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antihypertensive drugs Flashcards

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1
Q

what is the mechanism of action of beta blockers?

A

block the beta adrenoreceptors in the heart, bronchi, pancreas, liver and peripheral vasculature [blood vessels outside of heart]

slow the heart and depress myocardium [heart muscles]

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2
Q

which beta receptors are found in the heart and in the lungs?

A

1 heart = B1

2 lungs = B2

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3
Q

what are ISA beta blockers and what do they do?

A

intrinsic sympathomimetic activity beta blocker

they stimulate and also block adrenergic receptors

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4
Q

what are the 2 benefits of ISA beta blockers?

A

less bradycardia and less coldness of extremities

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5
Q

give examples of ISA beta blockers [4]

A

ICE PACO

Pindolol
acebutolol
celiprolol
oxprenolol

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6
Q

what is the benefit of water soluble beta blockers?

what organ are they excreted by?

A

do not enter the blood brain barrier so cause less sleep disturbance and nightmares!

kidneys

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7
Q

give examples of water soluble beta blockers [4]

A

cans

celiprolol
atenolol
nadolol
sotalol

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8
Q

what are cardio SELECTIVE beta blockers and where do they work?

which patients are they used on?

A

they have less effects on the B2 receptors in the lungs, and work more the heart B1 receptors.
it is selective but not specific so can still affect B1 heart receptors.

can be used in hypertension in asthmatics when there is no other alternative

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9
Q

what are the examples of the cardio selective beta blockers? [4]

A

be a man

bisoprolol
atenolol
metoprolol
acebutol
nebivolol
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10
Q

give an example of a non cardioselective beta blocker [1]

A

sotalol

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11
Q

how often a day do short acting beta blockers have to be taken?

A

2/3 times a day

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12
Q

how often a day do long acting beta blockers have to be taken?

A

once daily

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13
Q

give examples of long acting beta blockers [4]

A

BACoN

bisoprolol
atenolol
celiprolol
nadolol

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14
Q

what are the side effects of beta blockers? [8]

A 
coldness of extremities [not with ISA]
fatigue
hyperglycaemia or hypoglycaemia
sleep disturbances/nightmares [not with water soluble]
hypotension
bradycardia
bronchoconstriction
masks signs of hypoglycaemia
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15
Q

can beta blockers be given to asthmatics?

if so which types of asthmatics?

A

yes but only if no other alternative
must only use cardioselective
only to patients with well controlled asthma

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16
Q

can beta blockers be given to asthmatic patients for co-existing conditions such as HF and following MI?

A

give cardioselective beta blocker at lowest dose by specialist and monitor pt for S/E

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17
Q

can beta blockers be used in diabetic patients?

A

yes but with caution and cardio selective beta blockers be used.

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18
Q

why are beta blockers to be used with caution in diabetic patients?

A

can cause hypo or hyperglycaemia

can mask symptoms of hypoglycaemia

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19
Q

what are the uses of beta blockers? [9]

A 
arrythmia
heart failure
hypertension
angina
myocardial infarction
anxiety
migraine prophylaxis
thyrotoxicosis
glaucoma
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20
Q

which beta blocker is used for anxiety?

A

propanolol

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21
Q

which beta blocker is used for arrythmia?

A

sotalol and esmolol

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22
Q

which beta blocker is used for migraine prophylaxis?

A

propanolol

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23
Q

what are the contra indications of beta blockers? [4]

A

worsening unstable heart failure
patients with 2nd or 3rd degree heart block [arrythmia]
pt with history of asthma, bronchospasm, obstructive airway disease
frequent episodes of hypoglycaemia

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24
Q

what are the cautions of beta blockers? [7]

A

pt with 1st degree AV heart block
diabetics
concurrent use with verapamil and diltiazem [can cause heart block]
stable heart failure
symptoms of thyrotoxicosis and hypoglycaemia
pt with severe hypotension and bradycardia
may reduce response to adrenaline

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25
what are the 2 important interactions of beta blockers?
1. iv verapamil and beta blockers increase risk of hypotension and heart failure 2. concurrent use with verapamil or rate limiting CCB such as diltiazem as can increase risk of heart block
26
what is the mechanism of action of calcium channel blockers?
interfere with inward displacement of calcium ions
27
what are the 3 different classes of CCBs?
benzothiapines dihydropines phenylaklyamines
28
give some examples of the dihydropyridines CCB drug class. [5] how do they work?
amlodIPINE, nifediPINE, lercanidipine, lacidipine and felodipine work by relaxing smooth muscle and widening vessels. no anti-arrhythmic effects and do not work directly on heart
29
which 2 CCBs should be brand specific for the MR preparations?
amlodipine and nifedipine
30
give an example of phenylaklyamine CCB how do they work?
verapamil minimal vasodilatory effects but does have cardiac depressant effects [slow heart rate] so can cause heart failure
31
what side effect can verapamil cause?
constipation
32
give an example of a benzothiapine CCB? | how do they work?
diltiazem have BOTH vasodilatory and cardiac depressant effects
33
which other drugs should benzothiazepines [eg diltiazem] be used with caution with and why?
beta blockers bc high risk of bradycardia
34
do CCB reduce risk of myocardial infarction in unstable angina?
no
35
when is verapamil and diltiazem used in unstable angina?
when pt are resistant to treatment with beta blockers
36
why is the sudden withdrawal of beta blockers bad in pt with unstable angina?
may worsen angina and lead to heart attack
37
what are the 2 prescribing and dispensing informations regarding diltiazem?
1: different versions of MR dilitazem containing more than 60mg may not have the same clinical effect 2. prescribers should prescribe by brand to prevent confusion
38
give 3 examples of other anti-anginal drugs
nicorandil ivabradine ranolazine
39
what are nicorandil, ivabradine and ranolazine used to treat?
long term treatment of angina
40
what are the side effects of calcium channel blockers? [7]
``` ankle swelling flushing headaches postural hypotension dizziness GI reactions skin reactions ```
41
what is the mechanism of action of thiazide like diuretics?
inhibit sodium reabsorption in the distal convulated tubule
42
what is the onset of action of thiazide diuretics and how long do the effects last for?
onset: 1-2 hours lasts for 12-24 hours
43
when during the day should thiazide diuretics be given and why?
in the morning to prevent diuresis [increased urination that interferes with sleep]
44
what are low doses of thiazide diuretics used to treat? what are high doses of thiazide diuretics used to treat?
low: used to lower blood pressure high: used for oedema due to coronary heart failure
45
what are the 3 examples of thiazide diuretics?
BIC bendroflumethiazide indapamide chlortalidone
46
what are the contraindications of thiazide diuretics? [4]
HYPOnatraemia HYPOkalaemia HYPERcalcaemia addisons disease [bc already low sodium and high potassium levels]
47
what are the side effects of thiazide diuretics? [4]
postural hypotension constipation [lose lots of water] electrolyte imbalance headaches
48
can thiazide diuretics be used to treat hypertension in pregnant women? what is the risk of them in pregnant women?
no should not be used to treat gestational hypertension can cause neonatal thrombocytopenia, bone marrow suppression, jaundice, electrolyte imbalance
49
can thiazide diuretics be used with hepatic and renal impairment?
use with caution in impairment | avoid in severe liver disease
50
what egfr rate should thiazides and related diuretics NOT be used in?
egfr of under 30 - avoid diuretics
51
what are the cautions of thiazide like diuretics?
Hypokalaemia elderly more susceptible to side effects so lower doses adjust according to renal failure [cautioned in renal impairment]
52
why is hypokalaemia bad in hepatic failure?
can lead to encephalopathy [brain damage] particularly in alcoholic cirrhosis
53
what 2 conditions can thiazide diuretics really worsen and how?
gout and diabetes | can cause hyperglycaemia and hyperuricaemia
54
what is the mechanism of action of loop diuretics?
inhibit reabsorption from the ascending loop of henle
55
give 2 examples of loop diuretics?
furosemide | bumetanide
56
in what conditions can loop diuretics be used to treat? out of loop and thiazide diuretics, which are more potent?
pulmonary oedema loop diuretics
57
are loop diuretics safe in diabetes?
no can worsen diabetes and gout
58
what is the onset of action of furosemide and bumetanide? | when is diuresis complete? therefore how often during the day can they be given?
onset of 1 hour diuresis complete within 6 hours can be given TWICE daily without interfering sleep
59
what are the side effects of loop diuretics? [6]
``` headache nausea electrolyte imbalance dizziness muscle spasm fatigue ```
60
what are the contraindications of loop diuretics? [4]
renal failure severe hypokalaemia severe hyponatraemia liver cirrhosis
61
which 2 diuretics can stain your urine slightly blue?
furosemide and triameterene [potassium sparing]
62
how can high doses of loop diuretics or rapid IV administration damage pt with renal impairment?
bc can cause tinnitus and deafness
63
give examples of potassoum sparing diuretics? give examples of aldosterone antagonist
amiloride and triamterene spironolactone and eplerenone
64
what can both potassium sparing diuretics and ace inhibitors cause a risk of?
severe hyperkalaemia
65
which supplements must NOT be given with potassium sparing diuretics?
potassium supplements
66
what are the side effects of spironolactone? [3]
electrolyte imbalance gynaecomastia hyperkalaemia
67
what is combination diuretic therapy?
strong diuretic [eg furosemide] used together with weak diuretic [eg amiloride] for pt with resistant oedema
68
what type of diuretic is mannitol? what is it used to treat?
osmotic diuretic to treat cerebral oedema and raised intraocular pressure
69
why are mercurial diuretics hardly used?
high risk of nephrotoxicity
70
what is the diuretic acetazolamide used to treat?
mountain sickness prophylaxis
71
what are the eye drops dorzolamide and brinzolamide [diuretics] used to treat?
glaucoma
72
what is the mechanism of action of angiotensin converting enzyme inhibitors? [ACE]
convert angiotensin 1 to angiotensin 2
73
what are some indications of ACE inhibitors? [4]
heart failure hypertension diabetic nephropathy prophylaxis of CV events
74
what are the 2 contraindications of ACE inhibitors?
1. concurrent use of ace and aliskiren in pt with diabetes or with egfr under 60 2. discontinue if any jaundice/ signs of hepatic impairment occur
75
what are the cautions of ace inhibitors?
afro-carribean pt bc risk of oedema concomitant use with diuretics bc can drop BP renal impairment [low dose first]
76
can ace inhibitors be given in pregnancy and why?
no avoid can cause skull defects, neonatal BP and renal function
77
why should ace inhibitors be avoided during dialysis?
can cause anaphylactoid reactions
78
what is the pt and carer advice for ace inhibitors?
take dose sitting down to prevent hypotension as first dose hypotension can occur
79
what is the monitoring requirements of ace inhibitors [2]
renal function | electrolytes
80
what are the directions for administration of ace inhibitors for HYPERTENSION?
take FIRST dose at night time!
81
which other heart meds should be discontinued before starting ACE inhibitors because of risk of hyperkalaemia?
potassium sparing diuretics or potassium supplements
82
in which patients should ACE inhibitors be constantly monitored in? [8]
``` pt with severe heart failure pt on high dose or multiple diuretics pt receiving concomitant use with aliskiren pt with hypovolaemia unstable heart failure renovascular disease hyponatraemia hypotension ```
83
what are the side effects of ace inhibitors? [7]
``` persistent dry cough GI problems skin reactions alopecia constipation electrolyte imbalance angiodema ```
84
can ace inhibitors be used in renal impairment?
use with caution - use low dose then titrate upwards
85
what can concomitant use of ace inhibitors and NSAIDs cause a risk of?
risk of renal damage
86
what 2 things should be checked before starting ace inhibitors?
renal function | electrolytes
87
give examples of ARB inhibitors? what is the mechanism of action?
candesartan, irbesartan, losartan, valsartan angiotensin 2 receptor antagonist
88
can ARB inhibitors be used in pregnancy?
avoid
89
what are the 2 cautions of arb inhibitors?
caution in renal impairment and in the elderly
90
what are the side effects of arb inhibitors? [3]
hyperkalaemia hypotension dizziness
91
give an example of a renin inhibitor what is the mechanism of action?
aliskiren inhibit renin [which converts angiotensin to angiotensin 1]
92
which drug should NOT be used in conjuction with aliskiren and why?
ace inhibitor | bc can lead to risk of hyperkalaemia, hypotension or renal impairment

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