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CPT > L3 Hypertensive Drugs > Flashcards

L3 Hypertensive Drugs Flashcards

(59 cards)

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1
Q

Hypertension

A

Elevation of blood pressure that is associated with an increased risk of harm

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2
Q

Essential hypertension

A

90%

Idiopathic

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3
Q

White coat effect

A

Spike in pulse and increase in blood pressure transiently when visiting the GP or hospital

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4
Q

Causes of secondary hypertension

A 
Pre hypertensive drugs 
Tumours e.g. pheochromocytoma
Diabetes
Hyperthyroidism 
Pre-eclampsia
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5
Q

When to offer hypertension treatment

A

140/90 - under 80yrs old + T2DM
150/90 - over 80 yrs old
135/85 - T1DM

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6
Q

Stages of hypertension

A

Stage 1 - 140/90
Stage 2 - 160/ 100
Stage 3 - 180/120

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7
Q

How to treat pre-hypertension

A
  • promote regular exercise
  • decrease cholesterol and healthier diet
  • reduced stress
  • limit alcohol intake
  • reduced excessive caffeine intake
  • stop smoking
  • decrease salt intake
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8
Q

Angiotensin converting enzyme

A
  • Released from the luminal surface of capillary endothelial cells especially in the lungs
  • catalysed the conversion of ang I to ang II
  • breakdown bradykinin
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9
Q

Angiotensin II receptors

A

AT1 - predominant
AT2 - higher concentrations in the brain

Also released from ang I independent of ACE via chymases

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10
Q

Ang II functions via AT1

A
  • increased sympathetic activity
  • increased Na+ and water reabsorption
  • stimulates release of ADH from the posterior pituitary gland
  • stimulates the release of aldosterone
  • vasoconstriction
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11
Q

ACE inhibitors

A

Inhibit the conversion of Ang I to Ang II by inhibiting circulation and tissue ACE

Therefore:

  • vasodilation
  • less ADH and aldosterone release
  • less salt and water reuptake - decreasing stroke volume and preload
  • reduced cell growth and proliferation of SMC (lesser extent)
  • decrease breakdown of bradykinin
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12
Q

Bradykinin

A

Vasodilation via nitric oxide and prostaglandins

Can cause dry cough

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13
Q

Side effects of ACE inhibitors

A

Hypotension
Dry cough
Hyperkalaemia - reduced aldosterone release
Renal failure - vasodilation of efferent arterioles decreases GFR
Angioedema - via bradkinin and more common in black people

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14
Q

Contraindications and important interactions of ACE inhibitors

A

Contraindications:

  • Renal artery stenosis
  • AKD
  • Pregnancy
  • Breastfeeding

Interactions:

  • potassium sparing drugs
  • NSAIDs - inhibit prostaglandins which causes vasodilation of the afferent arterioles
  • other antihypertensives
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15
Q

Examples of ACE inhibitors

A

Ramipril

Lisinopril

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16
Q

Angiotensin II receptor blocker (ARBs) examples

A

Candesartan

Losartan

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17
Q

ARB mechanism of action

A

Directly targets AT1 receptors therefore more effective at inhibiting Ang II mediated vasoconstriction

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18
Q

Benefits of ARBs

A

Does not cause dry cough or angioedema

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19
Q

Disadvantages of ARBs

A

Less effective in hypertensive patients with low renin e.g. black population

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20
Q

Contraindications and interactions of ARBs

A

Contraindications

  • renal artery stenosis
  • AKD
  • pregnancy
  • breast feeding

Interactions:

  • K+ sparring drugs
  • NSAIDs
  • other antihypertensives
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21
Q

L- type calcium channels

A
  • Allow influx of calcium into cells via voltage operated Ca2+ channels (VOCC)
  • Expressed throughout the body e.g. SAN, AVN, cardiac myocytes and vascular SMC
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22
Q

Classes of calcium channel blocker

A

Dihydropyridines
Phenylalkylamines
Benzothiaziapines

Interact with different sites on the alpha 1 sub unit of VOCC

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23
Q

Dihydropyridines

A

Selective for peripheral vasculature
First line CCB for hypertension
Can be selective for cerebral or peripheral smooth muscle

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24
Q

Mechanism of action of CCB

Study These Flashcards
A

Decreased influx of calcium into a cell therefore less smooth muscle contraction occurs

Used as first line hypertensive in patients with low renin levels

25
When are cerebral CCBs used?
If a patient has had a subarachnoid haemorrhage
26
Phenylalkylamine mechanism of action
Selective for cardiomyocytes, SAN and AVN - decreases SAN impulses - negative chronotropy - decreased strength of contraction of cardiomyocytes - negative inotropy - decreased peripheral vasodilation - class IV antihypertensive drug which inhibits calcium influx therefore prolonging action potentials for a longer refractory period - decrease upstroke + longer plateau
27
Benzothiazapines
Affect peripheral SMCs and heart
28
Examples of dihydropyridines
Amlodipine Nifedipine Nimodipine - cerebral vasculature
29
Side effects of dihydropyridines
Ankle swelling Flushing Headaches - vasodilation Palpitations - compensatory tachycardia can occur therefore not useful in angina
30
Contraindications and interaction of dihydropyridines
Contraindications - unstable angina - severe aortic stenosis Interactions - when amlopdipine is used with simvastatin, the effect of simvastatin increases therefore may need a lower simvastatin dose - other hypertensives
31
When are phenylalkylamines used?
Patients with: - arrhythmia - angina - hypertension (lesser extent)
32
Side effects of phenylalkylamines
Constipation Bradycardia - IV Heart block Cardiac failure
33
Contraindications and interactions of phenylalkylamines
Contraindications: - poor LV contractility and function - AV nodal conduction delay Interactions: - Beta blockers - Other antihypertensives - other antiarrhythmic agents
34
Example of phenylalkylamines
Verapamil
35
Benzothiazapine example
Diltiazem
36
Examples of thiazides and thiazides like diuretics
Bendroflumethiazide | Indapamide
37
Mechanism of action of thiazides diuretics
Inhibit the Na+/Cl- cotransporter in the DCT Therefore decreasing sodium and water reabsorption - can activate RAAS - useful over CCB in oedema
38
Side effects of thiazides diuretics
Hypokalaemia Hyponatraemia Hyperuricaemia Arrhythmia Increased glucose - especially with beta blockers Increased cholesterol and triglycerides
39
Contraindications and interactions of thiazides diuretics
Contraindications: Hypokalaemia Hyponatraemia Gout - due to hyperuricaemia Interactions: - NSAIDs - K+ secreting drugs e.g. furosemide
40
First line treatments of hypertension
Black Africa or 55 yrs old or over: - CCB T2DM or under 55 yrs old - ACEi or ARB
41
Step 4 in treating hypertension
Confirm elevated BP with ABPM or HBPM Discuss adherence Check for postural hypotension - low dose spironolactone if blood potassium is less than 4.5 mmol/l - alpha or beta blocker if blood K+ is higher
42
Two pronged approach to treating primary hypertension
- decreases diabetic nephropathy and CKD with proteinuria by dilating the efferent arteriole - therefore GFR decreases decreasing intraglomerular oressure therefore the load on the kidneys decreases and good for T2DM - also peripheral vascular resistance decreases which decreases BP
43
Spironolactone
Aldosterone receptor antagonist
44
Contraindications and interactions of spironolactone
Contraindications: - Hyperkalaemia - Addison’s disease - decreased aldosterone release due to destruction of the adrenal cortex Interactions: - K+ sparring drugs including ACEi and ARBs
45
Beta adrenoceptor blocker examples
Labetalol Bisoprolol Metoprolol
46
Mechanism of action of beta adrenoreceptor blockers
Decreased sympathetic tone Blocks noradrenaline receptors Reduces myocardial contraction - decreasing CO and HR Decreased renin secretion
47
Side effects of B Blockers
``` Bronchospasm Heart block Raynaud’s - cold hands Lethargy Impotence ```
48
Contraindications and interactions of beta blockers
Contraindications: - asthma - COPD - haemodynamic instability - hepatic failure - dose monitoring Interactions: - non dihydropyridine CCB - similar mechanisms of action therefore can go into asystole
49
Alpha adrenoreceptor blocker example
Doxazosin
50
Mechanism of action of alpha adrenoreceptor blockers
- Selective antagonism of alpha 1 adrenoreceptors - Reduces peripheral vascular resistance - in urinary tract, bladder neck and prostate
51
Tamsulosin
Treats BPH by acting on alpha 1 adrenoreceptor a causing decreased peripheral vascular resistance
52
Side effects of alpha adrenoreceptor blockers
``` Postural hypotension Dizziness Syncope Head ache Fatigue ```
53
Contraindications and interactions of alpha adrenoreceptor blockers
Contraindications: - postural hypotension Interactions: - dihydropyridine CCB - cause oedematous effects
54
Heart failure drug administration
1. Offer furosemide diuretic for symptoms and fluid retention 2. HFpEF - manage comorbidities e.g. hypertension and atrial fibrillation 3. HFrEF - ACEi (consider ARB if intolerant) and Beta blocker 4. If symptoms continue - spironolactone
55
If resistance to ACEi and ARB
Hydralazine and nitrate
56
Reduced ejection fraction
Below 45%
57
Non pharmological treatment of HF
- reduced salt intake | - liquid reduction to 1.5 L
58
Symptoms of heart failure
Exercise intolerance Dyspnoea Fatigue Oedema
59
Aims in treating heart failure
Reduce symptoms Increase exercise tolerance Address arrhythmias, hyperlipidaemia and diabetes Decrease mortality

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