Treatment of Hypertension in Children课件.ppt

Diuretics1-3, 5 Amiloride, Chlorothiazide, Chlorthalidone, Triamterene, Furosemide, HCTZ*, Spironolactone, Metolazone, Bumetanide Mechanisms of Action: Loop Diuretic: (Furosemide, Bumetanide) Inhibits reabsorption of Na and Cl in the ascending loop of Henle and distal tubule – causing increased excretion of water, K, Na, Cl, Mg, Ca Diuretics Mechanism of Action: continued Thiazide Diuretic: (HCTZ, Chlorothiazide) Inhibits Na reabsorption in the distal tubules causing increased excretion of Na and water as well as K, Mg, Ca, hydrogen, phosphate, bicarb ions K Sparing Diuretic: (Spironolactone) Competes with aldosterone for receptor sites in the distal renal tubules, increasing NaCl and water excretion while conserving K and hydrogen ions; may block the effect of aldosterone on arteriolar smooth muscle as well Miscellaneous: (Metolazone) Inhibits sodium reabsorption in the cortical diluting site and proximal convoluted tubules http://sprojects.mmi.mcgill.ca/nephrology/presentation/images/86no2.gif Diuretics Diuretics Patient’s Characteristics: Volume dependent, low plasma renin activity Black race Congestive heart failure Avoid in athletes Diuretics Comments: ADR: Dizziness, Photosensitivity, Rash, Vomiting Monitor Electrolytes Adjust in renal impairment Furosemide and Chlorothiazide available in solutions Good data to compound Spironolactone, Metolazone and HCTZ into oral suspensions BB 1-3, 5 Βeta-Blocker Atenolol, Bisoprolol/HCTZ, Metoprolol, Propranolol* Mechanism of Action: Selective inhibitor of beta1-adrenergic receptors at lower doses; also inhibits beta2-receptors at higher doses /ojni/ni/602/strate1.jpg BB BB Patient’s Characteristics: High plasma renin activity Hyperdynamic circulation Anxiety Migraine Hyperthyroidism Neuroadrenergic tumors BB Comments: Good data to compound Metoprolol and Atenolol Propranolol available as a solution Worried about higher doses in asthma patients Contraindicated in sick sinus syndrome Avoid in athletes and