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Pre-reg Exam 2021 > Antihypertensives > Flashcards

Antihypertensives Flashcards

1
Q

What are step 1 and 2 of the antihypertensive guidelines for adults with type 2 diabetes and hypertension/ under 55 (not of black or African or African-Caribbean family origin)?

A
  1. ACEi / ARB

2. CCB / thiazide like diuretic

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2
Q

What are step 1 and 2 of the hypertension guidelines for Black African / African-Caribbean family origin OR aged 55 or over?

A
  1. CCB

2. ACEi/ARB

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3
Q

What are step 3 and 4 of the hypertension guidelines?

A
  1. ACEi or ARB + CCB + thiazide like diuretic

4. Resistant hypertension - spironolactone if K+ < 4.5 mmol/L, alpha blocker or beta blocker if K+ > 4.5 mmol/L

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4
Q

What is a normal BP?

A

120/80

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5
Q

What is stage 1 hypertension?

A

140/90

Lifestyle advice
Treat if under 80 and co morbidity

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6
Q

What is stage 2 hypertension?

A

160/100

Treat

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7
Q

What is stage 3 hypertension?

A

> 180/ 110

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8
Q

What is the mechanism of action of ACEi?

A

Inhibits the conversion of angiotensin I to angiotensin II

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9
Q

What are the ACEi?

A 
Captopril (BD)
Enalapril
Lisinopril
Perindopril (30-60 mins before food)
Ramipril

Take first dose at bed time

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10
Q

What are the ARBs?

A 
Candesartan
Irbesartan
Losartan
Olmesartan
Valsartan
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11
Q

What are the side effects of ACEi?

A 
Persistent dry cough
Hyperkalaemia 
Angioedema
Renoprotective in renal disease
Nephrotoxic in AKI (DAMN)
Cholestatic jaundice
Hepatic failure
Oral ulcer
Taste disturbance 
Hypoglycaemia 
Avoid in pregnancy
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12
Q

What interaction causes hyperkalaemia when used with ACEi?

A

Aliskiren
ARB
K+ sparing diuretics/aldosterone antagonists

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13
Q

What is the interaction between NSAIDs and ramipril?

A

Nephrotoxicity

Reduced eGFR

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14
Q

What interaction does diuretics and lisinopril cause?

A

Hypotension

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15
Q

What drugs cause renal impairment, hyperkalaemia and hypotension when used with ACEi?

A

ACEi/ARB
Renin inhibitors
ACE + ARB in diabetic nephropathy

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16
Q

What is the mechanism of action for ARBs?

A

Blocks angiotensin II receptor

Does not inhibit breakdown of bradykinin

Alternative to ACEi if persistent dry cough occurs

17
Q

What are the centrally acting anti-hypertensives?

A

Methyldopa (driving, drowsiness)

Clonidine (flushing)

Moxonidine

18
Q

What are the vasodilator antihypertensives?

A

Hydralazine (fluid retention, tachycardia)

Minoxidil (tachycardia, fluid retention, increases cardiac output)

19
Q

What are the alpha blockers?

A

Prazosin
Doxazosin
Tamsulosin

20
Q

What is the mechanism of action of beta blockers?

A

Block b-adrenoceptors in the heart, peripheral vasculature, bronchi, pancreas, liver

21
Q

What is esmolol specifically used for?

A

Hypertension in peri-operative period

22
Q

What is labetalol used for?

A

Hypertension in pregnancy

Hepatotoxic

23
Q

What is sotalol?

A

Class 3 anti arrhythmic

Causes torsades de pointes

24
Q

Which beta blockers cause less bradycardia and less coldness of extremities?

A

ice PACO

Pindolol
Acebutolol
Celiprolol
Oxprenolol

25
Q

Which beta blockers cause fewer nightmares and less sleep disturbance?

A

water CANS

Water soluble so less likely to cross BBB

Celiprolol
Atenolol
Nadolol
Sotalol

26
Q

Which beta blockers are cardioselective so cause less bronchospasm?

A

Be A MAN

Bisoprolol 
Atenolol 
Metoprolol 
Acebutolol 
Nebivolol
27
Q

Which beta blockers have a long duration of action so only have OD dosing?

A

BACoN

Bisoprolol
Atenolol
Celiprolol
Nadolol

28
Q

What are the side effects of beta blockers?

A

Bradycardia
Hypotension
Hyperglycaemia
Masks symptoms of hypoglycaemia

29
Q

What are the contraindications of beta blockers?

A

Asthma - causes bronchospasm
Worsening unstable heart failure
Heart block
Severe hypotension and bradycardia

30
Q

What are the interactions of beta blockers?

A

Verapamil - asystole and hypotension

Hyperglycaemia - thiazide like diuretic

31
Q

What is the mechanism of action of calcium channel blockers?

A

Blocks calcium channels to reduce force of contraction, conductivity and vascular tone

32
Q

What are the vasodilatory CCBs?

A 
Dihydropyridines:
Amlodipine
Felodipine
Lacidipine
Nifedipine (maintain same MR brand)
Lercanidipine
33
Q

What are the rate limiting CCBs?

A

Verapamil

Diltiazem

34
Q

When should rate limiting CCBs be avoided?

A

In heart failure

35
Q

What is a side effect of verapamil?

A

Constipation

It’s the only CCB licensed in arrhythmia

36
Q

What is an important point to remember about diltiazem preparations?

A

Should maintain in the same brand when doses > 60mg

37
Q

What are the common side effects of CCBs?

A

Ankle swelling
Flushing
Headaches

38
Q

What is the interaction between amlodipine and grapefruit juice?

A

It increases the CCB concentration

39
Q

What is the maximum recommended dose of simvastatin when used with amlodipine or diltiazem?

A

20mg/day

Pre-reg Exam 2021 (79 decks)

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