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antihypertensive drugs Flashcards

1
Q

what is the mechanism of action of beta blockers?

A

block the beta adrenoreceptors in the heart, bronchi, pancreas, liver and peripheral vasculature [blood vessels outside of heart]

slow the heart and depress myocardium [heart muscles]

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2
Q

which beta receptors are found in the heart and in the lungs?

A

1 heart = B1

2 lungs = B2

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3
Q

what are ISA beta blockers and what do they do?

A

intrinsic sympathomimetic activity beta blocker

they stimulate and also block adrenergic receptors

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4
Q

what are the 2 benefits of ISA beta blockers?

A

less bradycardia and less coldness of extremities

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5
Q

give examples of ISA beta blockers [4]

A

ICE PACO

Pindolol
acebutolol
celiprolol
oxprenolol

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6
Q

what is the benefit of water soluble beta blockers?

what organ are they excreted by?

A

do not enter the blood brain barrier so cause less sleep disturbance and nightmares!

kidneys

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7
Q

give examples of water soluble beta blockers [4]

A

cans

celiprolol
atenolol
nadolol
sotalol

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8
Q

what are cardio SELECTIVE beta blockers and where do they work?

which patients are they used on?

A

they have less effects on the B2 receptors in the lungs, and work more the heart B1 receptors.
it is selective but not specific so can still affect B1 heart receptors.

can be used in hypertension in asthmatics when there is no other alternative

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9
Q

what are the examples of the cardio selective beta blockers? [4]

A

be a man

bisoprolol
atenolol
metoprolol
acebutol
nebivolol
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10
Q

give an example of a non cardioselective beta blocker [1]

A

sotalol

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11
Q

how often a day do short acting beta blockers have to be taken?

A

2/3 times a day

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12
Q

how often a day do long acting beta blockers have to be taken?

A

once daily

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13
Q

give examples of long acting beta blockers [4]

A

BACoN

bisoprolol
atenolol
celiprolol
nadolol

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14
Q

what are the side effects of beta blockers? [8]

A 
coldness of extremities [not with ISA]
fatigue
hyperglycaemia or hypoglycaemia
sleep disturbances/nightmares [not with water soluble]
hypotension
bradycardia
bronchoconstriction
masks signs of hypoglycaemia
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15
Q

can beta blockers be given to asthmatics?

if so which types of asthmatics?

A

yes but only if no other alternative
must only use cardioselective
only to patients with well controlled asthma

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16
Q

can beta blockers be given to asthmatic patients for co-existing conditions such as HF and following MI?

A

give cardioselective beta blocker at lowest dose by specialist and monitor pt for S/E

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17
Q

can beta blockers be used in diabetic patients?

A

yes but with caution and cardio selective beta blockers be used.

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18
Q

why are beta blockers to be used with caution in diabetic patients?

A

can cause hypo or hyperglycaemia

can mask symptoms of hypoglycaemia

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19
Q

what are the uses of beta blockers? [9]

A 
arrythmia
heart failure
hypertension
angina
myocardial infarction
anxiety
migraine prophylaxis
thyrotoxicosis
glaucoma
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20
Q

which beta blocker is used for anxiety?

A

propanolol

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21
Q

which beta blocker is used for arrythmia?

A

sotalol and esmolol

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22
Q

which beta blocker is used for migraine prophylaxis?

A

propanolol

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23
Q

what are the contra indications of beta blockers? [4]

A

worsening unstable heart failure
patients with 2nd or 3rd degree heart block [arrythmia]
pt with history of asthma, bronchospasm, obstructive airway disease
frequent episodes of hypoglycaemia

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24
Q

what are the cautions of beta blockers? [7]

A

pt with 1st degree AV heart block
diabetics
concurrent use with verapamil and diltiazem [can cause heart block]
stable heart failure
symptoms of thyrotoxicosis and hypoglycaemia
pt with severe hypotension and bradycardia
may reduce response to adrenaline

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25
Q

what are the 2 important interactions of beta blockers?

A
  1. iv verapamil and beta blockers increase risk of hypotension and heart failure
  2. concurrent use with verapamil or rate limiting CCB such as diltiazem as can increase risk of heart block
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26
Q

what is the mechanism of action of calcium channel blockers?

A

interfere with inward displacement of calcium ions

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27
Q

what are the 3 different classes of CCBs?

A

benzothiapines
dihydropines
phenylaklyamines

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28
Q

give some examples of the dihydropyridines CCB drug class. [5]

how do they work?

A

amlodIPINE, nifediPINE, lercanidipine, lacidipine and felodipine

work by relaxing smooth muscle and widening vessels. no anti-arrhythmic effects and do not work directly on heart

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29
Q

which 2 CCBs should be brand specific for the MR preparations?

A

amlodipine and nifedipine

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30
Q

give an example of phenylaklyamine CCB

how do they work?

A

verapamil

minimal vasodilatory effects but does have cardiac depressant effects [slow heart rate] so can cause heart failure

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31
Q

what side effect can verapamil cause?

A

constipation

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32
Q

give an example of a benzothiapine CCB?

how do they work?

A

diltiazem

have BOTH vasodilatory and cardiac depressant effects

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33
Q

which other drugs should benzothiazepines [eg diltiazem] be used with caution with and why?

A

beta blockers bc high risk of bradycardia

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34
Q

do CCB reduce risk of myocardial infarction in unstable angina?

A

no

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35
Q

when is verapamil and diltiazem used in unstable angina?

A

when pt are resistant to treatment with beta blockers

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36
Q

why is the sudden withdrawal of beta blockers bad in pt with unstable angina?

A

may worsen angina and lead to heart attack

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37
Q

what are the 2 prescribing and dispensing informations regarding diltiazem?

A

1: different versions of MR dilitazem containing more than 60mg may not have the same clinical effect
2. prescribers should prescribe by brand to prevent confusion

38
Q

give 3 examples of other anti-anginal drugs

A

nicorandil
ivabradine
ranolazine

39
Q

what are nicorandil, ivabradine and ranolazine used to treat?

A

long term treatment of angina

40
Q

what are the side effects of calcium channel blockers? [7]

A 
ankle swelling
flushing
headaches
postural hypotension
dizziness
GI reactions
skin reactions
41
Q

what is the mechanism of action of thiazide like diuretics?

A

inhibit sodium reabsorption in the distal convulated tubule

42
Q

what is the onset of action of thiazide diuretics and how long do the effects last for?

A

onset: 1-2 hours

lasts for 12-24 hours

43
Q

when during the day should thiazide diuretics be given and why?

A

in the morning to prevent diuresis [increased urination that interferes with sleep]

44
Q

what are low doses of thiazide diuretics used to treat?

what are high doses of thiazide diuretics used to treat?

A

low: used to lower blood pressure
high: used for oedema due to coronary heart failure

45
Q

what are the 3 examples of thiazide diuretics?

A

BIC

bendroflumethiazide
indapamide
chlortalidone

46
Q

what are the contraindications of thiazide diuretics? [4]

A

HYPOnatraemia
HYPOkalaemia
HYPERcalcaemia
addisons disease [bc already low sodium and high potassium levels]

47
Q

what are the side effects of thiazide diuretics? [4]

A

postural hypotension
constipation [lose lots of water]
electrolyte imbalance
headaches

48
Q

can thiazide diuretics be used to treat hypertension in pregnant women?

what is the risk of them in pregnant women?

A

no should not be used to treat gestational hypertension

can cause neonatal thrombocytopenia, bone marrow suppression, jaundice, electrolyte imbalance

49
Q

can thiazide diuretics be used with hepatic and renal impairment?

A

use with caution in impairment

avoid in severe liver disease

50
Q

what egfr rate should thiazides and related diuretics NOT be used in?

A

egfr of under 30 - avoid diuretics

51
Q

what are the cautions of thiazide like diuretics?

A

Hypokalaemia
elderly more susceptible to side effects so lower doses
adjust according to renal failure [cautioned in renal impairment]

52
Q

why is hypokalaemia bad in hepatic failure?

A

can lead to encephalopathy [brain damage] particularly in alcoholic cirrhosis

53
Q

what 2 conditions can thiazide diuretics really worsen and how?

A

gout and diabetes

can cause hyperglycaemia and hyperuricaemia

54
Q

what is the mechanism of action of loop diuretics?

A

inhibit reabsorption from the ascending loop of henle

55
Q

give 2 examples of loop diuretics?

A

furosemide

bumetanide

56
Q

in what conditions can loop diuretics be used to treat?

out of loop and thiazide diuretics, which are more potent?

A

pulmonary oedema

loop diuretics

57
Q

are loop diuretics safe in diabetes?

A

no can worsen diabetes and gout

58
Q

what is the onset of action of furosemide and bumetanide?

when is diuresis complete? therefore how often during the day can they be given?

A

onset of 1 hour
diuresis complete within 6 hours
can be given TWICE daily without interfering sleep

59
Q

what are the side effects of loop diuretics? [6]

A 
headache
nausea
electrolyte imbalance
dizziness
muscle spasm
fatigue
60
Q

what are the contraindications of loop diuretics? [4]

A

renal failure
severe hypokalaemia
severe hyponatraemia
liver cirrhosis

61
Q

which 2 diuretics can stain your urine slightly blue?

A

furosemide and triameterene [potassium sparing]

62
Q

how can high doses of loop diuretics or rapid IV administration damage pt with renal impairment?

A

bc can cause tinnitus and deafness

63
Q

give examples of potassoum sparing diuretics?

give examples of aldosterone antagonist

A

amiloride and triamterene

spironolactone and eplerenone

64
Q

what can both potassium sparing diuretics and ace inhibitors cause a risk of?

A

severe hyperkalaemia

65
Q

which supplements must NOT be given with potassium sparing diuretics?

A

potassium supplements

66
Q

what are the side effects of spironolactone? [3]

A

electrolyte imbalance
gynaecomastia
hyperkalaemia

67
Q

what is combination diuretic therapy?

A

strong diuretic [eg furosemide] used together with weak diuretic [eg amiloride] for pt with resistant oedema

68
Q

what type of diuretic is mannitol? what is it used to treat?

A

osmotic diuretic

to treat cerebral oedema and raised intraocular pressure

69
Q

why are mercurial diuretics hardly used?

A

high risk of nephrotoxicity

70
Q

what is the diuretic acetazolamide used to treat?

A

mountain sickness prophylaxis

71
Q

what are the eye drops dorzolamide and brinzolamide [diuretics] used to treat?

A

glaucoma

72
Q

what is the mechanism of action of angiotensin converting enzyme inhibitors? [ACE]

A

convert angiotensin 1 to angiotensin 2

73
Q

what are some indications of ACE inhibitors? [4]

A

heart failure
hypertension
diabetic nephropathy
prophylaxis of CV events

74
Q

what are the 2 contraindications of ACE inhibitors?

A
  1. concurrent use of ace and aliskiren in pt with diabetes or with egfr under 60
  2. discontinue if any jaundice/ signs of hepatic impairment occur
75
Q

what are the cautions of ace inhibitors?

A

afro-carribean pt bc risk of oedema
concomitant use with diuretics bc can drop BP
renal impairment [low dose first]

76
Q

can ace inhibitors be given in pregnancy and why?

A

no avoid can cause skull defects, neonatal BP and renal function

77
Q

why should ace inhibitors be avoided during dialysis?

A

can cause anaphylactoid reactions

78
Q

what is the pt and carer advice for ace inhibitors?

A

take dose sitting down to prevent hypotension as first dose hypotension can occur

79
Q

what is the monitoring requirements of ace inhibitors [2]

A

renal function

electrolytes

80
Q

what are the directions for administration of ace inhibitors for HYPERTENSION?

A

take FIRST dose at night time!

81
Q

which other heart meds should be discontinued before starting ACE inhibitors because of risk of hyperkalaemia?

A

potassium sparing diuretics or potassium supplements

82
Q

in which patients should ACE inhibitors be constantly monitored in? [8]

A 
pt with severe heart failure
pt on high dose or multiple diuretics
pt receiving concomitant use with aliskiren
pt with hypovolaemia
unstable heart failure
renovascular disease
hyponatraemia
hypotension
83
Q

what are the side effects of ace inhibitors? [7]

A 
persistent dry cough
GI problems
skin reactions
alopecia
constipation
electrolyte imbalance
angiodema
84
Q

can ace inhibitors be used in renal impairment?

A

use with caution - use low dose then titrate upwards

85
Q

what can concomitant use of ace inhibitors and NSAIDs cause a risk of?

A

risk of renal damage

86
Q

what 2 things should be checked before starting ace inhibitors?

A

renal function

electrolytes

87
Q

give examples of ARB inhibitors?

what is the mechanism of action?

A

candesartan, irbesartan, losartan, valsartan

angiotensin 2 receptor antagonist

88
Q

can ARB inhibitors be used in pregnancy?

A

avoid

89
Q

what are the 2 cautions of arb inhibitors?

A

caution in renal impairment and in the elderly

90
Q

what are the side effects of arb inhibitors? [3]

A

hyperkalaemia
hypotension
dizziness

91
Q

give an example of a renin inhibitor

what is the mechanism of action?

A

aliskiren

inhibit renin [which converts angiotensin to angiotensin 1]

92
Q

which drug should NOT be used in conjuction with aliskiren and why?

A

ace inhibitor

bc can lead to risk of hyperkalaemia, hypotension or renal impairment

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