Hypertension Medications Overview

Hypertension Medications

• Diuretics:
  • Carbonic anhydrase inhibitors (e.g., Acetazolamide): Reduce sodium bicarbonate reabsorption, lowering blood volume and pressure. Side effects include hypokalemia (low potassium) and metabolic acidosis. Indications include glaucoma and congestive heart failure, contraindicated in pregnancy and renal insufficiency.
  • Loop diuretics (e.g., Furosemide, Torsemide): Inhibit sodium chloride reabsorption in the loop of Henle leading to increased excretion, greater diuretic effect. Side effects include hypokalemia, hyperuricemia, and hypocalcemia. Indicated for hypertension and congestive heart failure. Contraindicated in pregnancy.
  • Thiazides (e.g., Hydrochlorothiazide, Indapamide, Chlorothiazide): Inhibit sodium chloride reabsorption in the distal convoluted tubule. Side effects include hypokalemia, hyperuricemia, and hypercalcemia. They're indicated for hypertension, but can have side effects like hyperlipidemia and photosensitivity. Contraindicated in pregnancy and renal insufficiency.
  • Potassium-Sparing Diuretics (e.g., Amiloride, Spironolactone): These agents reduce sodium reabsorption and increase potassium excretion. Amiloride blocks sodium channels, while Spironolactone is an aldosterone antagonist. Side effects includes hyperkalemia, metabolic acidosis, and, for Spironolactone, gynecomastia and menstrual irregularities. Indicated for hypertension alongside other diuretics, and in conditions like liver cirrhosis and congestive heart failure. Contraindicated in pregnancy; avoid in patients with renal disease or anuria.

Calcium Channel Blockers

• Dihydropyridines (e.g., Amlodipine, Felodipine): Inhibit L-type calcium channels in vascular smooth muscle. This leads to peripheral vasodilation, lowering blood pressure. Side effects include peripheral edema, gum swelling, headaches, dizziness, and flushing. Indications include hypertension and angina pectoris; also useful for heart failure. Commonly contraindicated in patients with hypotension.
• Non-Dihydropyridines (e.g., Verapamil, Diltiazem): These act on both vascular smooth muscle and the heart's conducting system (AV/SA node). This leads to decreased heart rate and slowed conduction, and also vasodilation. Side effects include bradycardia, arrhythmias and AV block. They're useful for hypertension and arrhythmias but carry risks like AV block and bradycardia.

Renin-Angiotensin-Aldosterone System (RAAS) Inhibitors

• ACE Inhibitors (e.g., Perindopril, Lisinopril, Captopril, Ramipril): Inhibit angiotensin-converting enzyme, reducing angiotensin II production. This leads to vasodilation and reduced sodium retention. Side effects include dry cough, hyperkalemia, and angioedema. Used to treat hypertension and heart failure; pregnancy contraindication.
• ARBs (e.g., Telmisartan, Losartan, Candesartan): Block angiotensin II receptors, also reducing angiotensin II's effects. Side effects include hyperkalemia. They're similarly indicated for hypertension and heart failure. Contraindicated in pregnancy.

Antiplatelets

• TXA2 Inhibitors (e.g., Aspirin): Irreversibly inhibit cyclooxygenase, reducing thromboxane A2 formation. Side effects include bleeding. Indications include antiplatelet therapy, fever and pain relief. Contraindicated in patients with stomach ulcers, asthma, or allergies.
• P2Y12 Inhibitors (e.g., Clopidogrel, Ticagrelor, Prasugrel): Block ADP receptors on platelets, reducing platelet aggregation. Side effects include bleeding. Indications include antiplatelet therapy after MI, and for atrial fibrillation.
• GP2A/3B Inhibitors (e.g., Tirofiban, Abciximab, Eptifibatide): Bind to platelet GPIIb/IIIa receptors, inhibiting fibrinogen binding and platelet aggregation. Side effects include bleeding. Uses are for antiplatelet therapy, especially in situations like unstable angina and NSTEMI.

Anticoagulants

• Heparin (unfractionated and low molecular weight): Inactivates clotting factors via antithrombin. Side effects include bleeding and, in some cases, heparin-induced thrombocytopenia (HIT). Indications include preventing thrombotic events, DVT, PE, and atrial fibrillation. Contraindicated in patients with a history of HIT or hypersensitivity to heparin.
• NOACs (e.g., Rivaroxaban, Apixaban, Dabigatran): Directly inhibit specific clotting factors, primarily factor Xa or thrombin. Side effects include bleeding. Useful in situations like preventing DVT, PE, and stroke. Contraindications include bleeding disorders or liver dysfunction.
• Vitamin K Antagonists (e.g., Warfarin): Interfere with Vitamin K-dependent clotting factor synthesis, reducing coagulation. Side effects include bleeding and interactions with various medications. Indications include anticoagulant therapy in conditions like DVT, PE, and atrial fibrillation, though it's often used in cases with a history of clots. Avoid in patients with bleeding disorders or liver impairments.
• Thrombolytics (e.g., Alteplase, Reteplase, Urokinase, Streptokinase): Dissolve existing blood clots, activating plasmin. Side effects include bleeding, intracranial hemorrhage, and allergic reactions. Commonly used for acute myocardial infarction (MI) or ischemic stroke. Contraindicated in patients with a history of intracranial neoplasms, recent ischemic stroke, major surgery within 72 hours.

Diabetes Medications

• Biguanides (e.g., Metformin): Reduce hepatic glucose production, increase insulin sensitivity, and increase glucose uptake in muscle. Side effects include lactic acidosis (renal insufficiency concern), impaired vitamin B12 absorption . First-line treatment.
• Sulfonylureas (e.g., Glimepiride): Stimulate insulin release from beta cells. Side effects include hypoglycemia, weight gain.
• Meglitinides (e.g., Repaglinide): Similar to sulfonylureas but faster-acting and shorter-lasting. Side effects include hypoglycemia.
• DPP-4 Inhibitors (e.g., Sitagliptin, Linagliptin): Increase incretin levels, prompting more insulin release. Side effects include hypoglycemia, urinary infections, and pancreatitis.
• GLP-1 Agonists (e.g., Exenatide, Liraglutide): Mimic the effects of incretins, promoting insulin release and reducing glucagon release. Side effects include nausea, vomiting, and pancreatitis.
• SGLT2 Inhibitors (e.g., Canagliflozin, Dapagliflozin, Empagliflozin): Reduce glucose reabsorption in the kidneys. Side effects include increased urinary glucose (glucosuria), dehydration, and increased urinary tract infections.
• Alpha-Glucosidase Inhibitors (e.g., Acarbose): Delay carbohydrate absorption in the intestine. Side effects include gastrointestinal issues like diarrhea and bloating.

Hyperlipidemia Medications

• Statins (e.g., Lovastatin, Simvastatin, Pravastatin): Reduce cholesterol by inhibiting HMG-CoA reductase. Side effects include liver damage, muscle pain. Often first-line treatment, but adverse effects limit use in some patients.
• Ezetimibe: Inhibits cholesterol absorption. Side effects include liver issues. Consider for patients who don't tolerate or respond to statins.
• PCSK9 Inhibitors (e.g., Evolocumab, Alirocumab): Increase LDL receptor production. Side effects are generally minor. Useful for patients with high LDL who don't respond or tolerate other therapies and high LDL.
• Bile acid sequestrants (e.g., Cholestyramine, Colestipol, Colesevelam): Increase bile acid excretion. Side effects include constipation, bloating.
• Fibrates (e.g., Gemfibrozil, Fenofibrate): Increase lipoprotein lipase activity and lower triglycerides. Side effects include muscle pain. Useful for high triglyceride levels.
• Omega-3 Fatty Acids (e.g., Fish Oil): Increase HDL and lower triglycerides, with fewer and usually milder side effects.

This quiz covers essential information about various medications used to manage hypertension, focusing on diuretics, including carbonic anhydrase inhibitors, loop diuretics, and thiazides. It details their mechanisms, side effects, indications, and contraindications. Test your knowledge on the pharmacology of hypertension treatment!