Antihypertensive Drugs Flashcards
Examples of cardio-selective beta blockers
BAtMAN
Bisoprolol
Atenolol
Metoprolol
Acebutolol
Nebivolol
Examples of cardio-selective beta blockers
BAtMAN
Bisoprolol
Atenolol
Metoprolol
Acebutolol
Nebivolol
Less likely to cause bronchospasm
Examples of water soluble beta blockers
Water CANS
Celiprolol
Atenolol
Nadolol
Sotalol
Less likely to cross BBB therefore less associated with nightmares
Examples of intrinsic sympathomimetic beta blockers
Ice PACO
Pindolol
Acebutolol
Celiprolol
Oxprenolol
Less likely to cause cold extremities
Side effects of beta blockers
Bradycardia or heart failure
Masked effects of hypoglycaemia - cautioned in diabetics
Hyperglycaemia
Bronchospasm - contraindicated in asthmatic patients
Fatigue
Cold extremities
Sleep disturbances (nightmares)
Beta blocker interactions
Amiodarone or digoxin - increases bradycardia which can lead to heart failure / heart block
Any other hypotensive drug
Thiazide diuretics - mask hypoglycaemia symptoms
Beta blocker monitoring parameters
HR and BP
Renal function - especially with water soluble
Examples of beta blockers with arteriolar vasodilating action - what is the consequence of this action?
Labetalol
Celiprolol
Carvedilol
Nebivolol
Lower peripheral resistance
Examples of dihydropyridine CCBs
Amlodipine
Felodipine
Lacidipine
Lercanidipine
Nicardipine
Nifedipine
Nimodipine
Examples of non-dihydropyridine CCBs
Verapamil and Diltiazem (rate limiting)
Which CCB can be used in heart failure and why can’t the others be used?
Amlodipine
They can further depress cardiac function and exacerbate symptoms
They can also increase mortality after myocardial infarction in patients with left ventricular dysfunction and pulmonary congestion.
Which CCB should not be used with beta blockers?
Verapamil
Most common side effect of verapamil
Constipation
Side effects of CCB
Flushing
Headache
Fainting
Ankle swelling
Gingival hyperplasia (enlarged gums)
Complete atrioventricular block; more common in rate-limiting (this is why you never give anti-arrhythmatics in QT prolongation)
Which CCB is licensed for the treatment of acute life-threatening hypertension?
Nicardipine hydrochloride
Examples of ACE-I
Ramipril
Enalapril
Lisinopril
Perindopril
Catopril
Side effects of ACE-I
CHHHARD
Cough (give ARB instead)
Hyperkalaemia
Hyponatraemia
Hepatic failure
Angioedema
Renal impairment
Dizziness and headaches
ACE-I interactions
ARBs, K-sparing diuretics, NSAIDs - Increase risk of renal failure
Heparins, ARBs, NSAIDs, K-sparing diuretics, beta-blockers - Hyperkalaemia
Diuretics - Increase risk of volume depletion
Lithium - Increase plasma levels of lithium
ACE-I monitoring requirements
Renal function and electrolytes - baseline,
BP
Examples of ARBs
Candesartan
Irbesartan
Losartan
Olmesartan
Telmisartan
Valsartan
Why are ARBs less likely to cause a dry cough?
They do not inhibit the breakdown of bradykinin and other kinins therefore less likely to cause the persistent dry cough
Side effects of ARBs
Same as ACE-I apart from no cough and no angioedema
Example of a renin inhibitor
Aliskiren
Side effects of combination therapy with two drugs affecting the renin-angiotensin system
Increased risk of hyperkalaemia, hypotension, and renal impairment
