
Arbs- ipine, verapamil & diltazem
Thiazide- iaside, chlorthalidone, imdapamide, metolazone
calcium channel blocker
2. Know first line treatment options for HTN for African Americans without renal impairment.
Calcium channel blockers
Thiazide
3. First line option for HTN for anyone with chronic kidney disease
Ace inhibitors
ARB’s
Diuretics:
4. Types, Uses, Side effects
Thiazides (HCTZ)
Uses- HTN, CHF, edema, useful in decreases calcium stone formation
Off label HCTZ- osteoporosis and diabetes
AE- hypokalemia, hyperglycemia, arrhythmias, metabolic alkalosis, fatigue, postural Hypotension
Loop diuretics (furosemide, torsemide, ethacrynic acid) *preferred diuretics for renal
Impairment
Uses- CFH, HTN, nephrotic syndrome, cirrhosis, pulmonary edema
AE-hypocalcemia, hyponatremia, hypokalemia, ototoxicity
Carbonic anhydrase inhibitors (acetazolamide) *weak diuretic
Uses- edema, epilepsy, glaucoma, mountain sickeness
AE- toxic epidermal necrolysis, agranulocytosis, aplastic anemia, thrombocytopenia, metabolic acidosis
Potassium-sparing (spironolactone, eplerenone)
Uses- CHF (in combo with thiazides or ACE and loop), HTN
AE-gynomastia, n/v, erectile dysfuction, electrolyte imbalance, metabolic acidosis
5.
6.
7.
**postdiuretic sodium retention- It is important for pts to adhere to a low sodium diet. As drug
concentrations fall, there is a period of positive sodium balance
** If a pt has a sulfa allergy= take ethacrynic acid
Preferred diuretic with renal impairment-
Loop diuretics because they retain efficacy even with moderate renal insufficiency: such as furosemide,
buetanide, torsemide, ethacrynic acid.
Uses: Edematous states (HF, cirrhosis, pulmonary edema, nephrotic syndrome), hypercalcemia
Side effect of post diuretic sodium retention pg 374
As drug concentrations decrease, period of + Na balance, this is the post diuretic sodium retention
If there is a high Na intake then Na lost with diuresis is offset.. diuretic resistance
Recognition that some diuretics are sulfa derivatives (carbonic anhydrase inhibitors, loop diuretics,
thiazides, but NOT ethacrynic acid)
Loops- Examples: furosemide, bumetanide, torsemide, ethacrynic acid
"The Loop FURiously BUMmed my TORSo like ACID"
Common side effects: orthostatic hypotension, excessive diuresis, tinnitus, vertigo, hyperuricemia note all
these are precursors to toxicity
Thiazides Hydrochlorothiazide, Chlorothoazide, , Chlorthalidone, Indapamide, Metolazone
1st line for HTN, Chronic Calcium Kidney Stones, HF, Idiopathic hypercalciuria, Nephrogenic diabetes
insipidus, Osteoporosis. Other common side effects: orthostatic hypotension, dizzy, drowsy, syncope,
weakness, nausea, GI irritation, elevated BUN, depressed respirations lethargy
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