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Alle Oberthemen / Medicine / Pharmacology / PharmaSkills
4
Do I need to consider differences among the different members of a given class of antihypertensives?
● Yes. Prescribe drugs which are sufficiently effective if given once daily, as this improves therapy adherence. For example, prescribe the long-acting angiotensin converting enzyme inhibitor ramipril rather than the short-acting captopril. Likewise, among calcium channel blockers amlodipine is favored over nifedipine. Due to the slower effect onset, amlodipine causes less reflex tachycardia and is safer in patients with latent or manifest coronary heart disease.
● If applicable and possible, choose a drug effective against co-morbidities frequently associated with or resulting from hypertension. For example, ramipril is prescribed so frequently for hypertension due to its proven effects against diabetic nephropathy, myocardial infarction, and congestive heart failure. The only calcium channel blockers considered safe for hypertensive patients with congestive heart failure are amlodipine and felodipine. The effectiveness against congestive heart failure favors using metoprolol succinate, bisoprolol, and carvedilol over other beta blockers.
● Antihypertensives differ in efficacy and side-effects. Atenolol is inferior to the aforementioned beta blockers, probably due to the absence of CNS effects caused by its poor lipophilicity. Propranolol causes more bronchospasms due to its non-selectivity towards towards ß1 receptors and is considered obsolete against hypertension if other drugs are at your disposal.
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Karteninfo:
Autor: LWojnowski
Oberthema: Medicine
Thema: Pharmacology
Schule / Uni: University Clinical Center
Ort: Mainz
Veröffentlicht: 24.05.2013

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