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Drugs > Antihypertensive Drugs > Flashcards

Antihypertensive Drugs Flashcards

1
Q

Stages of hypertension SBP/DBP

A

Stage 1 - mild >/= 140/90
Stage 2 - moderate >/= 160/100
Stage 3 - severe >/= 180/110

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2
Q

Primary vs secondary hypertension

A

Primary - cause unknown 90% cases

Secondary - identified cause e.g. Polycystic renal disease, renal artery stenosis, pheochromocytoma

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3
Q

BP equation(s)

A

BP= CO x TPR
CO=HR x SV
Therefore
BP=HRxSVxTPR

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4
Q

5 ACE inhibitors

Which is the worst adherence-wise?

A
  • Captopril - short plasma half life so must be taken 2-3 tames a day, therefore bad for patient adherence
  • Ramipril
  • enalapril
  • trandolapril
  • lisinopril
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5
Q

ACE Inhibitor mechanism

A

Blocks angiotensin-converting enzyme so angiotensin I can’t turn into angiotensin II which causes vasoconstriction
Blocking this hence causes vasodilation

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6
Q

Explain ACE inhibitor side effects of oedema and cough

A

ACE normally inactivates bradykinin
Because we are inactivating ACE, this means bradykinin is not inactivated, so bradykinin is activated
Bradykinin produces spasmogen actions on bronchial smooth muscle, producing a cough
Also causes oedema

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7
Q

ACE inhibitors dilate veins and arteries, what does this mean CVS wise?

A

Decrease cardiac workload
But doesn’t affect cardiac contractility
Therefore Increase in CO

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8
Q

ACE inhibitor side effects

A

Rash/angiodema
Dry cough
Progressive renal failure if patient already has renal artery stenosis
DO NOT USE in pregnancy as can cause congenital abnormalities to fetus

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9
Q

Advantages of using angiotensin receptor blocker

A
  • well tolerated (no cough)
  • reduced angiotensin II vasoconstriction
  • reduced salt/water retention
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10
Q

Disadvantages of using angiotensin receptor blockers

A
  • Dizziness
  • Hyperkalaemia
  • Cost $$ (why they are not 1st line)
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11
Q

Name 3 angiotensin receptor blocker drugs

A

Losartan
Valsartan
Candesartan

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12
Q

Name 5 Calcium channel blockers and put a star* next to the two that are more effective in vascular smooth muscle compared to cardiac smooth muscle

A 
Nifedipine*
Amlodipine*
Diltiazem 
Nicardipine 
Verapamil
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13
Q

Side effects of calcium channel blockers

Warning to tell patients

A

Oedema, headache, constipation
React with grapefruit juice as also a CYP450 transporter - if taken with grapefruit juice this will increase the concentration of the drug in blood and may be harmful

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14
Q

Why do calcium channel blockers cause oedema?

A

Dilation of resistance vessels, increased blood flow to capillaries
Which causes an increased hydrostatic pressure across the capillary wall at the arteriole end
Fluid loss occurs across the wall

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15
Q

How Beta-1-antagonists have antihypertensive effect

A

Beta1 receptors increase HR/force of contraction and increase renin release
So if you block these
-CO reduced
-Renin release from juxta-glomerular apparatus reduced
so vasomotor centre in medulla oblongata is also reduced
Vasodilation!

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16
Q

Name 5 B1-antagonists/blockers

A

Propranolol, atenolol, labetalol, bisoprolol, metaprolol

17
Q

Propranolol details

A

B1-blocker

  • competitive antagonist
  • non-selective beta blocker
  • relatively lipid-soluble, so good CNS penetration
18
Q

Atenolol (also bisoprolol and metoprolol) details

A

Competitive antagonist
Relatively selective for B1 blockers
Relatively water-soluble - poor CNS penetration
-not 1st line as can worsen insulin resistance and other drugs are better at reducing blood pressure

19
Q

Labetalol details

A

Mixed alpha1/beta1 blocker

Can be used safely in pregnancy

20
Q

B1 blockers adverse effects

A
  • Bronchoconstriction
  • Precipitation of cardiac failure or heart block, but carveilol may be used in patients with heart disease
  • hypoglycaemia, masks sympathetic sweating, tachycardia and tremor
  • cold extremities
  • vivid dreams
21
Q

Name 2 alpha blockers, which is best for adherence?

When are alpha blockers used?

A

Prozosin and Doxazosin
Doxazosin better for adherence as can be taken once daily as longer half life
Both used in antihypertensive treatment when other treatments have failed or are not acceptable

22
Q

Name 3 thiazide or thiazide-like diuretics

How do they work in the treatment of hypertension

A

Chlortalidone
Indaparmide
Bendoflumethiazide

Initially reduce blood volume, but then have a vasodilator effect

23
Q

Side effects of thiazide and thiazide-like diuretics

A

Hypokalaemia
Reduced insulin release
Increase in plasma lipid and urate
Erectile dysfunction

24
Q

Name a loop diuretic used for hypertension

What’s good about this one in particular? What is bad?

A

Furosemide
Good for resistant hypertension but
Short duration of action

25
Q

Loop diuretic side effects

A

E.g. Furosemide

  • can affect hearing
  • gout
  • hypokalaemia
26
Q

Name 3 potassium-sparing diuretics
When are they used in treatment of hypertension?
Why?

A

Amiloride, triamterene, spironolactone
Used alongside thiazide diuretics
Don’t decrease K+, but can increase it (hyperkalamia)
Can also decrease Na+ in blood (hyponatraemia)

27
Q

Name 5 vasodilator drugs

A 
Hydralazine 
Minoxidil 
Sodium nitroprusside
Methyldopa 
Sildenafil
28
Q 
Hydralazine
How it works 
Where it acts
When it is used
Side effects
A

Works by opening K+ATP channels
Acts mainly on arteries/arterioles
Used in moderate to severe hypertension and for short term treatment of hypertension in pregnancy
IV in hypertensive emergencies
Decrease in blood pressure causes reflex tachycardia

SEs:
Palpitations
GI disturbance
SLE-like syndrome (pain in joints and skin)

29
Q 
Minoxidil 
When is it used 
Why is it good?
How does it work?
What is it given with?
Side effects
A 
Used in severe, resistant hypertension 
Very potent and long-acting 
Increases cardiac output and heart rate, this causes fluid retention 
Given with loop diuretics 
SEs: 
Peripheral oedema (see above) 
GI disturbance 
Hypertrichosis (abnormal hair growth)
30
Q

Methyldopa
When is it used?
How does it work?
Side effects

A

Hypertension in pregnancy
Blocks DOPA decarboxylase enzyme, hence less dopamine produced
SEs:
GI disturbance, dry mouth, bradycardia

31
Q 
Sodium Nitroprusside 
How does it work?
Bad side of it?
How is it given?
Side effects
A

NO donor, acts equally on arterial and venous smooth muscle
In solution hydrolyses to cyanide
Short half life so given as continuous infusion and only for short term (<72 hours) treatment
SEs:
Headache
Dizziness
Nausea

32
Q

Siledenafil
Use(s)
How it works
Side effects

A

Pulmonary hypertension and erectile dysfunction (Trade name is Viagra)
Works by blocking phosphodiesterase 5 enzyme (PDE V)
SEs: GI disturbance

Drugs (9 decks)

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