DIURETICS
(memory trick: Diuretics = Diuresis = Dry inside)
Loop
Name Furosemide
(Lasix)
Mechanism of acts on ascending loop of
Henle to block reabsorption of
Action Na+, Cl-, K+
Therapeutic Uses - HTN
- heart failure
- edematous states
(pulmonary; liver, kidney)
Adverse Effects - K+, Na+, Cl-, hydration
- hypotension (loss of volume;
relaxation of smooth muscle)
- ototoxicity (reversible)
- hyperglycemia
- uric acid
- disruption of lipid
metabolism
Contraindications - Digoxin/Lithium toxicity
- ototoxic drugs
- potass.-sparing diuretics
- antihypertensive agents
- NSAIDs = efficacy
- suffix: -nide, -mide
Other Important Info - other names: Ethacrynic acid,
Bumetanide, Torsemide (only one
that can be used for HTN from this
list)
- Lasix very potent
- not used: pregnant, diabetes, gout
Thiazide Potassium-Sparing
Hydrochlorothiazide
block reabsorption of Na+ ,
K+, and Cl-; H20 follows
- HTN
- heart failure
- renal disease
- Diabetes insipidus
- liver cirrhosis
- edema
- K+, Na+, Cl-, hydration
- hyperglycemia
- uric acid
- Digoxin/Lithium toxicity
- augments effects of
hypertensive meds
- NSAIDs =. efficacy
- CAN be combined w/
ototoxic agents w/o
increased risk of hearing loss
- suffix: -thiazide
- max diuresis considerably
lower than w/ loop diuretics
- not effective when urine
flow is scant (unlike w/loop)
- peaks in 4-6 hours
Osmotic
Spironolactone Mannitol
(memory trick: S think Sparing)
(Aldosterone antagonist) thickness of the filtrate so
blocks aldosterone water can’t be reabsorbed
receptors;
excretion of Na+ & H20
(lets fluid out of the body,
into the potty!)--NOT K+
- HTN - intracranial/ intraocular
- heart failure pressure
- edematous states - prophylaxis (guarding
- hyperaldosteronism against development) of
- PMS; PCOS; acne in young renal failure
women
- K+ - edema
- benign & malignant tumors - headache
- endocrine effects - nausea/ vom
- gynecomastia - fluid/ electrolyte imbalance
- impotence
- menstrual irregularities
- counteracts loop & thiazide - anuria
- avoid foods high in K+ - severe hypovolemia
- avoid salt subs - active intracranial bleeding
- ACE, ARBs, K+ supps = risk
of hyperkalemia
- modest urine production - must be given parenterally
- rarely used alone for
therapy
- nonaldosterone
antagonists: Triamterene;
Amiloride

Name
Mechanism of Action
Therapeutic Uses
Adverse Effects
Contraindications
Other Important Info
*Also Spironolactone-- see Diuretic meds for specifics
ANTI-HYPERTENSIVES (RAAS suppressors)
ACE inhibitors ARBs Direct Renin Inhibitors
Lisinopril Losartan Aliskiren
inhibits RAAS; block action of angiotensin II allowing binds tightly w/ renin and inhibits
reduce angiotensin II levels; vasodilation; cleavage of angiotensinogen to
increase levels of bradykinin reduce K+ excretion; angiotensin I (block activity of renin
decrease aldosterone release & cause vasodilation)
- HTN - HTN - HTN
- heart failure - heart failure
- DM & nonDM nephropathy - DM nephropathy
- prevents CVAs - prevents CVAs
- protects kidney
- A= angioedema - angioedema - angioedema
- C= cough - renal failure - cough
- E= elevated K+ - dizziness; headache - GI effects
- 1st dose hypotension - hypotension - K+
- neutropenia - fetal injury; death
- antiHTN meds, diuretics = risk - antiHTN meds = risk hypotension - PTs w/ diabetes mellitus who are
hypotension taking an ACE inhibitor or ARB
- K+ drugs = risk hyperK+
- lithium toxicity
- NSAIDs = absorption
- suffix: -pril - other forms: valsartan, olmesartan, - newer type of med so long term
- other forms: captopril, enalapril, azilsartan effects unknown
fosinopril, moexipril - do NOT inhibit kinase II; do NOT
- all admin orally (except enalapril) increase bradykinin levels (= lower
- can be admin w/o food (except instance of cough)
captopril & moexipril) - could cause fetal harm
- could cause fetal harm
 CALCIUM CHANNEL BLOCKERS
Phenylalanine Benzothiazepine Dihydropyridine
Name Verapamil Diltiazem Nifedipine
Mechanism of Action act on arterials and the heart; act on arterials and the heart; blocks act primarily on arterioles;
decrease Ca which decreases Ca calcium channels in heart and BVs vasodilation by blocking Ca channels;
avail. for transmission of nerve BP & HR BP
impulses force of contraction HR & contractile force
BP & HR **blockade at AV node
force of contraction (decreasing coronary perfusion
cardiac output)
**blockade at AV node
coronary perfusion
Therapeutic Uses - HTN - HTN - HTN
- angina pectoris - angina pectoris - angina pectoris
- cardiac dysrhythmias - cardiac dysrhythmias - investigational: migraine & suppressing
- migraine preterm labor
- cannot be used to treat dysrhythmias
Adverse Effects - constipation (most common - similar to verapamil but less - flushing
complaint) constipation - dizziness
- dizziness - exacerbates bradycardia, sick sinus - headache
- facial flushing syndrome, HF, second- or third-degree - peripheral edema
- headache heart block - gingival hyperplasia
- peripheral edema - chronic eczematous rash in older PTs
- gingival hyperplasia - reflex tachycardia
- heart block - cardiac oxygen demand
- pain in angina PTs
Contraindications - Digoxin - Digoxin - immediate release (not sustained) has
- beta-adrenergic blocking agents - beta-adrenergic blocking agents been associated w/ mortality in PTs w/ MI
- toxicity: severe hypotension; and unstable angina
bradycardia & AV block; ventricular
tachydysrhythmias
Other Important Info - suffix: -amil - do not abruptly withdraw (same w/ - suffix: -dipine
- treat toxicity w/ gastric lavage & verapamil) = can cause rebound - less likely than verapamil to exacerbate
activated charcoal hypertension preexisting cardiac disorders
- IV verapamil for dysrhythmias can - can be combined w/ beta blocker for
cause severe cardiovascular effects prevention of reflex tachycardia (beta
(monitor BP/ECG; keep resuscitation blockers effects of nifedipine but can
equip. avail.) intensify adverse cardiac effects of
verapamil and diltiazem)
 ANTIANGINAL AGENTS
Organic Nitrates Beta Blockers Ranolazine
Name Nitroglycerin Metoprolol Ranolazine
Mechanism of Action vasoDilator cardiac workload, oxygen demand, exact mechanism unknown
Decrease BP resistance, output (won’t be able to
Dilates vessels reach target HR)
Decrease vascular resistance blocks NE and EPI (fight or flight
cardiac workload & oxygen demand hormones)
(for stable)
oxygen supply; does NOT reduce
oxygen demand; relaxes or prevents
spasm in coronary arteries (for variant)
Therapeutic Uses - angina (stable & variant) - stable angina - chronic angina
- prevent angina attacks - HTN
- chronic HF (not acute)
- dysrhythmias
Adverse Effects the H’s: the B’s of Beta Blockers: - nausea
Headache Bradycardia & heart Blocks - constipation
Hypotension (orthostatic) Breathing problems (Bronchi spasms) - headache; dizziness
Hot flushing of the face Bad for HF PT’s (in acute setting) - tachycardia
- reflex tachycardia Blood sugar masking (masks S&S of - difficulty breathing
hypoglycemia) - fainting
BP lowered (hypotension) - QT interval prolongation
Contraindications - do not take w/ phosphodiesterase - don’t use with diabetics or - use w/ strong CYP3A inhibitors or
inhibitors (drugs for ED) asthma/COPD PTs inducers
- hypotensive drugs - insomnia - PTs with hepatic impairment
- beta blockers, verapamil, diltiazem - depression - digoxin & tricyclic antidepressants = may
- bizarre dreams need reduced doses when used with
- sexual dysfunction ranolazine
Other Important Info - 3 doses sublingually every 5 min., followed by - suffix: olol - belongs to 1st new class of antianginal
IV if persistent - other forms: propranolol, nadolol, agents approved in more than 25 yrs
- tolerance can develop rapidly = to minimize
use lowest effective dose possible (start low, go acebutolol
slow!) - give first dose IV if chest pain is
- long acting formulas = need 8 drug-free hours ongoing
per day
- forms: sublingual tablets or spray; SR capsules;
transdermal patch; topical ointment; IV infusion
*Also Calcium Channel Blockers-- see Antihypertensives for specifics