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Chapter 15: Drug Therapy of Hypertension, Edema, and Disorders of Sodium and Water Balance

INTRODUCTION

This chapter will be most useful after having a basic understanding of the material in the section on hypertension in Chapter 27 Drug Therapy of Myocardial Ischemia and Hypertension in Goodman & Gilman’s The Pharmacological Basis of Therapeutics, 12th Edition (pp 765-785), as well as material in Chapter 25 Regulation of Renal Volume and Vascular Volume and Chapter 26 Renin and Angiotensin. In addition to the material presented here, the 12th Edition contains:

  • The molecular structures of drugs used to treat hypertension, edema, and other disorders of Na+ and water balance

  • Figure 25-1 The anatomy and nomenclature of the nephron

  • Figure 25-5 Changes in the extracellular fluid volume and weight with diuretic therapy

  • An extensive discussion of the functions and effects of the renin-angiotensin system in Chapter 26

LEARNING OBJECTIVES

  • Understand the mechanisms of action of drugs used to treat hypertension, edema, and other disorders of Na+ and water balance.

  • Know the untoward effects of drugs used to treat hypertension, edema, and other disorders of Na+ and water balance.

  • Know which patients should be treated and when treatment should be initiated.

  • Know which drugs are most effective in treating individual hypertensive patients with specific comorbidities, including diabetes mellitus, congestive heart failure, and renal disease.

  • Know which drugs can be used in combination.

  • Know how to set treatment goals based on target blood pressures and other clinical measures.

DRUGS INCLUDED IN THIS CHAPTER

  • Acetazolamide (DIAMOX, others)

  • β Adrenergic receptor antagonists (many; Table 15-1; see Chapter 7)

  • Aliskiren (TEKTURNA)

  • Amiloride (MIDAMOR, others)

  • Amiloride/hydrochlorothiazide (generic)

  • Amlodipine (NORVASC)

  • Bendroflumethiazide (NATURETIN)

  • Benzapril (LOTENSIN, others)

  • Bumetanide (BUMEX, others)

  • Candesartan cilexetil (ATACAND)

  • Captopril (CAPOTEN, others)

  • Chlorothiazide (DIURIL)

  • Chlorthalidone (HYGROTON)

  • Clevidipine (CLEVIPREX)

  • Clonidine (CATAPRES, others)

  • Conivaptan (VAPRISOL)

  • Desmopressin acetate (1-deamino-8-d-arginine vasopressin, DDAVP, others)

  • Diazoxide

  • Dichlorphenamide (DARAMIDE)

  • Diltiazem (CARDIZEM)

  • Doxazosin (CARDURA, others)

  • Enalapril (VASOTEC, others)

  • Enalaprilat (VASOTEC INJECTION, others)

  • Eplerenone (INSPRA, others)

  • Ethacrynic acid (EDECRIN, others)

  • Felodipine (PLENDIL)

  • Fenoldopam (CORLOPAM)

  • Fosinopril (MONOPRIL, others)

  • Furosemide (LASIX, others)

  • Glycerin (OSMOGLYN)

  • Guanabenz (WYTENSIN)

  • Guanadrel

  • Guanfacine (INTUNIV, TENEX)

  • Human recombinant ANP (carperitide, available only in Japan)

  • Human recombinant BNP (nesiritide, NATRECOR)

  • Hydralazine (APRESOLINE)

  • Hydrochlorothiazide (HYDRODIURIL)

  • Hydroflumethiazide (SALURON)

  • Indapamide (LOZOL)

  • Irbesartan (AVAPRO)

  • Isosorbide (ISMOTIC)

  • Isradipine (DYNACIRC)

  • Lisinopril (PRINIVIL, ZESTRIL, others)

  • Losartan (COZAAR)

  • Mannitol (OSMITROL, others)

  • Methazolamide (GLAUCTABS)

  • Methyclothiazide (ENDURON)

  • Methyldopa (ALDOMET, others)

  • Metolazone (MYKROX, ZAROXOLYN)

  • Minoxidil (LONITEN)

  • Moexipril (UNIVASC, others)

  • Nicardipine (CARDENE)

  • Nifedipine (PROCARDIA ER)

  • Nisoldipine (SULAR)

  • Nitroprusside

  • Olmesartan medoxomil (BENICAR)

  • Perindopril (ACEON)

  • Polythiazide (RENESE)

  • Prazosin (MINIPRESS, others)

  • Quinapril (ACCUPRIL, others)

  • Quinethazone (HYDROMOX)

  • Ramipril (ALTACE, others)

  • Reserpine

  • Spironolactone (ALDACTONE, others)

  • Telmisartan (MICARDIS)

  • Terazosin (HYTRIN and others)

  • Terlipressin (LUCASSIN)

  • Tolvaptan (SAMSCA)

  • Torsemide (DEMADEX, others)

  • Trandolapril (MAVIK, others)

  • Triamterene (DYRENIUM)

  • Triamterene/hydrochlorothiazide (DYAZIDE, MAXZIDE, others)

  • Trichlormethiazide (NAQUA)

  • Urea (UREAPHIL, currently not available in the United States)

  • Valsartan (DIOVAN)

  • Vasopressin (8-l-arginine vasopressin, PITRESSIN, others)

  • Verapamil (CALAN, others)

Table 15-1Criteria for Hypertension in Adults
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