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CARDIAC DRUG THERAPY - PART 4

Sự mất cân bằng mất nước và điện giải là những tác dụng phụ phổ biến nhất. Liều quá lớn nếu các dấu hiệu của mất nước hoặc hạ huyết áp tư thế đứng phát triển, hoặc nếu bệnh nhân đã tăng urê 10.0 mmol / L hoặc tăng 7,0 mmol / L so với ban đầu, mg 7 clorua 32 mEq (mmol) / L, và acid uric / dL (420 mmol / L) | 118 Cardiac Drug Therapy I Beta-blocker I ----Angina ----Silent ischemia ----Post Ml ----Preoperative ----Migraine ----Aneurysm b--Mitral valve prolapse I-Hyperlipidemia 3---LVH i---LV dysfunction II--Diabetest More common than angina in men 50 yr. Statin and beta-blocker or ACE inhibitor not alpha-blocker. fNot prone to hypoglycemia. ịNot renovascular. Fig. 8-6. Choice of antihypertensive agent in patients with coexisting diseases. Advice Adverse Effects and Interactions Contraindications Hypersensitivity to thiazides or sulfonamides. Anuria or severe renal failure. Pregnancy and breastfeeding see Chapter 20 . Concomitant lithium therapy. Adverse Effects These include the following 1. Dehydration and electrolyte imbalance are the most common adverse effects. The dose is too large if signs of dehydration or orthostatic hypotension develop or if the patient has increased urea 10.0 mmol L or an increase of 7.0 mmol L from baseline chlorides 94 mEq mmol L total carbon dioxide 32 mEq mmol L and uric acid 7 mg dL 420 qmol L . 2. Hypokalemia occurs in a significant number of patients receiving thiazides and contributes to increased risk of cardiac arrest 32 . Chlorthalidone causes a greater loss of potassium K than for equivalent doses of HCTZ. The incidence of hypokalemia can be decreased by the use of low-dose thiazide regimens with K -sparing diuretics. It is advisable to use the following a. A thiazide-K -sparing diuretic such as amiloride with HCTZ Moduretic Moduret if renal function is normal for patients aged 75 yr serum creatinine level 1.3 mg dL 115 qmol L for patients aged 75 yr serum creatinine level 1.0 mg dL 88 qmol L . Chapter 8 I Hypertension 119 b. If mild renal dysfunction exists hyperkalemia may occur with the use of K -sparing diuretics therefore a plain thiazide is recommended without potassium supplements. 3. If the physician does not wish to use the combination of amiloride and HCTZ Moduretic or the combination of triamterene and HCTZ Dyazide when .