Hypertension & Dyslipidemia Meds: Thiazides & ACE Inhibitors

• Medications, their use, pharmacodynamics, pharmacokinetics, and clinical details relevant to hypertension and dyslipidemia management

Thiazide and Thiazide-Like Diuretics

• Medications include: Hydrochlorothiazide (Microzide®), Chlorthalidone, Indapamide, Metolazone (Zaroxolyn®)
• Use: First-line treatment for hypertension
• Pharmacodynamics: Inhibits Na+/Cl- transporter in the distal convoluted tubule, reducing sodium reabsorption, which decreases blood volume and lowers BP
• Pharmacokinetics: Oral absorption; renally excreted
• Less effective in renal impairment
• Can be combined with loop diuretics for resistant hypertension
• Avoid nighttime dosing to prevent nocturia

ACE Inhibitors (ACE)

• Medications: Lisinopril (Prinivil®, Zestril®), Ramipril (Altace®), Enalapril (Vasotec®), Benazepril (Lotensin®), Captopril (Capoten®)
• Use: First-line for hypertension, heart failure, and CKD
• Pharmacodynamics: Inhibits angiotensin-converting enzyme (ACE) to prevent angiotensin II formation, leading to vasodilation and reduced aldosterone secretion
• Pharmacokinetics: Oral absorption, hepatic metabolism, renal excretion
• May cause hyperkalemia, dry cough, and angioedema
• Avoid in pregnancy and bilateral renal artery stenosis
• Monitor kidney function and electrolytes

Angiotensin Receptor Blockers (ARBs)

• Medications: Losartan (Cozaar®), Valsartan (Diovan®), Irbesartan (Avapro®), Telmisartan (Micardis®), Candesartan (Atacand®)
• Use: Alternative to ACE inhibitors for hypertension
• Pharmacodynamics: Blocks angiotensin II receptors, preventing vasoconstriction and lowering BP
• Pharmacokinetics: Hepatic metabolism, renal/fecal excretion
• Does not cause cough like ACE inhibitors
• Avoid in pregnancy
• Contraindicated with ACE inhibitors due to increased renal risks

Dihydropyridine Calcium Channel Blockers (CCBs)

• Medications: Amlodipine (Norvasc®), Nifedipine (Adalat CC®, Procardia®), Nicardipine (Cardene®)
• Use: Hypertension, especially in Black patients and elderly
• Pharmacodynamics: Inhibits calcium influx in vascular smooth muscle, leading to vasodilation and BP reduction
• Pharmacokinetics: CYP3A4 metabolism, fecal/renal excretion
• Common side effects include peripheral edema, flushing, headache.
• Avoid immediate-release nifedipine due to increased risk of MI

Loop Diuretics

• Medications: Furosemide (Lasix®), Torsemide (Demadex®), Bumetanide (Bumex®)
• Use: Resistant hypertension, heart failure, renal failure
• Pharmacodynamics: Blocks Na+/K+/2Cl- transporter in the loop of Henle, leading to diuresis and BP reduction
• Pharmacokinetics: Renal elimination, short half-life
• More potent than thiazides, but causes hypokalemia
• Can cause dehydration & ototoxicity
• Monitor electrolytes & kidney function

Beta-Blockers

• Medications: Metoprolol (Lopressor®, Toprol XL®), Atenolol (Tenormin®), Carvedilol (Coreg®), Labetalol (Trandate®)
• Use: Post-MI, heart failure, arrhythmias (not first-line for hypertension)
• Pharmacodynamics: Blocks beta-1 receptors, reducing heart rate, cardiac output, and renin secretion
• Pharmacokinetics: Hepatic metabolism, renal excretion
• Can cause bradycardia, fatigue, depression
• Avoid in asthma due to bronchospasm risk

Statins (HMG-CoA Reductase Inhibitors)

• Medications: Atorvastatin (Lipitor®), Rosuvastatin (Crestor®), Simvastatin (Zocor®), Pravastatin (Pravachol®)
• Use: First-line for dyslipidemia, lowers LDL cholesterol, reduces CV events
• Pharmacodynamics: Inhibits HMG-CoA reductase, reducing cholesterol synthesis & increasing LDL clearance
• Pharmacokinetics: Hepatic metabolism, fecal excretion
• Can cause myopathy & liver toxicity
• Avoid in pregnancy
• Check lipid panel & liver enzymes regularly

Ezetimibe (Zetia®)

• Use: Adjunct to statins for LDL reduction
• Pharmacodynamics: Inhibits cholesterol absorption in the small intestine, lowering LDL levels
• Pharmacokinetics: Hepatic metabolism, fecal excretion
• Less effective than statins but well-tolerated
• Used in combination with statins for additional LDL lowering

Overview of Thiazide and ACE inhibitor medications, focusing on pharmacodynamics and pharmacokinetics. Includes drug examples like Hydrochlorothiazide and Lisinopril. Details their use as first-line treatments for hypertension and their mechanisms of action.