Now with this table, we are going to quickly
run through this pharmaceutical agents that
are then appropriate to treat different parts
or different types of blood pressure. Thiazides,
we've talked about this already. First line usage,
patients with gout, pregnancy, electrolyte
disorders, avoidance be careful, please. Because
with thiazides, the fact that everyone is
not able to actually retain certain things.
And thiazide tell me about its effect on calcium.
It doesn't get rid of it, actually holds on
to it. Where does it work? I told you earlier,
works on the DCT. Works in the receptor that
PTH works upon and there is every possibility
that thiazide might actually reabsorb the calcium.
Keep that in mind. Beta-blockers, prior MI,
stable angina, atrial arrhythmia. What are
you trying to do in those patients? Well hypertension,
but then if it is stable angina, remember
what are you trying to do with this patient?
It is the fact that you are trying to decrease
the demand for oxygen by the heart instead
therefore by giving beta-blockers in stable
angina. Who is your patient? "Hey doc, walk
a couple of blocks and I have chest pain.
I stop and the pain then goes away." Exertional
angina stable. What might you want to do?
Beta-blocker, hypertension. These are issues.
But avoidance. If your patient already has
heart block, if it is some type of let's say
AV nodal type of blocks, why do you want
to use that a beta-blocker? There is every possibility
that you might stop the heart permanently.
Why would you want to do that? Sick sinus
syndrome. Same concept here as well. It is
the fact that you have arrhythmia in which
there is going to be a little bit of a gap,
as far as your EKG is concerned and you do
not want to stop the heart permanently. COPD,
remember please. If you stimulate your beta-2
receptors, albuterol, inhalers, what are they
going to do? Bronchodilate. So please make
sure that you pay attention to in great detail
as to when you use the beta-blocker to make
sure that your patient is not suffering from
bronchospasms because then you may exacerbate
it. Same thing with asthma. Let us continue.
ACE inhibitor. You tell me automatically, if your patient
has diabetes mellitus, ACE inhibitors would be a
good thing. ACE inhibitors would be contraindicated
in which patient please? Talked about this
a number of times. Atherosclerosis. Remember
the patient, in the body requires angiotensin II
to then preferentially work on which arterial?
Efferent. You constrict it. You are going
to restore GFR. And so therefore by giving
ACE inhibitor, all you are going to do
is exacerbate. So make sure that you pay
attention. Pregnancy, renal vascular hypertension
and angioedema are conditions in which you
try to avoid ACE inhibitors at all cost. Duffy
pregnancy because it is the teratogen, not
only is going to work on the pregnant lady,
but it is going to kill that fetus. You kill
the fetal kidneys and you don't want that.
ARBs, heart failure, diabetes, kidney disease
pretty much the same as you hear as well. Calcium
channel blockers, atrial arrhythmia and especially
Raynaud syndrome. When is your patient Raynaud?
They walk out into the cold. When they walk
out in the cold, what make then happen to
the fingers? You may then have aggregation.
You might actually have cryoglobulinemia. And
when you do so, then what then happens to the digits?
The digits then may become bluish and cyanotic.
Welcome to Raynauds. And so, therefore, you
are thinking about using calcium channel blocker.
However, avoidance once again, heart block,
sick sinus, pregnancy and heart failure. Aldosterone
receptor blockers and you have once again
prior MI, heart failure. Pregnancy and hyperkalemia,
definitely avoid by giving, remember, don't
forget this. Aldosterone normally exists to
get rid of your potassium. If your patient
already has hyperkalemia, may be secondary
to renal failure, and you give an aldosterone
blocker, the effects of aldosterone had been
lost. What are you going to do? You are going
to exacerbate the hyperkalemia. And what is that
going to affect? It is going to affect your
heart. Isn't that the number one organ that
you worried about? Absolutely and so, therefore,
you might have T tenting as you should know.