【高血压英文ppt课件】Hypertension in CKD.pptVIP

Thiazide Diuretics JNC first choice BP med Very effective in multiple trials Often available in combo with RAAS agent Low K, increase BG, lipids at dose 25mg Ineffective at GFR 50 Can boost efficacy of loop diuretics Loop Diuretics Necessary to maintain volume status in GFR 50 Furosemide is classic but short half life so poor for HBP Bumetanide is same but better absorbed Torsemide has much longer half-life and is my choice now that it is generic Titrate to increase UOP then increase frequency Low potassium is main issue, especially with thiazides (metolazone) Beta Blockers Selective Beta Blockers Atenolol, metoprolol, bisoprolol, nebivolol Non – selective Beta Blockers Propranolol Alpha – Beta Blockers Labetolol, carvedolol Beta Blockers Next class in CKD patients Reduces HR, SV and also renin Reduces incidence of sudden cardiac death and arrhythmias Reduces CV events in CHF, post-MI Counter-acts reflex increase in HR/CO induced by vasodilators and diuretics Beta Blockers Carvedolol, labetolol are better for HBP Atenolol, metoprolol better for CHF, HR reduction and arrhythmia Propranolol for ascites/cirrhosis, anxiety Bradycardia and fatigue are main side effects Central Adrenergic Agents Clonidine is predominant drug Probably same benefits as b blockers No studies and never will be Synergy with b blockers debatable Dry mouth, fatigue, t.i.d., bradycardia Good for acute HBP/prn use Patch available Methyldopa for HBP in pregnancy Dihydropyridine Calcium Channel Blockers Nifedipine, amlodipine, felodipine Direct vasodilators Very effective – prob 4th drug of choice Can cause peripheral edema especially in females No effect on HR, CHF Increase GFR, proteinuria Glomerular Perfusion Non-Dihydropyridine CCB’s Diltiazem and Verapamil Reduce HR and Lower BP Arrhythmia control Reduction in proteinuria but no renal outcomes Edema, bradycardia, gingival hyperplasia, CyP450 interactions 代理报关委托书委托报关协议关于审理城镇房屋租赁合同纠纷案件司法解释有关劳务派遣制度设计及对劳务派遣行业的影响分析糖皮质激素在呼吸系统疾病中的合理应用严重脓毒