Anti-Hypertensives Flashcards
What is the definition of hypertension?
a sustained systolic B.P > 140 mmHg
OR
a sustained diastolic B.P >90 mmHg
What is the initial treatment strategy for hypertension?
- Reduce weight
- Reduce salt intake
- Reduce alcohol intake ( it increases circulating fats)
- More fruit and veg
- More exercise
- Less fatty foods
- Stop smoking
What can hypertension cause?
- Strokes
- Ischaemic heart disease
- Peripheral vascular disease
What causes hypertension?
- genetic factors
- low birth weight
- diabetes
- drugs
- kidney/ cardio-vascular disease
- environmental factors - long term stress/ diet/ obesity
B.P = ______ X ______
B.P = cardiac output X total peripheral resistances
What determines cardiac output?
- volume of blood pumped out
- heart rate
- blood volume
- venous tone
Targets for anti-hypertensive drugs …A,B,C,D.
Ace inhibitors ( & angiotensin receptor blockers)
Beta blockers
Calcium channel blockers
Diuretics
Name 5 Ace inhibitors.
Its ACE in aPRIL!
- Benazepril
- Captopril
- Enalapril
- Fasinopril
- Lisinopril
- Moexipril
- Perindopril
- Quinopril
- Ramipril
- Trandolapril
What are the side effects of Ace inhibitors?
- Persistent dry cough (10-20% of people)
- Rash
- Renal problems - don’t use in patients with renal disease
- Hypotension
- DO NOT use in pregnancy
How are Ace inhibitors taken?
Orally
What type of anti-hypertensive drugs are used as first line treatment?
Ace inhibitors are recommended as first-line treatment
What are the actions of ace inhibitors?
- They block the enzyme ace which divides angiotensin I to form the potent vasoconstrictor angiotensin II/ reduces angiotensin II.
- This results in vasodilation
- Reduces peripheral resistance
- Reduces both cardiac pre-load and afterload, thereby decreasing cardiac work.
- check this card
Angiotensin II receptor antagonists/blockers …Name 5 examples.
- Azilsartan medoxomil
- Candesartan
- Eprosartan
- Irbesartan
- Losartan
- Olmesartan
- Telmisartan
- Valsartan
How do angiotensin II receptor blockers work?
&
What is an advantage?
- They are alternatives to ace - they don’t produce the cough
- They block angiotensin receptors
- decrease the activation of AT receptors by angiotensin II
- They produce arteriole and venous dilation
- Block aldosterone secretion
- Used as first line treatment
Side effects of angiotensin II receptor blockers are…
- DO NOT use in pregnancy
- Hypotension
- Renal problems
- Rash
Name 5 beta blockers.
Beta blockers = lol
- Acebutolol
- Atenolol
- Betaxolol
- Carvedilol
- Metoprolol
- Nadolol
- Penbutolol
- Propranolol
- Timolol
How do beta blockers work?
- Reduce blood pressure
- Decrease sympathetic outflow from CNS
- Block vasoconstriction
- Increase blood flow to kidney so reduce renin secretion
- Can be use in pregnancy
What are the side effects of Beta blockers?
- Fatigue, lethargy and insomnia
- Erectile dysfunction
- Impaired concentration/memory
- Aggravation in asthma sufferers
- Exacerbation of Raynards disease
- Bradycardia
Name 5 calcium channel blockers.
Most end in ine..?
- Amlodipine
- Clevidipine
- Dilitazem
- Felodipine
- Isradipine
- Nicardipine
- Verapamil
How do calcium channel blockers act?
- Dilate arteries
- Reduce heart contractility
- Reduce heart rate
- They do not dilate veins
Nifedipine, Amlodipine and Nicardipine …
*may not need this card
- more potent on blood vessels than heart
- may cause headaches, flushing, dizziness, peripheral oedema (ankle swelling)
Verapamil, dilitazem
* may not need this card
- more potent on heart than blood vessels
- may cause constipation, heart block and precipitate cardiac failure
What are the side effects of calcium channel blockers ?
- headaches, flushing, dizziness, peripheral oedema
- constipation
- flushing
- hypotension
- precipitate cardiac failure
Name three types of diuretic drugs.
- Thiazide diuretics
- Loop diuretics
- Potassium - sparing diuretics
How do thiazide diuretics act?
- Lower BP initially by increasing NA+ & H20 excretion.
- This causes decrease in extracellular volume resulting in a decrease in cardiac output and renal blood flow.
- Decrease in blood volume
what are the side effects of thiazide diuretics?
- hypokalaemia (lack of potassium)
- reduced insulin release
- increased plasma lipids and urate —-> causing gout
- erectile dysfunction
name a thiazide diuretic
- Hydrochlorothiazide
- Chlorthiazide
- Indapamide
- Bendroflumethiazide
how do potassium-sparing diuretics act?
- they are used in combination with loop diuretics and thiazides
- because they reduce potassium lost in the urine
what are the side effects of potassium-sparing diuretics?
- hyperkalaemia
- hypernatremia (to much sodium in the blood)
name a potassium sparing diuretic.
- Amiloride
- Spironolactone
- Triamterene
How do loop diuretics work?
- act promptly by blocking sodium & chloride reabsorption in the kidney
- cause decrease renal vascular resistance and increase renal blood flow
what are the side effects of loop diuretics?
- Hypokalaemia
- May cause gout
- Can effect hearing
Name a loop diuretic
- Furosemide
- Torsemide
- Bumetanide
- Ethacrynic acid
Summary
________inhibitors ( block angiotensin II production) or ARB’s
________(reduce heart rate, dilate arteries, reduce renin release)
_________(reduce heart rate, dilate arteries)
_________ ( increase urine output—> so decreases blood volume.
Ace
Beta Blockers
Calcium channel blockers
Diuretics
Captopril is an anti-hypertensive drug which blocks the formation of:
Angiotensin II
Which of the following (organs) is not a target for anti-hypertensive drugs? the kidney the blood vessel the liver the heart
the liver
Calcium channel blockers (e.g. nifedipine) work by:
reducing the force of contraction of the heart
