antihypertensive drugs Flashcards
what combination of drugs cause triple whammy?
RASi + diuretics + NSAIDs
RASi : vasodilation of efferent arterioles
NSAIDs: vasoconstriction of afferent arterioles
diuretics: decrease plasma volume
contraindications of RASi
- pregnancy
- renal artery stenosis
- do not use with NSAIDs and diuretics
what is perindopril?
ACE inhibitor
what is irbesartan?
Angiotensin-receptor blocker
what are some adverse effects of RASi?
- Cough (dry - (increased bradykinin for ACEi)
- Angioedema
- Teratogen
- increased Creatinine
- Hyperkalaemia
- Hypotension (dizziness)
what is propranolol?
non-selective beta blocker
what is atenolol?
b1-selective beta blocker
contraindications of beta blockers
- asthma, COPD
- diabetes (mask hyperglycaemia)
- avoid combination with Ca2+ channel blockers
what is verapamil?
cardio-selective Ca2+ channel blocker
what is amlodipine/nifedipine?
peripheral-selective Ca2+ channel blocker
contraindications of Ca2+ channel blockers
- avoid with beta blocker
- heart failure –> Ca2+ channel blockers decrease cardiac output
what are some adverse effects of beta blockers?
- bradycardia
- diarrhoea
- impotence
- exercise intolerance
- sleep disturbance
- depression
- bronchoconstriction
what are some adverse effects of Ca2+ channel blockers?
symptoms related to vasodilation
1. oedema
2. flushing
3. headaches
4. bradycardia
what is Aliskiren?
renin inhibitor
what is the mechanism of action of renin inhibitors?
competitive inhibitor to renin –> decrease formation of ATII –> decrease BP
what is endothelin receptor antagonist indicated in?
pulmonary hypertension (not effective in primary hypertension)
what is bosentan and its MOA?
mixed ETa and ETb receptor antagonist
- prevents vasoconstriction
ETa mediates vasoconstriction
ETb mediates vasodilation
- overriding effect is vasoconstriction
what is ambrisentan and its MOA?
ETa-selective receptor antagonist
ETa mediates vasoconstriction –> drug blocks this –> vasodilation –> decrease BP
what is phentolamine?
non-selective a-receptor blocker (vasodilator used as add-on therapy for hypertension)
what is prazosin indicated in?
patients with benign prostate hyperplasia and hypertension
what are the adverse effects of prazosin?
- postural hypotension
- reflex tachycardia
- urinary urgency
what is prazosin?
selective a1 antagonist
what is methyldopa?
brain a2-receptor inhibitor
what is methyldopa indicated in?
pregnancy-related hypertension
what is hydralazine indicated in?
pregnancy-related hypertension
what is sodium nitroprusside (vasodilator) indicated in?
used IV for emergency treatment of hypertension
A combination of RASi + NSAID + diuretic can cause renal failure, as:
a. RASi decrease efferent blood flow and diuretics decrease plasma volume
b. NSAIDs decrease afferent blood flow and RASi increase efferent blood flow
c. NSAIDs increase afferent blood flow and RASi decrease efferent blood flow
d. NSAIDs decrease afferent blood flow and diuretics increase plasma volume
b. NSAIDs decrease afferent blood flow and RASi increase efferent blood flow
NSAIDs: afferent arteriole constriction –> decrease afferent blood flow –> lower GPF
RASi: efferent arteriole dilation –> increase efferent blood flow –> lower GFR
