4) Hypertension and Heart Failure Flashcards
What are Non Pharmacological Treatments of Hypertension ?
> Stopping Smoking
Lowering Alcohol Consumption
Reduce Salt Intake
Exercise
What is the protocol for pharmacological treatment for Hypertension ?
Aged under 50:
A - ACE Inhibitor / ARB
C - Ca2+ Channel Blocker
D - Diuretic
For someone who is >55 / Black person of African / Caribbean Family
> Start with C
If ACD does not work add further diuretic or a / b blocker
Give examples of ACE Inhibitors
LisoniPRIL
RamiPRIL
What is the mechanism of action of ACEi
Prevents the conversion of Angiontensin I => Angiotension II
What physiological effects do ACEis have ?
> Vasodilation - Decrease PVR -> Reduced Afterload
Reduction in Aldosterone release - Na+ + Water excretion
Reduced Vasopressin release - Increase Water excretion
Reduced Cell growth and proliferation`
What are some Warnings/Contraindications of ACEi
> Patients with Renal Artery Stenosis > AKD => CKD potentially > Don't take if pregnant or breast feeding > Dry Cough - Bradykinin build up > Angio- oedema > Hypotension > Hyperkalaemia
What are some Important interactions of ACEis
> Do not use K+ Sparing drugs
Do not use along NSAIDS
Watch out when using with other antihypertenisve drugs
Give examples of ARBs
Angiotension Receptor Blockers
CandeSARTAN
IoSARTAN
What is the mechanism of action of ARBs
Block ATII receptor therefore has the same effect as ACEis without having the side effects of BK build up
What are some Warnings/Contraindications of ARBs
> Patients with Renal Artery Stenosis
AKD => CKD
Pregnant / Breastfeeding
What are some important interactions of ARBs
> Don’t use along side K+ Sparing Drugs
Don’t use along NSAIDs
Watch out when using other anti hypertensive drugs
Give examples of L-Type Ca2+ and Ca2+ Channel Blockers
Dihydropyridines:
> AmlodIPINE - Shorter t1/2
> NifedIPINE
> NimoDIPINE (Selectivity for Cerebral Vasculature) Used in sub arachnoid haemorrhage
Non-Dihydropyridines:
Phenylalkymines => Verapamil
Benzothiazapines => Diltiazem
What is the mechanism of action of CCBs
Block different sites where VOCC > Vascular Smooth Muscle Cells > Cardiac Myocytes > SAN + AVN Ultimately relaxes the target site e.g. Vasodilation => Reduced preload to the heart
What are some warning/contraindications to CCBs (Dihydropyridines)
> Unstable Angina
> Severe Aortic Stenosis
What are some important interactions of CCBs (Dihydropyridines)
> Interaction with Simvastatin => Increases the effect of Statin
Other anti-hypertensive drugs
What are some side effects of Dihydropyridines ?
> Peripheral Oedema
Headaches
Palpitations => Compensatory Tachycardia
What is Verapamil typically used for ?
> Anti arrhythmic agent => Prolongs AP / effective refractory period
It is has less peripheral dilation, -ve chrono and inotropic effects
Angina
What are some Warnings / Contraindications of Phenylalkylamines ?
> Poor LV function
> AV Nodal conduction delay
What are some important interactions of Phenylakylamines ?
> B blockers
> Don’t use along side other anti hypertensives and anti arrhythmic drugs - It can worsen heart failure
What are some side effects of Phenylakylamines ?
> Constipation
Bradycardia
Heart Block
Cardiac Failure
Give some examples of Diuretics (Thiazides)
> Bendroflumenthiazide
> Indapamide
What is the mechanism of action of Diuretics (Thiazides)
Inhibit NCX in the DCT leading to reduced Na+ Reabsorption so reduced BV
What are some warnings/Contraindications of Diuretics (Thiazides)
> Hypokalaemia
Hyponatraemia
Gout
What some side effects of Thiazides ?
> Hyperglycaemia
Hypokalamia - RAAS compensation => Increase K+ secretion
Increased LDL
