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NR 601 Case Study: 1st line treatment for HTN
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NR 601 Case Study: 1st line treatment for HTN
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lOMoARcPSD|87833221st Line Treatment for HTN - Case Study
Primary Care of the Maturing and Aged Family Practicum (Chamberlain University)
, lOMoARcPSD|8783322
1st line treatment for HTN (non-black, no CKD)
ACEI (arb), thiazide, ccb
1st line treatment for HTN for black pts (no ckd)
thiazide, ccb
1st line option for HTN for anyone with CKD
ACEI (arb)
Types of diuretics
thiazides, loop diuretics, k-sparing
preferred diuretic with renal impairment
loop-diuretics
diuretics - S/E & D/I
S/E All - hypokalemia, arrhythmia, metbolic alkalosis, fatigue, postrual hypotension,
hyperlipidemia
S/E for k-sparing - hyperkalemia, gynecomastia, peptic ulcer)
S/E for thiazides - hyperglycemia & hypercalcemia
S/E for loop hypocalcemia
D/I All- digoxin (hypokalemia/toxicity risk), NSAIDs (reduce diuresis), lithium (toxicity
risk), corticosteroids (enhance hypokalemia), anti-diabetic drugs (decrease anti-diabetic
levels)
D/I for thiazides - BB's - increase hyperglycemia/ hyperlipidemia
D/I for loops - aminoglycosides = ototoxicity & nephrotoxicity
which diuretic causes post diuretic sodium retention
loop diuretics
post-diuretic effect, a compensatory sodium-retention process that begins as the
diuretic action wanes.
Diuretics that do not contain a sulfonamide derivative
***ethacrynic acid**
also: amiloride, hydrochloride, eplerenone, spironolactone, and triamterene (safe for pt
with allergy to sulfa)
CHF drugs including diuretic choices
First line: ACEI's or ARB, Beta-blocker, diuretics (loop & potassium sparing)
-ACEI's & ARB's decrease mortality
-if ACEI contraindicated: use ARB or Hydralizine & Isosorbide (decrease mortality/less
effective than ACEI)
-Beta-blockers: decrease mortality, NEVER when active failure, ONLY after diuresed &
other medications
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