A 49-year-old male is diagnosed with hypertension. He is a known asthmatic. His creatinine and potassium are both slightly elevated. Which of the following drugs would be appropriate in his case?
Answer: a) Amlodipine* Amlodipine is a dihydropyridine-type calcium channel blockers. Dihydropyridine calcium channel blockers (amlodipine) do not have contraindications related to renal impairment or potassium levels and can be safely administered in patients with asthma.* Hydrochlorothiazide is metabolized by the kidney, so it would not be a good choice in this patient as there is renal impairment (as indicated by elevated creatinine), because the drug itself can aggravate renal failure.* Spironolactone is a potassium-sparing diuretic. In this patient, it would only worsen the already elevated potassium level.* Beta-blockers are contraindicated in the presence of asthma.TREATMENT OF HYPERTENSION WITH CO-EXISTING CONDITIONSConcomitant conditionDrugs preferredDrugs to be avoidedAnginab blocker ,CCBVasodilatorsBHPa-blocker Diabetes and hyperlipidemiaACEI, ARB, CCB, a-blockerb-blocker, diureticsElderly and isolated systolic hypertensionDiuretics, CCB Low renin hypertensionDiuretics, CCB High renin hypertensionACEI, ARB, b-blocker AsthmaCCB, diuretics, ACEI, ARBb-blockerCHFACEI, diureticsCCBPost MIb-blocker, ACEI DM with CRF/proteinuriaACEI Peripheral Vascular DiseaseCCB, a-blockerb-blockerThyrotoxicosisb-blockerVasodilators* Dihyropyridine calcium channel blockers work to block vascular calcium channels resulting in vascular smooth muscle relaxation and have no specific contraindications.* They can cause peripheral edema (due to venous dilation) and dizziness.* Non-dihydropyridine calcium channel blockers (verapamil and diltiazem) work mostly on cardiac calcium channels and thus decrease the heart rate and inotropy of the heart.* They can also be used to treat hypertension and are contraindicated in systolic congestive heart failure.* Hydrochlorothiazide is not effective to treat hypertension when renal insufficiency is present. Propranolol is a non-cardioselective beta-blocker (blocks both beta-1 and beta-2 receptors) which can worsen asthmatic bronchoconstriction (cardioselective beta-blockers do this to a lesser degree). Spironolactone, an aldosterone antagonist, is also contraindicated in renal insufficiency and with elevated potassium levels.Recommendations of JNC-8 (Joint National Committee)* >60 years of, not diabetic/ not CKD:, target BP level; <150/90 mmHg* 18 to 59 years without major comorbidities + >60 years with DM/ CKD/Both; goal is <140/90 mmHg.* First-line medications: thiazide-type diuretics, calcium channel blockers (CCBs), ACEIs, and ARBs* Second- and third-line: higher doses or combinations of ACEIs, ARBs, thiazide-type diuretics, and CCBs.* Later-line alternatives: Beta-blockers, Alpha-blockers, Alphal/beta-blockers (eg, carvedilol), Vasodilating beta-blockers (eg, nebivolol), Central alpha2-adrenergic agonists (eg, clonidine), Direct vasodilators (eg, hydralazine), Loop diuretics (eg, furosemide), Aldosterone antagonists (eg, spironolactone), Peripherally acting adrenergic antagonists (eg, reserpine),* When initiating therapy, patients of African descent without chronic kidney disease should use CCBs and thiazides instead of ACEIs.* Use of ACEIs and ARBs is recommended in all patients with CKD.* ACEIs and ARBs should not be used in the same patient simultaneously.* CCBs and thiazide-type diuretics should be used instead of ACEIs and ARBs in patients over the age of 75 with impaired kidney function due to the risk of hyperkalemia, increased creatinine, and further renal impairment.Preferred Parenteral Drugs fc>r Selected Hypertensive EmergenciesHypertensive encephalopathyNitroprusside, nicardipine, labetalolMalignant hypertension (for IV therapy)Labetalol, nicardipine, nitroprusside, enalaprilatStrokeNicardipine, labetalol, nitroprussideMyocardial infarction/unstable anginaNitroglycerin, nicardipine, labetalol, esmololAcute left ventricular failureNitroglycerin, enalaprilat, loop diureticsAortic dissectionNitroprusside, esmolol, labetalolAdrenergic crisisPhentolamine, nitroprussidePostoperative hypertensionNitroglycerin, nitroprusside, labetalol, nicardipinePreeclampsia/eclampsia of pregnancyHydralazine, labetalol, nicardipine
Amlodipine
Spironolactone
Propranolol
Hydrochlorthiazide
C.V.S