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4 Cards in this Set
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Initial Drug Therapy
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Thiazide like drugs
Hydrochlorothiazide is most common, or Indapamide Titrate for 1-2 months because drugs take time to start working, remember to check for sulfa allergies |
only 1 drug if stage 1 hypertension |
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Drug Combination Therpay
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Thiazide +
ACEi-bradykinin effect, change if dry cough stop if angioedema ARB-See above Beta Blockers-if HR already 50-60 don't want to use cause of bradycardia effects Calcium Channel Blockers-Verapamil is cardiospecific so good for patients with arrhythmias, "dipines" target vessels |
If stage 1 start with thiazide, then add others if no improvement If stage 2 start with 2 drugs |
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Additional Drugs
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Thiazide +
first ACEi, ARB Use beta blocker first if there is co-morbidity Calcium channel blockers are 2nd, 3rd line Menoxodil, clonidine-after all other drugs have been tried |
If stage 1 start with thiazide, then add others if no improvement If stage 2 start with 2 drugs |
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Special Cases
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Ischemic Heart Disease-start with beta blocker, verapamil or ditiazem. If MI or post MI use beta blocker and ACEi
Heart Failure-ACEi and Beta Blocker (LV dysfunction requires ACEi (prevent angiotensin II), BB (stop renin and neurohormonoal), spironolactome (aldosterone antagonist) and loop) Diabetic Hypertension-Two or more, Thiazide, BB, ACEi, CCB Kidney Disease with low GFR and HTN-ACEi or ARB+loop, use ACEi only if chornic, if acute ACEi will make it WORSE Stroke-ACEi (best data) and thaizide |
