Adverse effects of antihypertensive drugs

What it is

The classes and their drugs:

• ACEI: lisinopril, captopril
• ARBs: losartan, valsartan
• CCB: amlodipine, nifedipine, verapamil. The non-dihydropyridines are verapamil and diltiazem; the dihydropyridines are amlodipine, felodipine and nifedipine
• Beta blockers: selective bisoprolol and atenolol; non selective propranolol and nadolol
• Diuretics: thiazide, loop furosemide, potassium sparing spironolactone

Each class has a side effect that is its own, and the exam asks you to match it back to the drug.

How it presents

ACE inhibitors: dry cough, hyperkalemia, angioedema, teratogenic. Also first dose hypotension, rash, and renal impairment. Contraindicated in pregnancy, in angioneurotic edema, in bilateral renal artery stenosis, and in stage 4&5 renal failure. If the patient has chronic cough and he is on ACEI, give him ARB - stop lisinopril and add losartan. ARBs: teratogenic, hyperkalemia, renal impairment. Beta blockers: bradycardia, hypotension, bronchospasm, CNS fatigue, lethargy and insomnia, and erectile dysfunction. Contraindicated in asthma - bronchospasm is the effect that carries that contraindication - and in grade 2 or 3 AV block. CCB: they work as peripheral vasodilators, so ankle and peripheral edema, flushing, dizziness, headache and hypotension, plus 1st degree AV block and constipation. Gingival hypertrophy is a CCB effect too: nifedipine, amlodipine and verapamil, more common with nifedipine, along with phenytoin and cyclosporine. Diuretics: hypokalemia, and hyperkalemia with the potassium sparing ones, hyperuricemia and hyponatremia. Thiazides such as hydrochlorothiazide give hypokalemic metabolic alkalosis, hyponatremia and hyperGLUC - hyperglycemia, hyperlipidemia, hyperuricemia, hypercalcemia - and are contraindicated in gout; so when a patient on several blood pressure drugs turns hyponatremic, hydrochlorothiazide is the one to name. Loop diuretics give ototoxicity, hypokalemia, hypocalcemia, hyperuricemia, dehydration and gout. Potassium sparing agents give hyperkalemia, gynecomastia and sexual dysfunction, though eplerenone does not carry the effect that leads to gynecomastia. Loops lose calcium; thiazides take it in. Both cause hypokalemia and hyperuricemia. Two class lines are worth setting out on their own, because they name the severe adverse effects as well as the common ones. Thiazide diuretics are contraindicated in anuria; their common adverse effects are dizziness and hypokalemia, and their severe adverse effects are cardiac dysrhythmias, cholestatic jaundice, new onset diabetes mellitus and pancreatitis. Calcium channel blockers are contraindicated in hypersensitivity to CCBs; their common adverse effects are flushing, peripheral edema and dizziness, and their severe adverse effect is angioedema.