Anti-hypertensives Flashcards
What are the indications for beta-blockers? When are they contra-indicated? Give some examples of ADRs associated with their use.
Indications:
- angina/MI
- heart failure (caution as failing myocardium is dependent on heart rate, therefore initiate at low dose and titrate up)
- diabetes (except in CHD)
- peripheral vascular disease
Contra-indications:
- asthma
- COPD
- heart block
ADRs:
- lethargy
- impaired concentration
- reduced exercise tolerance
- bradycardia
- Raynaud’s syndrome
- reduced glucose tolerance
When are alpha-blockers indicated? When are they contra-indicated? Give an example of an alpha-blocker.
e.g. doxazosin
Indications:
- benign prostatic hyperplasia
- postural hypotension (with caution)
- heart failure (with caution)
Contra-indications:
- urinary incontinence
Outline the epidemiology of hypertension.
40% of adults in England have hypertension
A 10mmHg reduction is associated with a 58% reduction in risk of stroke and 37% risk of coronary heart disease
Why is cessation of smoking indicated in hypertension?
Smoking does not directly affect BP, but reduces the CVD risk
Give some examples of ACE inhibitors. When are they indicated? When are they contra-indicated?
e.g. lisinopril, ramipril
Indications:
- heart failure
- LV dysfunction
- MI
- type 1 diabetes
- nephropathy
Use with caution in renal impairment and peripheral vascular disease
Contra-indications:
- pregnancy
- renovascular hypertension
Give some examples of ADRs associated with ACE inhibitors.
- dry cough (~10%-15%)
- angioedema (rare, more common in black population)
- renal failure (including renal artery stenosis)
- hyperkalaemia
- hypotension
- rash
- pancreatitis
- sinusitis/rhinitis
- N&V
Give some examples of angiotensin II receptor blockers. When are they indicated? When are they contra-indicated?
e.g. losartan, valsartan
Indications:
- ACE inhibitor intolerance
- hypertension in LV hypertrophy
Use with caution in renal impairment and peripheral vascular disease
Contra-indications:
- pregnancy
- renovascular hypertension
Give some examples of ADRs associated with angiotensin II receptor blockers.
- renal failure
- hyperkalaemia
What are the different types of calcium channel blockers? Give some examples for each class. When is each class indicated? When is each class contra-indicated?
Dihydropyridines
- e.g. nifedipine, amlodipine
- indicated for hypertension (inc. isolated systolic hypertension in elderly)
Benzothiazepines
- e.g. diltiazem
- indicated for angina (caution when used with beta-blockers), AF, and other arrhythmias
- contra-indicated in heart block and heart failure (not well tolerated)
Phenylalkylamines
- e.g. verapramil (reduce SAN and AVN conduction)
- indicated for AF and other arrhythmias
- contra-indicated in heart failure (not well tolerated)
What should the salt intake be in hypertension?
Less than 6g per day
What are the NICE guidelines for the treatment of hypertension?
Less than 55yrs
- ACE inhibitors or angiotensin II receptor blockers
- Add calcium channel blockers or thiazide diuretics
- All of the above
- Consider adding spironolactone, alpha-blockers, or beta-blockers
Over 55yrs or black
- Calcium channel blockers or thiazide diuretics
- Add ACE inhibitors or angiotensin II receptor blockers
- All of the above
- Consider adding spironolactone, alpha-blockers, or beta-blockers
