heart med 3 Flashcards
Management
of
hypertension
Aim of treatment is
to reduce blood
pressure and reduce cardiovascular
events and reduce premature
mortality
Antihypertensive drugs act to .
reduce cardiac output (CO) and/or peripheral vascular resistance (PVR)/total peripheral resistance (TPR)
Management of hypertension drugs
ACE inhibitors Angiotensin II receptor blockers Calcium channel blocker Thiazide diuretics Beta adrenergic receptor blockers
ACE inhibitors
Mechanism of action
Example
Adverse effects
Mechanism of action
• Blocks the conversion of angiotensin I into angiotensin II resulting in reduced PVR and decreased BP. The fall in
angiotensin II and consequently in aldosterone, promotes diuresis.
• Inhibits degradation of bradykinin leading to accumulation of both bradykinin and substance P sensitising airways and
producing cough
Example
•Enalapril, Captopril, Perindopril, Lisinopril
Adverse effects – hypotension, palpitations, tachycardia, dizziness, vertigo, abdominal pain, persistent non-productive
cough
Angiotensin II receptor blockers
Mechanism of action
Example
Adverse effects
Mechanism of action
•Antagonise angiotensin II receptors on vascular smooth muscle and adrenal cortex (responsible for vasoconstriction and
regulation of salt and water)
•Increases renal blood flow and maintains/increases glomerular filtration rate while decreasing renal vascular resistance
Example
•Irebesartan, Losartan
Adverse effects – hypotension, palpitations, tachycardia, dizziness, headache, depression, fatigue, back pain, arthralgia,
flu-like symptoms
Calcium channel blocker
Mechanism of action
Example
Adverse effects
Mechanism of action
•Dilates peripheral arteries and arterioles, reducing PVR and therefore BP
• Impede the influx of calcium ions through slow channels of cell membrane during depolarisation of cardiac and vascular
smooth muscle improving myocardial oxygen supply and CO and reducing myocardial word by reducing afterload
•Dilates coronary arteries
•Divided into 3 types (Phenylalkylamine, benzothiazepine, dihydropyridine)
Example
• Amlodipine, Felodipine, Nifedipine, (dihydropyridine), Verapamil (Phenylalkylamine), Diltiazem (benzothiazepine)
Adverse effects –Dizziness, headache, AV block, palpitations, tachycardia, hypotension, exacerbation of angina
Thiazide diuretics
Mechanism of action
Example
Adverse effects
Mechanism of action
• Increase renal sodium and chloride excretion leading to a fall in blood volume and CO
• These drugs may also have vasodilating properties which contribute to their antihypertensive effects
Example
• Metalozone, Hydrochlorothiazide, Chlortalidone
Adverse effects – electrolyte disturbance (hypokalaemia, hyponatraemia etc), hypovolaemia, dehydration, dizziness, vertigo,
blurred vision, hypotension, increased serum cholesterol
Management
of heart
failure
Aim of treatment is to
improve QoL
by reducing symptoms, lengthen
survival and slow the progression of
cardiac deterioration
Management
of heart
failure Primarily drug therapies
modify the
activation of the renin-angiotensin
system that occurs in response to a
decrease in CO
Management of heart failure
ACE and ARB Diuretics Cardiac glycoside Beta adrenergic receptor blockers Vasodilators
Diuretics Mechanism of action Example Adverse effects Management of heart failure
Mechanism of action
•Depends on site of action but in general they reduce fluid accumulation by increasing renal salt and water excretion. Preload, pulmonary congestion and
systemic oedema are thereby relieved
Example
•Frusemide (Loop diuretic) Metalozone, Hydrochlorothiazide, Chlortalidone (Thiazide diuretic), Spironolactone (potassium-sparing diuretic)
Adverse effects – depends on drug type
Cardiac glycoside Mechanism of action Example Adverse effects Management of heart failure
Mechanism of action
•Inhibit the sodium pump in cardiac muscle and increase intracellular sodium and also calcium which enhances cardiac contractility
Example
•Digoxin
Adverse effects – nausea and vomiting, diarrhoea, abdominal pain, bradycardia, arrhythmia, dizziness, headache, drowsiness
Vasodilators Mechanism of action Example Adverse effects Management of heart failure
Mechanism of action
• Depends on site on drug but in general they reduce afterload, increasing CO
• Dilate arterioles of the kidney, increasing perfusion and fluid loss
• Decrease BP and preload
Example
• Frusemide (Loop diuretic) Metalozone, Hydrochlorothiazide, Chlortalidone (Thiazide
diuretic), Spironolactone (potassium-sparing diuretic)
Adverse effects – depends on drug type
