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Diuretics and antihypertensives Flashcards

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1
Q

K sparing diuretic examples

A

Amiloride hydrochloride

Triamterene

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2
Q

Use of k sparing diuretics

A

If k levels becoming low- retains K

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3
Q

Diuretic for pulmonary oedema

A

Furosemide and loop diuretics

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4
Q

Loop diuretics and where do they act

A

Furosemide
Bumeranide
Torasemide

Act in loop of henle NaK Cl transporter

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5
Q

Side effects of diuretics

A

Monitor K levels
Most diuretics - cause Na retention and K excretion –> hypokalaemic
K sparing - can cause hyperkalaemia

Nephrotoxic so stop in AKI

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6
Q

Nephrotoxic drugs

A 
Diuretic
ACE in
Aminoglycosides
Penicillins
Metformin
NSAIDs
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7
Q

Thiazides, example and when used

A

Bendroflumethiazide
Used in HTN
Don’t use in renal failure

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8
Q

Other thiazides

A

Chlortalidonel

Metolazine

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9
Q

Use of k sparing diuretics

A

Use with other diuretics to balance k levels

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10
Q

Where do k sparing diuretics act

A

ENAc channels in LDT and CD

Inhibits Na Channels

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11
Q

How do aldosterone antagonists work and when used

A

Antagonise aldosterone formation of ENAc channels in LDT and CD
Spironolactone
Eplernone

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12
Q

Cerebral oedema

A

Mannitol osmotic diuretic

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13
Q

Where does mannitol act

A

PCT and throughout by altering osmolarity (increases solute concentration in the nephron therfore promoting water to stay in the nephron and get excreted- it reduces its reuptake

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14
Q

Diuretic used to treat glaucoma

A

Acetazolamide

Carbonic anhydrase inhibitor-

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15
Q

Mechanisms of ca inhibitors

A

PCT prevents HCO uptake and Na

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16
Q

Which drugs should you monitor and use with caution with thiazides diuretics

A

Hypokalameia - digoxin and steroids

B blockers- hyperglycaemia

Carbamazepine- caution of low Na (epilepsy)

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17
Q

Diuretic for chronic HF

A

Loop furosemide bumetanide

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18
Q

Diuretic for uncontrolled HTN

A

Spironolactone

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19
Q

When would you not use furosemide or bumetanide

A

Liver cirrhosis
Renal failure
Hypercalcaemia
With other drugs causing hyponatraemia or hyperkalaemia

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20
Q

Effects of hyperkalaemia

A

6.5-8.0: Can cause a fib and ectopic beats. St elevation.

Later chases widening of QRS, and can cause ventricular fibrillation, bundle branch block and or axis deviation

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21
Q

ECG changes inn hyperkalaemia

A

Early: tall peaked t waves, prolonged PR

Mid: st elevation, loss of p waves, ectopic beats

Late: QRS widening, wide sine wave, axis deviation and ventricular fibrillation

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22
Q

Effects of hypokalamea

A 
Mild <3.5
Muscle cramps, weakness and fatigue, 
Delirium and psychological symptoms
Palpitations 
Severe: arrhythmias bradycardia, cardiovascular collapse
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23
Q

Signs of hypoklamaeia in ecg

Study These Flashcards
A

Prolonged OR interval
ST depression
U wave
Shallow T wave

24
Q

First line treatment for >55 year old with HTN

Study These Flashcards
A 
Ca channel blocker
Or diuretic (thiazides)
25
Example of ca channel blocker
Dihydrooyridines e.g, amlodipine | Nifedipine
26
First line treatment for under <55years with HTN
Ace in | Or ARB
27
Ace in
Lisinopril | Ramopril
28
ARB
Losartan | Valsartan
29
Second line medications for hypertension | Name examples
``` ACE in & (Ca channel blocker or diuretic) Lisinopril and (amiopidine or lorsartan) ```
30
How would you manget HTN if first and second line treatments are ineffective
All three - acein calcium and diuretic | Then add in additional diuretic beta blocker or alpha blocker
31
Which diuretic can be used in add on therapy for HTN
Aldosterone antagonists e.g. Spironolactone
32
General management for HTN
Treat any underlying cause Treat risk factor and co morbidities Reduce salt limit alcohol excercise stop smoking etc Then pharm
33
When do you treat HTN?
Bp >160/80 | Or over 140 if risk factors
34
Why are certain drugs preferred to treat hypertension in elderly patients?
Ca banner blockers or diuretics preferred in elderly or Afro Caribbean because they don't cause sodium retention and therfore fluid retention Better if co morbidities such as renal failure, or heart failure, or Ischaemia heart disease
35
How do ACEin work
Inhibit formation of ACE from the kidney and pulmonary endothelium, Prevents formation of AT2 and its effects - symptwthetic, aldosterone secretion --> Na reabsorption and h20 retention, vasoconstriction, ADH secretion(post pit--> collecting duct h20 reabsoption)
36
Use of ACEin
HTN in <55s or add on therapy HF HTN in pregnancy
37
Side effects of ACEin and name some ACEin
Lisinopril Ramopril Dry cough, angio oedema, renal failure hyperkalaemia
38
Drugs of choice in heart failure
``` Treat cause- e.g. Valve disease, arrhythmias. Treat exacerbating factors e.g. Infection, thyroid disease Diuretic Ace in/ARB B blockers Aldosterone antagonists Digoxin Vasodilators ```
39
Examples of ARB and their use
Losartan, valsartan HTN in the over 55/s HF with lv systolic problems Pregnancy HTN
40
Mechanism of ca channel blockers
Act in the heart Cardiac smooth muscle- vasodilation Cardiac nodal tissue- slow conduction - slow chronotrohy Myocardium- reduce contraction velocity- inotrophy
41
What is verapamil and what is its use
Ca channel blocker - class 5 antihypertensives Slightly different from amilopidine and less effective in HF. Use in a fib as more cardiac selective and slows the SAN and AVN conduction
42
Side effects of ca channel blockers- how do they vary and when to use each
Amilopidine - SNS activation so palpitations, tachycardia, swearing, oedema. Can cause increased tachycardia as baroreceptor reflexes activation Verapamil and benzothiazepines - bradycardia and worsen heart failure.
43
Use of calcium channel blockers
Amilopidine- heart failure (Ischaemia) and HTN. Short acting , good in renal failure. Caution if tachycardic. Verapamil- anti arrhythmic, used for atrial fibrillation and stable angina, Depresses SAN and slows av conduction. Can worsen heart failure, causes bradycardia. Benzothiazepines- similar to above, reduce ca transport across myocardium and slows conduction. Causes bradycardia- can worsen HF
44
Side effects of verapamil
Bradycardia Constipation Reduced contractility worsening heart block
45
What drug should you not use with verapamil
Beta blocker s
46
Side effects of thiazides like diuret it's
Hypokalaemia- k excreted Increased urea and Uric acid levels Impaired glucose tolerance- unknown cause Cholesterol and TAG levels increased- more converted from glucose Don't use with beta blockers cos glucose
47
Side effects of beta blockers
beta blockers: reduced adrenaline, reduces gluconeogenesis and utilisation and can mask hypoglycaemia
48
Example of alpha blocker and when used
Dizazosin Last resort HTN. BPH
49
Side effects of doxazosin
``` Use in BPH and can use in HTN postural hypotension Dizziness Headache Fatigue Oedema ```
50
Mechanism of alpha blockers
Selective antagonism NA in vascular smooth muscle. Reduce resistance, Doesn't effect lipids and glucose so fine in DM.
51
New vasodilators used in HTN - name and mechanisms
Aliskrin Bind to renin and prevent cleavage into AT--> AT1 Therfore reduces activity Causes vasodilation
52
Use of aliskrin Contraindications of its use
Hypertension not responding to other treatments Don't use in heart failure renal problems Don't use with furosemide or K sparing diuretics - risk of hyperkalaemia
53
Alternativeantihypretensives - centrally acting agents
Methyl dopa- HTN in pregnancy Clonidine Moxinidine Se - tiredness depression lethargy
54
Use of a GTN spray
Angina | Venous venodilation
55
Use of digoxin
Cardiac glycoside used in AF
56
Hydroalazine And isobide finitrate Use and mechanisms
Vasodilators | Used in HTN and or heart failure (if ACEin or ARB not working)

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