Anti- hypertensives and heart failure drugs Flashcards
Name 2 ACE inhibitors
Ramipril and Lisinopril
What is the mode of action for losartan and candesartan?
Angiotensin receptor blockers
What are the 3 classifications of calcium channel blockers?
Dihydropryidines, phenylalkamines, benzothiazepines
Name one dihydropyridine calcium channel blocker
Amlodipine, nifedipine
Name one phenylalkamine calcium channel blocker?
Verapamil
Name one benzothiazepine calcium channel blocker
dilitazem
What type of diuretic is most commonly used in hypertension? name one example of one
Thiazides- eg bendroflumethiazide, indapamide
How does doxazosin work to reduce BP?
Theyre alpha adrenoreceptor blockers
How does aliskiren work to reduce BP?
Renin inhibitor
How does hydralazine work to reduce BP?
Stimulates NO release and Inhibits ca2+ release from SER so vasodilates
Which diuretics are commonly combined to reduce BP but keep glucose and K+ stable?
A thiazide diuretic and amiloride (K+ sparing diuretic)
What drugs are used to treat phaeochromocytoma?
phenoxybenzamine (non competative alpha blocker) and phentolamine (competative alpha blocker)
What drugs are used to treat hypertensive emergencies?
Sodium Nitroprusside- mimic NO to cause vasodilation
Above what BP is classed as mild, moderate and severe hypertension?
Grade 1 (mild) = >140/90 Grade 2 (moderate)= >160/100 grade 3 (severe)= > 180/110
What 4 lifestyle interventions can help reduce BP?
- Normal BMI
- Reduce salt intake to <6g/ pday
- limit alcohol consumption
- aeorbic exersize for >30 mins per day
- > 5 portions fruit and veg
- reduce fat intake
List 3 side effects of ACEi like lisinopril and ramipril? (think about effect on kidneys)
- dry cough, N+V, dizziness
- Angio- odema (puffy face)
- renal failure (as inhibits efferent arteriole constriction)
- Hyperkalaemia (inhibits aldosterone, less K+ secretion at collecting ducts
List 3 side effects of losartan/ candesartan (angiotensin receptor blockers)
- No cough
- GI upset, dizziness, muscle cramps
- Still renal failure + hyperkalamia
Describe side effects of calcium channel blockers
- bradycardia (tachycardia w/ amlodipine)
- constipation (particularly verapamil)
- headache
- palpitations
- flushings
- sweating
- odema
List 3 side effects of thiazides
- hypokalaemia
- Gout
- hyperglycaemia (impaired glucose tolerance)
- increased TAG and LDLs
- activates RAAS, so usually given with ACEi
list 3 side effects of doxazosin (alpha receptor blocker)
- postural hypotension (have more effect when standing upright)
- headaches, fatigue, odema
- safer in renal disease
Describe the NICE guidlines on deciding on drug treatment
<55 1st line= ACE i or ARB
>55 or black 1st line= Calcium channel blocker
2nd line for both= add ACEi/ARB + CCB together
3rd line= add thiazide diuretic as well as ACEi & CCB
4th line= add further diuretic or alpha or beta blocker
List 3 endocrine causes of secondary hypertension
Conns syndrome (hyperaldosteronism) Adrenal hyperplasia Cushings syndrome Phaechromocytoma Acromegaly Thyroid disease
List 1 renal causes of secondary hypertension
Renovascular hypertension
Diabetic renal disease
Renal artery stenosis
List the 4 principles of treating heart failure
- correct cause
- non pharmacological
- pharmacological
- manage complications/ co morbidities/ risk factors
What benefit do diuretics have in heart failure?
reduce odema
What benefit do B blockers, ACEi and ARB have in heart failure?
ACEi and ARB reduce preload, and so workload of heart. B blockers reduce HR, so workload- need to be careful that BP doesnt drop too low.
What benefit does spironolactone have in heart failure?
Reduces odema, reduced pre and afterload, and reduces aldosterone. Aldosterone is high with ACEi, ARB, diuretics etc and increases myocardial fibrosis, hypertrophy, endothelial dysfunction, and so spironolactone actually helps slow course of heart failure as well as reduce risk of arrhythmias and acute coronary events.
What does sacubitril and why is it good for heartfailure?
it inhibits breakdown of ANP and BNP, which help reduce BP
Why are lots of people with heart failure on the cardiac glycoside digoxin?
Because it enhances vagal activity, leading to a slower heart rate. It also inhibits Na/K/ATPase leading to increased contractility. This means it can be used in those at risk of hypotension
In what population is hydralazine and nitrate most effective at reducing blood volume, and so preload?
Ppl of african descent
How does GTN spray work to reduce angina
Venous vasodilation–> lowers preload–> lowers workload of heart–> lowers metabolic demand.
Also vasodilation of collateral blood flow of coronary arteries
What drug, other than GTN spray, can be used to treat angina?
Isosorbide mononitrate
