Page 207 - Basic _ Clinical Pharmacology ( PDFDrive )

CHAPTER 11 Antihypertensive Agents 193

PREP AR A TIONS A V AIL ABLE

GENERIC NAME AVAILABLE AS GENERIC NAME AVAILABLE AS GENERIC NAME AVAILABLE AS
BETA-ADRENOCEPTOR BLOCKERS ALPHA 1 -SELECTIVE ADRENOCEPTOR Nifedipine Generic, Adalat,
Acebutolol Generic, Sectral BLOCKERS Procardia, Adalat CC,
Atenolol Generic, Tenormin Doxazosin Generic, Cardura Procardia-XL
Betaxolol Generic, Kerlone Prazosin Generic, Minipress Nisoldipine Generic, Sular
Bisoprolol Generic, Zebeta Terazosin Generic, Hytrin Verapamil Generic, Calan,
Isoptin, Calan SR,
Carvedilol Generic, Coreg GANGLION-BLOCKING Verelan
AGENTS
Esmolol Generic, Brevibloc ANGIOTENSIN-CONVERTING ENZYME
Mecamylamine Generic (orphan
Labetalol Generic, Normodyne, drug for Tourette’s INHIBITORS
Trandate Benazepril Generic, Lotensin
syndrome)
Metoprolol Generic, Lopressor, VASODILATORS USED Captopril Generic, Capoten
Toprol-XL IN HYPERTENSION Enalapril Generic, Vasotec,
Nadolol Generic, Corgard Enalaprilat (parenteral)
Diazoxide Hyperstat IV,
Nebivolol Bystolic Proglycem (oral for Fosinopril Generic, Monopril
Penbutolol Levatol insulinoma) Lisinopril Generic, Prinivil,
Pindolol Generic, Visken Fenoldopam Corlopam Zestril
Propranolol Generic, Inderal, Hydralazine Generic, Apresoline Moexipril Generic, Univasc
Inderal LA Minoxidil Generic, Loniten Perindopril Generic, Aceon
Timolol Generic, Blocadren Topical Rogaine Quinapril Generic, Accupril
CENTRALLY ACTING Nitroprusside Generic, Nitropress Ramipril Generic, Altace
SYMPATHOPLEGIC DRUGS Trandolapril Generic, Mavik
CALCIUM CHANNEL
Clonidine Generic, Catapres, BLOCKERS ANGIOTENSIN RECEPTOR BLOCKERS
Catapres-TTS Amlodipine Generic, Norvasc Azilsartan Edarbi
Guanabenz Generic, Wytensin Clevidipine Cleviprex Candesartan Generic, Atacand
Guanfacine Generic, Tenex Diltiazem Generic, Cardizem, Eprosartan Generic, Teveten
Methyldopa Generic, Methyldopate Cardizem CD, Cardizem Irbesartan Generic, Avapro
HCl SR, Dilacor XL
POSTGANGLIONIC Felodipine Generic, Plendil Losartan Generic, Cozaar
SYMPATHETIC NERVE TERMINAL Olmesartan Benicar
BLOCKERS Isradipine Generic, DynaCirc, Telmisartan Generic, Micardis
Dynacirc CR
Guanadrel Hylorel Nicardipine Generic, Cardene, Valsartan Diovan
Guanethidine Ismelin Cardene SR, RENIN INHIBITOR
Reserpine Generic Cardene IV) Aliskiren Tekturna

C ASE STUD Y ANSWER

The patient has Joint National Committee stage 1 hyperten- Initial management in this patient can be behavioral,
sion (see Table 11–1). The first question in management is including dietary changes and aerobic exercise. However, most
how urgent is it to treat the hypertension. Cardiovascular patients like this will require medication. Thiazide diuretics
risk factors in this man include family history of early coro- in low doses are inexpensive, have relatively few side effects,
nary disease and elevated cholesterol. Evidence of end-organ and are effective in many patients with mild hypertension.
impact includes left ventricular enlargement on electro- Other first-line agents include angiotensin-converting enzyme
cardiogram. The strong family history suggests that this inhibitors, angiotensin receptor blockers, and calcium channel
patient has essential hypertension. However, the patient blockers. Beta blockers might be considered if the patient had
should undergo the usual screening tests including renal func- coronary disease or had labile hypertension. A single agent
tion, thyroid function, and serum electrolyte measurements. should be prescribed and the patient reassessed in a month.
An echocardiogram should also be considered to determine If a second agent is needed, one of the two agents should be a
whether the patient has left ventricular hypertrophy secondary thiazide diuretic. Once blood pressure is controlled, patients
to valvular or other structural heart disease as opposed to should be followed periodically to reinforce the need for
hypertension. compliance with both lifestyle changes and medications.