Diuretics ACE inhibitors

Diuretics, ACE inhibitors, ARBs, and CCBs are primary agents acceptable as first-line options based on outcome data demonstrating CV risk reduction benefits (Table 10-2). /TBIockers may be used either to treat a specific compelling indication or as combination therapy with a primary antihypertensive agent for patients without a compelling indication. 

In patients with type 2 diabetes and nephropathy, ARB therapy has been shown to significantly reduce progression of nephropathy. For patients with LV dysfunction, ARB therapy has also been shown to reduce the risk of CV events when added to a stable regimen of a diuretic, ACE inhibitor, and fi-blocker or as alternative therapy in ACE inhibitor-intolerant patients. 

An aldosterone antagonist may be considered in addition to a diuretic, ACE inhibitor or ARB, and /1-blocker. Regimens employing both an aldosterone antagonist and ARB are not recommended because of the potential risk of severe hyperkalemia. 

Many different drug classes have shown to cause hypotension and orthostatic reactions and drugs for cardiovascular conditions, psychoactive medicines and polypharmacy, can all have this side effect (Box 5.15). Among the most frequently used drugs in the elderly are diuretics, ACE-inhibitors, angiotensin II antagonists, calcium channel blockers and antidepressants. 

Diuretics, ACE-inhibitors and NSAID affects the elimination of electrolytes... 

On the basis of the mechanisms that control blood pressure, it is not surprising that the drags used in the treatment of hypertension include diuretics, ACE inhibitors, angioten-sin-II receptor blockers, and Ca ion channel inhibitors. 

Older patients with CHF may be faced with multiple therapies of diuretics, ACE inhibitors/angioten-sion II blockers and beta-blockers. This puts them at risk of hypotension, orthostatic hypotension, azo-taemia and electrolyte imbalance. Drugs should be added carefully, starting at low dose and patients should be monitored for volume depletion and changes in serum creatinine and electrolyte concentrations. 

The therapeutic efficacy of ATi-receptor blockers in hypertensive disease is well documented. The ATi-blockers are assumed to be as effective as various classes of well-known antihypertensives, such as jS-blockers, diuretics, ACE-inhibitors and calcium antagonists. A major advantage of the ATi-blockers may be their favourable pattern of side-effects, which so far does not appear to differ from the use of placebo. In particular the fact that ATi-blockers do not cause cough (in contrast to the ACE-inhibitors) appears to be an advantage. 

Studies with ACE inhibitors have shown that in black patients the response is poor. However, the response becomes the same as in whites when ACE inhibitors are combined with a low-dose thiazide diuretic. ACE inhibitors can be effective in black hypertensive patients but in higher doses compared to white and Indian peoples. 

Paradoxically, these agents—not positive inotropic drugs—are the first-line therapies for chronic heart failure. The drugs most commonly used are diuretics, ACE inhibitors, angiotensin receptor antagonists, aldosterone antagonists, and blockers (Table 13-1). In acute failure,... 

Uses HTN, edema, CHF Action Thiazide diuretic T Na, Cl, H20 excretion in distal tubule Dose 1.25-5 mg/d PO Caution [D, ] T Effect w/ loop diuretics, ACE inhibitors, cyclosporine, digoxin, Li Contra Anuria, thiazide/sulfonamide allergy, renal insuff, PRG Disp Tabs SE X- BP, dizziness, photosens Interactions ... 

In the past, prescription of a diuretic plus digitalis was almost automatic in every case of chronic heart failure, and other drugs were rarely considered. At present, diuretics are still considered as first-line therapy, but digitalis is usually reserved for patients who do not respond adequately to diuretics, ACE inhibitors, and B-blockers (Table 13-1). 

Strategies include improving myocardial contractility (e.g., positive inotropic agents), lower sodium retention (diuretics, ACE inhibitors), and decreasing arteriolar and venous resistance in order to decrease work load (vasodilators and ACE inhibitors) and to increase exercise tolerance. 

The drugs of first choice in antihypertensive therapy are those that have been unambiguously shown in clinical studies to reduce mortality of hypertension—diuretics, ACE inhibitors and AT, antagonist, p-blockers, and calcium antagonists. 

Hyperkalemia, due to potassium chloride, potassium-retaining diuretics, ACE inhibitors, or angiotensin-receptor antagonists, reduces the apparent affinity of digitalis for Na/K-ATPase and thereby reduces its tissue binding. 

Hyperkaiemia 4 PG, 4 R/tA axis activity, 4 K+ deiivery to renal tubule Renal disease, CHF, type 2 DM, multiple myeloma, use of K supplements, K+ sparing diuretics, ACE inhibitors Discontinue NSAID, avoid indomethacin in patients at risk... 

Examples chlorpropamide, lithium, captopril, NSAIDs, fluoride, diuretics, ACE inhibitors... 

Older patients with isolated systolic hypertension are often at risk for orthostatic hypotension when drug therapy is started. This is particularly prevalent with diuretics, ACE inhibitors, and ARBs. Although overall treatment should be the same, initial doses should be very low and dose titrations gradual to minimize risk of orthostatic hypotension. 

After diuretics, ACE inhibitors and /3-blockers (collectively considered standard therapy), other agents may be added to further reduce cardiovascular morbidity and mortality and reduce BP if needed. Early data suggested that ARBs may be better than ACE inhibitors in systolic heart failure. However, when directly compared in a well-designed prospective trial, ACE inhibitors were found to be better. ARBs are acceptable as an alternative therapy for patients who cannot tolerate ACE inhibitors and possibly as add-on therapy to those already on a standard three-drug regimen. ... 

ACE inhibitors are absolutely contraindicated in pregnancy (see Pregnancy section under Special Populations ) and in patients with a history of angioedema. Similar to diuretics, ACE inhibitors can increase lithium serum concentrations in patients on lithium therapy. Concurrent use of an ACE inhibitor with a potassium-sparing diuretic (including aldosterone antagonists), potassium supplements, or an ARB may result in excessive increases in potassium. 

Body fluid volume Edema, T renin and All Diuretics, ACE inhibitors, All antagonists... 

Drugs used to combat heart failure include those that decrease preload (e.g diuretics, ACE inhibitors, AT-1 receptor antagonists, and vasodilators), those that decrease afterload (e.g., ACE inhibitors, AT-1 receptor antagonists, and vasodilators), and those that increase cardiac contractibility (e.g., digitalis, beta agonists, and bipyridines). 

Property Alpha2 Agonists Alphat Blockers Beta Blockers Diuretics ACE inhibitors and AT-1 Antagonists Calcium Channel Antagonists (CCAs) Adrenergic Neuron Blockers Direct-acting Vasodilators... 

Drug groups used to control cardiac failure are cardiac glycosides, diuretics, ACE inhibitors and angiotensin II receptor antagonists. 

Drugs that are used to treat hypertension include diuretics, ACE inhibitors, angiotensin 11 receptor antagonists, P-blockers, calcium channel blockers, ai-antagonists and centrally acting antihypertensives. 

Diuretics, ACE inhibitors, fi-blockers and calcium channel blockers are all used to treat hypertension. Which of these drugs would be ... 

---