9.2 - Hypertension and HF treatment Flashcards
How do centrally acting agents work? Give an example
Work by reducing sympathewtic outflow to reduce BP. e.g. Methyldopa
How do alpha blockers work? ADRs?
Antagonism of alpha 1 adrenoreceptors
ADR - postural hypotension, dizziness, headaches and fatigue, oedema
How do thiazide diuretics work? ADRs?
Act on NaCl symporter in DCT, reducing water reabsorption and blood volume.
ADR - hypokalaemia, hyperuricaemia, hypercalcaemia, ED
CCB MoA? What are the 3 types? ADRs?
Bind to L-type calcium channels and reduce Ca entry. Vasodilates arteries.
3 groups:
- Dihydropyridines - tachycardia, sweating, flushing, oedema
- Phenylalkylamines - constipation, bradycardia
- Benzothiazepines - bradycardia, negative ionotropy.
What are some ADRs to ACEi?
dry cough, first dose hypotension, renal failure, hyperkalaemia
What is classified as a hypertensive emergency? How would you treat?
>220/120mmHg
Treat with IV sodium nitroprusside which acts as an endogenous nitric oxide.
Which CCB is the preferred?
Dihydropyridines
How would you treat mild, moderate, and severe hypertension?
Mild - Non pharm therapies
Moderate and severe - Pharm therapies
What is a pheochromocytoma?
Adrenal catecholamine secreting tumour
Describe the treatment plan for <55 yo
1) ACEi
2) +CCBs
3) +diuretics
4) + alpha blockers, beta blockers, centrally acting drugs, or vasodilators
Describe the treatment plan for a black person or a >55yo
1) CCBs
2) +ACEi
3) +diuretics
4) +alpha blockers, beta blockers, centrally acting drugs, or vasodilators
How do direct renin inhibitors work?
Bind to renin and prevents cleavage of angiotensinogen to angiotensin I
Define mild, moderate, and severe hypertension
Mild - 140-159 s, 90-99 d
Moderate - 160-179 s, 100-109 d
Severe - >180 s, >110 d
What antihypertensive drug is used preferably in pregnancy?
Centrally acting agent e.g. methyldopa
What are the 3 types of CCBs?
Dihydropyridines, benzothiazepines, phenylakylamines
If patient cannot tolerate ACEi, what is the alternative treatment? Name an example and its ADRs.
AG2 receptor blocker
e.g. Losartan. ADR is renal failure, hyperkalaemia
How do alpha blockers work?
Antagonise alpha 1 adrenoreceptors to reduce TPR
What is the MoA of ACEi? ADRs? Give .e.g
e.g. - ramipril
MoA - prevent AG2 generation by inhibiting ACE. Also prevents bradykinin degradation. This all reduces effect of RAAS system
ADRs - dry cough, first dose hypotension, renal failure and hyperkalaemia.
Name an example ACEi
Lisinopril, ramipril
How do centrally acting agents work? What drugs does this include? ADRs?
Methylodopa - alpha 2 agonist
Clinidine - alpha 2 agonist
All reduce sympathetic outflow to reduce BP
ADRs - tiredness, lethargy, depression
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Define hypertension. What are the 2 causes of hypertension?
>140/90mmHg
Primary - No known cause. 90% of cases
Secondary - known cause.
How do direct renin inhibitors work?
Bind to renin and prevent cleavage of angiotensinogen to angiotensin 1. Little effect on BP
How do beta blockers work?
Antagonise beta1 adrenoreceptor, reducing HR and CO. But little effect on BP
Define a hypertensive emergency. How would you treat? How does treatment work?
>220/120
IV sodium nitroprusside acts as endogenous N2O