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PMP 201 Patient-Centred Learning > Antihypertensive drugs > Flashcards

Antihypertensive drugs Flashcards

1
Q

Angiotensin II

A
  • Peptide hormone that acts as a AT1
  • Activated by a Gq coupled receptor
  • Vasoconstriction activation
  • Stimulates the thirst
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2
Q

ACE inhibitor

A
  • Zinc containing dipeptidyl carboxypeptidase
  • Produced in the lung
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3
Q

Arterial and venous vasodilation

A
  • Decrease arterial and venous pressure
  • Decrease in ventricular preload
  • Decrease blood vol
  • Downregulation of sympathetic activity
  • Suppression of hypertrophy
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3
Q

What is the ending of ACE inhibitor

A
  • Ending of -pril lowering blood pressure reduce vasoconstriction decrease peripheral resistance
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4
Q

Pharmacokinetics of ACE inhibitor

A
  • 40-60% bioavailable depending on drug
  • Bind to tissue
  • Metabolism in the liver
  • Eliminated through the kidney
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5
Q

Captopril

A
  • Absorbed and eliminated quickly
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6
Q

Enalapril

A
  • Later ACE inhibitor inactive pro-drug that requires hydrolysis
    during or active absorption
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7
Q

Lisinopril

A
  • Itself active
  • Lisinopril is not metabolized and is
    excreted as an unchanged drug
  • Completely eliminated in the urine
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8
Q

Mechanism of ACE

A
  • Bradykinin is a potent vasodilator and this is stimulated by specific endothelial B2 receptor
  • Dilates arterioles releasing prostacyclin and nitric oxide
  • ACE converts bradykinin to inactive peptide
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9
Q

Common Adverse effect of ACE inhibitor

A
  • Dry irritated cough due to bradykinin accumulation
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10
Q

Function Of ACE inhibitor

A
  • Block breakdown of bradykinin therefore there is an increase in levels
  • Effects sensory nerves adapting stretch receptors and C-fiber receptors that release neurokinin
  • Cause contraction of smooth muscle causes bronchoconstriction and dry cough
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11
Q

Rare adverse effects

A
  • Hyperkalemia - increase potassium cause depolarization can be lethal - aldosterone mediated
  • Taste disturbance - contain zinc bitterness in the mouth
  • Hypotension - rapid decease bp become low
  • Renal impairment (stenosis in kidney)
  • Increase in bradykinin cause angioedema rash and large lip
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12
Q

Clinical considerations

A
  • Cough is not dose dependent it is a class effect
  • Hypotension - combine with low dose diuretics
    Dehydration - vom and diarrhea temp suspend
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13
Q

Renal risk assessment

A
  • Beneficial for patients with chronic renal failure and hypertension
  • Assess renal function
  • Monitor serum creatinine
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14
Q

When to avoid ACE inhibitor

A
  • Patient 55 and above years
  • Caribbean black or African origin
  • Pregnant and breastfeeding women
  • Diabetic patients
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15
Q

Angiotensin receptor blocker

A
  • Receptor antagonist that block type 1 angiotensin II
  • AT1 receptors are coupled with Gq-proteins and IP3 signal transduction for muscle contraction
  • Ending with sartan
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16
Q

Advantages of using ARB instead ACEi

A
  • Avoids Bradykinin level rising no dry cough
17
Q

ADME of ARB

A
  • Readily absorbed 20-66%
  • Binds to plasma protein >90%
  • Metabolized in liver eliminated in kidney
18
Q

Adverse effects of ARB

A
  • Hyperkalaemia due to potassium retention
  • Renal impairment - Challenging nephron
  • Headache, fainting, nausea, back pain, liver fail, low white blood cells
19
Q

Clinical considerations for ARB

A
  • Patients with bilateral renal artery stenosis ARB
  • Damage both sides of the artery
  • Monitor glomerulus filtrate rate and creatinine levels
20
Q

Renin inhibition
Aliskiren

A
  • Inhibit the proteolytic enzyme causing vasodilation
  • Non-peptide renin inhibitor with antihypertensive activity bind to S3 sub pocket
21
Q

Calcium channel blocker

A
  • Blocks the calcium channel (L-type in vascular smooth muscle)
  • Regulates Calcium influx stimulating contraction
22
Q

‘dipine’ drugs (CCB)

A
  • Vascular effect - smooth muscle relaxation (Amlodipine) (Dihydropyridines)
  • Cardiac effect - decrease myocardial force generation and decreased heart rate and conduction velocity (Verapamil) (non-dihydropyridine)
23
Q

Dihydropyridines

A
  • Highly vascular selective reduce systemic vascular resistance
  • Flushing, headache, excessive hypotension and ankle oedema
  • Reflex tachycardia
24
Q

Nondihydropyridines side effects

A
  • Bradycardia
  • AV node block
  • Contractility
25
Q

Verapamil

A

Selective for the myocardium and is less effective as a systemic
vasodilator drug

26
Q

Diltiazem

A
  • Intermediate between verapamil and dihydropyridines in its selectivity for vascular
    calcium channels
27
Q

Thiazides and Thiazide-like diuretics

A
  • Moderately powerful diuretics
  • Block Na+ / Cl- symporter of early Inhibit active Na+ reabsorption and accompanying Cl-
    transport
  • Suffix ‘-ide’ and ‘-one’
  • Bendroflumethiazide
  • Indapamide
28
Q

Side effects of Thiazides and Thiazide-like diuretics

A
  • Hypokalemia increased sodium delivery to distil tube
  • Metabolic alkalosis (increased hydrogen ion loss in the urine)
  • Dehydration (hypovolemia),
  • Hypotension
29
Q

Major clinical problems with CCB

A
  • Negative membrane potential
  • Cardiac arrhythmias
  • Reduced activity of K+/Na+ pump
30
Q

Clinical considerations

A
  • Potassium supplements
  • Potassium-sparing diuretics
31
Q

Potassium-sparing diuretics
(Aldosterone receptor antagonists)

A
  • Antagonize aldosterone
  • Example spironolactone & eplerenone
32
Q

Potassium-sparing diuretics
(Na+ channel blockers)

A
  • Block apical ENaC in late DCT and CD
  • Na+ no longer retained at expense of K+
33
Q

Beta-adrenergic receptor antagonist

A
  • Increase heart rate and cardiac muscle contraction
  • Block beta-receptors and ending -lol
34
Q

Beta-blocker cardiac effects

A
  • Decrease contractility
  • Decrease relaxation rate
  • Decrease heart rate
  • Decrease conduction velocity
35
Q

Beta-blockers vascular effects

A
  • Smooth muscle contraction
36
Q

Reason why aged and ethnic background is not suitable

A
  • Reduced renal function with age less nephron
  • ACE inhibitor less functioning as African less dependent on RAAS mechanism
37
Q

Furosemide

A
  • Inhibits sodium reabsorption in the loop of henle as a diuretic
38
Q

Alpha-adrenoreceptors antagonist

A
  • Smooth muscle and lead to vasodilation like doxazosin
  • Acting as a arterial dilator
39
Q

Minoxidil

A
  • Potassium channel openers the ATP sensitive potassium channel in vascular smooth muscle

PMP 201 Patient-Centred Learning (51 decks)

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