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CPT > Hypertension & Heart Failure > Flashcards

Hypertension & Heart Failure Flashcards

1
Q

What are some examples of ACE inhibitors?

A

Ramipril
Captopril
Lisinopril

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2
Q

How do ACE inhibitors exert their actions?

A

Inhibit ACE therefore preventing conversion of Angiotensin I to Angiotensin II

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3
Q

What are the effects of ACE inhibitors?

A

Reduction in blood pressure

Vasodilation
Reduction in aldosterone release
Reduction in ADH release
Reduced cell growth and proliferation

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4
Q

What is the effect of ACE inhibitors on bradykinin?

A

Prevents breakdown

Build up of bradykinin => vasodilation via NO

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5
Q

What are some side effects of ACE inhibitors?

A

Persistent dry cough (bradykinin build up)
Angioedema
Renal failure
Hyperkalaemia

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6
Q

What are some examples of Angiotensin II receptor blockers?

A

Losartan
Candesartan
Eprosartan

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7
Q

How do ARBs exert their effects?

A

Block AT1 receptors

Inhibit Ang-II mediated vasoconstriction

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8
Q

What are some side effects of ARBs?

A

Renal failure

Hyperkalaemia

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9
Q

What are different classes of calcium channel blockers?

A

Dihydropyridine

Non-dihydropyridine

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10
Q

How do dihydropyridine CCBs act?

A

More selective for peripheral vasculature

Have little chronotropic or inotropic effect

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11
Q

What are some examples of dihydropyridine CCBs?

A

Amlodipine

Nifedipine

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12
Q

What are some adverse effects of dihydropyridine CCBs?

A

Sympathetic nervous system activation - tachycardia
Palpitations
Flushing, sweating
Oedema

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13
Q

What are some types of non-dihydropyridine CCBs?

A

Phenylalkyamine

Benzothiazapines

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14
Q

What is an example of a phenylalkyamine?

A

Verapamil

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15
Q

How do phenylalkyamines work?

A

Depress SA node and slows AV conduction - negative inotropic effect

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16
Q

What is the action of phenylalkyamines?

A

Impedes calcium transport across myocardial and smooth muscle cell membrane

17
Q

What are some adverse effects of phenylalkyamines?

A

Constipation
Risk of bradycardia
Negative inotrope, can worsen heart failure

18
Q

What is an example of a benzothiazapine?

A

Diltiazem

19
Q

How do benzothiazapines work?

A

Impedes calcium transport across myocardial and vascular smooth muscle wall
Prolongs action potential/refractory period

20
Q

What are some adverse effects of benzothiazapines?

A

Risk of bradycardia

Can worsen heart failure

21
Q

What is an example of a thiazide diuretic?

A

Bendroflumethiazide

22
Q

How do thiazide diuretics work?

A

Inhibit Na+ reabsorption in the DCT
Results in diuresis therefore lowering blood and ECF
Leads to lower TPR

23
Q

What are some adverse effects of thiazide diuretics?

A 
Hypokalaemia
Increased uric levels
Impaired glucose tolerance
Increased cholesterol and triglyceride levels
Activation of RAAS
24
Q

What are the NICE guidelines for treating a patient <55yrs with primary HTN?

A

Step 1 - ACE inhibitor or ARB
Step 2 - ACE inhibitor/ARB and CCB or thiazide diuretic
Step 3 - ACE inhibitor/ARB, CCB and diuretic
Step 4 - all of the above, βB or spironolactone

25
Q

What are the NICE guidelines for treating a patient >55yrs or African/Caribbean origin with primary hypertension?

A

Step 1 - CCB or thiazide like diuretic
Step 2 - ACE inhibitor/ARB and CCB or thiazide diuretic
Step 3 - ACE inhibitor/ARB, CCB and diuretic
Step 4 - all of the above, βB or spironolactone

26
Q

What is an example of an α-adrenoceptor blocker?

A

Doxazosin

27
Q

How do α-adrenoceptor blockers work?

A

Antagonise the contraction effects of noradrenaline on vascular smooth muscle
Reduce peripheral resistance
Safe in renal disease

28
Q

What are some adverse effects of α-adrenoceptor blockers?

A

Postural hypotension due to compromised baroreceptor reflex
Headache and fatigue
Oedema

29
Q

What is an example of a β-blocker?

A

Bisoprolol

30
Q

How do β-blockers exert their anti-hypertensive effects?

A

Decrease sympathetic tone by blocking noradrenaline and reducing myocardial contraction
Leads to reduced cardiac output

31
Q

What are some adverse effects of β-blockers?

A 
Bronchoconstriction - contraindicated in asthmatics and COPD pts 
Tachycardia 
Lethargy and impaired concentration 
Reduced exercise tolerance 
Bradycardia 
Raynaud’s
32
Q

How is heart failure managed?

A

Diuretics are used to manage symptoms, but have little impact on survival
Furosemide is typically used

33
Q

How do β-blockers exert their effects in heart failure?

A

Slower HR => longer diastolic filling period => increased filling => increased output

May also stabilise electrical conduction => reduced arrhythmias
May also inhibit renin, but this is a minor effect as ACE-inhibitors probs also being used

CPT (21 decks)

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