Anti-hypertensives Flashcards
What is the BP range for:
a) healthy
b) Elevated
c) Tier 1 high blood pressure
d) Tier 2 high blood pressure
e) Hypertensive crisis
a) <120 and <80
b) 120-129 and <80
c)130-139 or 80-90
d) >=140 or >=90
e) >=180 or >120
Name 4 consequences of hypertension
Congestive heart failure, myocardial infarction, renal damage, cerebrovascular accidents
Name one factor affecting preload and another factor affecting afterload
preload is affected by filling pressure, which is affected by blood volume and venous tone
afterload is affected by peripheral resistance, which is affected by arteriolar tone
Name 5 first line drug classes used in the management of hypertension
ACE-inhibitors, Angiotensin receptor blockers, beta-blockers, calcium channel blockers(dihydropyridines) and diuretics.
Explain 2 ways ACE-inhibitors help to lower blood pressure
1st way: Inhibition of Angiotensin Converting Enzyme (ACE), prevent it from cleaving Angiotensin I to Angiotensin II.
recap on RAAS:
Angiotensin –(renin)–> Ang I –(ACE)–> Ang II
Ang II: increase vasoconstriction and aldosterone secretion –> increase peripheral vascular resistance and increase water/salt retention–> raised BP.
2nd way: Inhibit bradykinin breakdown. increased NO and PG –> vasodilation –> decrease BP
Name 3 ACE-inhibitors
Lisinopril, Captopril, Enalapril, Perindopril
ACE-inhibitors end with ‘pril’
Name 4 clinical uses of ACE-inhibitors
Hypertension, cardiac failure, following MI, renal insufficiency
Name 3 adverse effects of ACE-inhibitors
severe hypotension, acute renal failure, hyperkalemia, angioedema* and dry cough**, contraindicated in pregnancy
*bradykinin and substance P induced “inflammation-like” responses: vasodilation, plasma extravasation–> angioedema
**bradykinin and prostaglandin idiosyncratic reactions –> increased sensitivity of bradykinin-dependent airway sensory nerve fibers
mechanism of action of AT1 blockers
block AT1 receptor, prevent Angiotensin II from binding to receptor.
Name 1 advantage of AT1 blockers over ACE-inhibitors
Less/no dry cough as it doesn’t affect bradykinin
Name 3 AT1 blockers
Valsartan, losartan, candesartan, irbesartan, telmisartan
AT1 blockers end with ‘sartan’
Beta-blockers MOA in managing hypertension?
B1 blockade inhibits adenylyl cyclase–> decreased cAMP –> decreased Protein Kinase A activation –> decreased calcium channel activation –> decreased contractility.
name 3 beta-blockers and their respective types
Non-selective: propanolol. pindolol, carvedilol*
Cardioselective (beta1): atenolol, bisoprolol, metoprolol
Mixed: Nebivolol* (beta1 selective in low dose/ fast metabolisers. non-selective in high dose/slow metabolisers
vasodilation effect through NO release
- can also treat heart failure
Name 2 clinical uses of beta-blockers
hypertension, cardiac failure, following MI, abnormal heart rhythm, anxiety
name 3 adverse effects of beta-blockers
hypotension
bradycardia
AV node block
reduced exercise capacity
bronchoconstriction (esp. asthma)
CNS: vivid dreams, clinical depression
Why can we use beta-blockers in arrythmia?
AV nodal block to reset pacemaker
MOA of thiazides
inhibit nacl reabsorption, blocking na/cl transporter
enhance Ca2+ reabsorption in DCT
Name 2 thiazides
hydrochlorothiazide, indapamide
What drugs should the patient avoid when on thiazides?
NSAIDS. (thiazide action depends on renal PGs synthesis)
4 clinical uses of thiazides?
Hypertension (preferred),
congestive heart failure,
nephrolithiasis due to idiopathic hypercalciuria,
nephrogenic diabetes insipidus
name 3 adverse effects of thiazides
hypokalemic metabolic alkalosis, hyponatremia, hyperuricemia, hyperglycemia, hyperlipidemia, hypercalcemia
mnemonic GLUCKN, last two hypo
Explain briefly the MOA of the following thiazide adverse effects:
hyperglycemia
hyperglycemia: thiazide causes hypokalemia: hyperpolarisation of pancreatic B cells, reduced exocytosis of insulin
hyperuricemia: Thiazides cause increased urate reabsorption in proximal tubule
hypokalemic metabolic alkalosis
Explain briefly the MOA of the following thiazide adverse effects: hyperuricemia
Explain briefly the MOA of the following thiazide adverse effects: hypokalemic metabolic alkalosis
Increase in aldosterone-mediated K+ and H+ ions excretion in intercalated cells of collecting duct
Explain briefly the MOA of the following thiazide adverse effects: hyponatremia
Thiazides decrease Na+ reabsorption and therefore decreased fluid reabsorption
remember that water follows Na+ !
hyponatremia likely to happen during first 2-3 weeks of therapy –> before steady state achieved
Name 3 classes of second line anti-hypertensives
hydralazine, mineralocorticoid receptor antagonists, alpha-adrenergic antagonists
MOA of alpha-adrenergic antagonists?
Target postsynaptic alpha adrenergic receptors on vascular smooth muscles
opposes alpha1-mediated vasoconstriction –> lower vessel tone(more dilated) which lowers peripheral vascular resistance, lowering BP
name 2 adverse effects of Alpha-adrenergic antagonists
reflex tachycardia, palpitations and orthostatic hypotension.
other AE: depression, urinary frequency, flushing
indicated for: patients with impaired renal function, pregnant, benign prostatic hyperplasia
What drug class would you use to treat hypertensive patients with angina pectoris
commonly used: beta-blockers, ca2+ channel blockers(DHP)
alt: diuretics, ACE-I/ARB
What drug class would you use to treat hypertensive patients with congestive heart failure?
Commonly used: Diuretics, ACE-I/ARB
Don’t use: Ca2+ channel blocker(DHP)
What drug class would you use to treat hypertensive patients with previous MI?
Commonly used: b blockers, ACE-I/ARB
What drug class would you use to treat hypertensive patients with chronic renal disease?
diuretics/ b blockers, DHP
What drug class would you use to treat hypertensive patients with asthma?
Diuretics, DHP
contraindicated: b blockers (vasoconstriction)
What drug class would you use to treat hypertensive patients with diabetes?
ACE-I / ARB
contraindicated b blcokers
What drug class would you use to treat hypertensive patients who are pregonananant?
diuretics, b blockers, DHP
contraindicated: ACE-I/ARB
