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CPT > CVS > Flashcards

CVS Flashcards

1
Q

What are the primary hypertension therapeutic agents?

A
  • ACEi
  • ARBs
  • CCBs
  • Diuretics thiazide and thiazide-like)
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2
Q

Lisinopril

A
  • ACEi
  • given orally
  • for hypertension
  • short-term treatment following MI
  • for type 2 diabetes
  • NOT for patients of Afro-Caribbean descent or over 55
  • side effects: hypotension, dry cough, hyperkalaemia, renal failure, POSTURAL disorder
  • renal function and electrolytes should be checked beforehand
  • warnings: renal artery stenosis, AKD, pregnancy, breastfeeding, CKD
  • important interactions: increases with K+drugs, NSAIDs, other antihypertensive agents
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3
Q

Ramipril

A
  • ACEi
  • side effects: hypotension, dry cough, hyperkalaemia, renal failure, angioedema, MuSCLE SPASMS, GI disorders
  • warnings: renal artery stenosis, AKD, pregnancy, breastfeeding, CKD, can cause hepatic impairment
  • important interactions: increases with K+ drugs, NSAIDS, other antihypertensive agents
  • give orally
  • for patients with heart failure, nephropathy
  • to prevent CVS events in patients with type 2 DM or atherosclerosis
  • not for Afro-Caribbean or over 55
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4
Q

Candesartan

A
  • ARB
  • AT1 receptor blocker
  • no effect on bradykinin
  • side effects: hyperkalaemia, hypotension, cough, increased risk of infection
  • oral
  • warnings: renal artery stenosis, AKD, pregnancy, breastfeeding, CKD, hepatic impairment
  • important interactions: increases with K+ drugs, NSAIDS, other antihypertensive
  • used for hypertension with intravascular volume depletion, heart failure with impaired left ventricular systolic function, migraine prophylaxis
  • not for Afro or over 55
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5
Q

Losartan

A
  • ARB
  • no effect on bradykinin so decrease in dry cough and angioedema
  • warning: renal artery stenosis, AKD, pregnancy, breastfeeding, CKD, hepatic impairment
  • important interaction: increases with K+ drugs, NSAIDs, other antihypertensive
  • side effects: hypotension, hyperkalemia, dizziness, ANAEMIA, HYPOGLYCAEMIA
  • oral
  • used for diabetic nephropathy in type 2, chronic heart failure when ACEi dont work, hypertension with intravascular volume depletion
  • not for Afro or over 55
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6
Q

What are the different classes of CCB?

A

Dihydropyridines

  • selective for peripheral vasculature
  • little chronotropic or inotropic effects
  • first line CCB for hypertension
  • cerebral vs peripheral selectivity

Phenylalkyamine

  • depresses SA node and slows AV conduction
  • negative inotropy

Benziothiazapines

  • have action on myocardium and some on pacing cells
  • effects on vascular smooth muscle

PRIMARY CHOiCE ANTIHYPERTENSIVE IN LOW RENIN PATIENTS

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7
Q

Amlodipine

A
  • CCB
  • long half-life compared to others
  • oral
  • used for prophylaxis of angina, hypertension
  • side effects: ankle swelling, flushing, headaches (vasodilation), palpitations, (compensatory tachycardia), VISION DISORDERS
  • warnings: unstable angina, severe aortic stenosis, hepatic impairment, pregnancy, breastfeeding
  • important interactions: with Siva statin (will increase statin effect), other antihypertensive
  • stop treatment if there is exacerbation of myocardial ischaemia
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8
Q

Nifedipine

A
  • CCB (dihydropyridine)
  • side effects: ankle swelling, flushing, headaches (vasodilation), palpitations, constipation
  • warnings: unstable angina, severe aortic stenosis, hepatic impairment, pregnancy, breastfeeding
  • important interactions: other antihypertensive
  • oral, take with a meal
  • stop if exacerbation of myocardial ischaemia
  • used for Raynauds syndrome, postponement of premature labour, chronic anal fissure
  • not for diabetics, over 55 or heart failure
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9
Q

Nimodipine

A
  • CCB (dihydropyridine)
  • selectivity for cerebral vasculature (sub-arachnoid haemorrhage)
  • side effects: ankle swelling, flushing, headaches (vasodilation), palpitations, thrombocytopaenia
  • monitor drug in renal impairment
  • stop if exacerbation of myocardial ischaemia
  • warnings: unstable angina, severe aortic stenosis, hepatic impairment, renal impairment, pregnancy, breastfeeding
  • important interactions: other antihypertensive
  • oral
  • use for defects following subarachnoid haemorhhage,
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10
Q

Verapamil

A

-CCB (phenylalkylamine)
-prolongs the action potential
-less peripheral vasodilation, negative chronotropic and inotropic effects
-used for: arrhythmia, angina, hypertension
-side effect: constipation, bradycardia (IV), heart block and cardiac failure, hypotension
-stop if exacerbated myocardial ischaemia
-warning: poor LV function, AV nodal conduction delay, hepatic impairment, pregnancy, breastfeeding
-important interactions: B blockers, other antihypertensive and antiarrhythmic
-oral or IV
-

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11
Q

Diltiazem

A
  • CCB (benzothiazipine)
  • oral
  • used for angina and chronic anal fissure
  • avoid if bradycardia
  • side effect: palpitation, drowsiness, headache, malaise, constipation
  • stop if exacerbated myocardial ischaemia
  • warning: hepatic impairment, renal impairment, pregnancy, breastfeeding
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12
Q

Bendroflumethiazide

A
  • thiazide diuretic
  • inhibits Na/Cl co-transporter in DCT
  • more useful over CCB in oedema, used for hypertension
  • side effects: hypokalaemia, hyponatremia, hyperuricaemia, arrhythmia, increase in glucose cholesterol and triglyceride
  • warnings: hypokalaemia, hyponatremia, gout, hepatic and renal impairment, pregnancy, breastfeeding
  • important interactions: NSAIDS, decrease in K+ drugs
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13
Q

Indapamide

A
  • thiazide diuretic
  • useful for oedema and hypertension
  • side effects: hypokalaemia, hyponatremia, hyperuricaemia, arrhythmia, increase in glucose, cholesterol and triglyceride, skin reactions
  • don’t use if sensitive to sulfonamides
  • warning: hypokalaemia, hyponatremia, gout, Addison’s disease, hepatic and renal impairment, pregnancy, breast-feeding
  • important interaction: NSAIDs, decrease with K+ drugs
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14
Q

Spironolactone

A
  • for resistant hypertension
  • aldosterone receptor antagonist
  • warning: hyperkalaemia, addisons, renal impairment, pregnancy, breast-feeding
  • important interaction: increase with K+ drugs, ACEi and ARB
  • oral
  • use for oedema, ascites, nephrotic syndrome, primary hyperaldosternosim
  • side effects: leg cramps, menstrual disorder, malaise, breast neoplasm
  • use a and b blockers if high K+
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15
Q

Labetalol

A
  • B blocker
  • decreases CO by reducing myocardial contraction
  • decreases renin secretion in B1
  • warning: asthma, COPD, haemodynamic instability, hepatic failure, hepatic and renal impairment, pregnancy, breastfeeding
  • important interaction: non-di CCB, asystole
  • side effects: bronchospasm, heartblock, raynauds (cold hands), lethargy, impotence, liver damage, ejaculation failure
  • when stopping b blockers, it must be gradual
  • oral or IV
  • used for hypertension in PREGNANCY, hypotension in anaesthesia, hypertension following MI
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16
Q

Bisoprolol

A
  • B blocker
  • side effect: bronchospasm, heart block, raynauds, lethargy impotence, mask tachycardia (sign of insulin induced hypoglycaemia), CONSTIPATION
  • caution if allergy
  • warning: asthma, COPD, haemodynamic instability, hepatic failure, renal impairment, pregnancy, breastfeeding
  • important interaction: non-di CCB
  • oral and used for hypertension, angina, heart failure
17
Q

Metoprolol

A
  • B blocker
  • side effect: bronchospasm, heart block, Raynaud’s, lethargy, impotence, mask tachycardia, constipation and palpitations
  • warning: asthma, COPD, haemodynamic instability, hepatic failure, pregnancy, breastfeeding
  • important interaction: non-di CCB, asystole
  • oral
  • used for hypertension, angina, arrhythmia, migraine, hyperthyroidism
18
Q

Doxazosin

A
  • alpha blocker
  • selective anatagonsim of a-1
  • reduced peripheral vascular resistance
  • urinary tract including bladder neck and prostate (BPH: tamsulosin)
  • relatively safe in renal disease
  • side effect: postural hypotension, dizziness, syncope, headache, fatigue
  • warning: postural hypotension, hepatic impairment, pregnancy, breastfeeding
  • important interaction: dihydropyridine CCB (oedema)
  • oral
  • used for hypertension and BPH
  • use with care for elderly
  • may affect driving skills
19
Q

Furosemide

A
  • for chronic heart failure
  • offer diuretic for congestive symptoms and fluid retention ‘
  • oral or iv
  • for oedema or resistant hypertension
  • caution with elderly, K+ loss, urinary retention
  • loop diuretic
  • side effect: nausea, dizziness, fatigue, metabolic alkalosis
  • warning: hepatic and renal impairment, pregnancy, breastfeeding
20
Q

Acetazolamide

A
  • carbonic anhydrase inhibitor
  • weak diuretic
  • mainly used for prophylaxis against mountain sickness
  • used for glaucoma and epilepsy
  • oral
  • side effect: metabolic acidosis
  • warning: renal and hepatic impairment, breastfeeding, pregnancy
21
Q

Mannitol

A
  • osmotic agent
  • gets rid of water
  • iv or inhalation
  • for cerebral oedema, raised intra-ocular pressure
  • side effects: cough, headache, vomiting
  • assess cardiac function before treatment
  • warning: renal impairment, pregnancy, breast-feeding
22
Q

SGLT2 inhibitors

A
  • helps to get rid of uric acid
  • natriuretic
  • inhibits Na/glucose co-transporter
  • decreases plasma glucose, body weight, bp, plasma uric acid
23
Q

Tolvaptan

A
  • ADH antagonist
  • V2 receptor antagonist
  • diuretic but NOT natriuretic
  • used to treat hyponatremia
  • oral
  • side effects: hepatic disorders, dizziness, dry mouth, dehydration, palpitations
  • warnings: hepatic and renal impairment, pregnancy, breastfeeding
  • lithium also does it as a side effect

CPT (16 decks)

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