Antihypertensives Flashcards
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)?
- ACEi / ARB
2. CCB / thiazide like diuretic
What are step 1 and 2 of the hypertension guidelines for Black African / African-Caribbean family origin OR aged 55 or over?
- CCB
2. ACEi/ARB
What are step 3 and 4 of the hypertension guidelines?
- 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
What is a normal BP?
120/80
What is stage 1 hypertension?
140/90
Lifestyle advice
Treat if under 80 and co morbidity
What is stage 2 hypertension?
160/100
Treat
What is stage 3 hypertension?
> 180/ 110
What is the mechanism of action of ACEi?
Inhibits the conversion of angiotensin I to angiotensin II
What are the ACEi?
Captopril (BD) Enalapril Lisinopril Perindopril (30-60 mins before food) Ramipril
Take first dose at bed time
What are the ARBs?
Candesartan Irbesartan Losartan Olmesartan Valsartan
What are the side effects of ACEi?
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
What interaction causes hyperkalaemia when used with ACEi?
Aliskiren
ARB
K+ sparing diuretics/aldosterone antagonists
What is the interaction between NSAIDs and ramipril?
Nephrotoxicity
Reduced eGFR
What interaction does diuretics and lisinopril cause?
Hypotension
What drugs cause renal impairment, hyperkalaemia and hypotension when used with ACEi?
ACEi/ARB
Renin inhibitors
ACE + ARB in diabetic nephropathy
What is the mechanism of action for ARBs?
Blocks angiotensin II receptor
Does not inhibit breakdown of bradykinin
Alternative to ACEi if persistent dry cough occurs
What are the centrally acting anti-hypertensives?
Methyldopa (driving, drowsiness)
Clonidine (flushing)
Moxonidine
What are the vasodilator antihypertensives?
Hydralazine (fluid retention, tachycardia)
Minoxidil (tachycardia, fluid retention, increases cardiac output)
What are the alpha blockers?
Prazosin
Doxazosin
Tamsulosin
What is the mechanism of action of beta blockers?
Block b-adrenoceptors in the heart, peripheral vasculature, bronchi, pancreas, liver
What is esmolol specifically used for?
Hypertension in peri-operative period
What is labetalol used for?
Hypertension in pregnancy
Hepatotoxic
What is sotalol?
Class 3 anti arrhythmic
Causes torsades de pointes
Which beta blockers cause less bradycardia and less coldness of extremities?
ice PACO
Pindolol
Acebutolol
Celiprolol
Oxprenolol
Which beta blockers cause fewer nightmares and less sleep disturbance?
water CANS
Water soluble so less likely to cross BBB
Celiprolol
Atenolol
Nadolol
Sotalol
Which beta blockers are cardioselective so cause less bronchospasm?
Be A MAN
Bisoprolol Atenolol Metoprolol Acebutolol Nebivolol
Which beta blockers have a long duration of action so only have OD dosing?
BACoN
Bisoprolol
Atenolol
Celiprolol
Nadolol
What are the side effects of beta blockers?
Bradycardia
Hypotension
Hyperglycaemia
Masks symptoms of hypoglycaemia
What are the contraindications of beta blockers?
Asthma - causes bronchospasm
Worsening unstable heart failure
Heart block
Severe hypotension and bradycardia
What are the interactions of beta blockers?
Verapamil - asystole and hypotension
Hyperglycaemia - thiazide like diuretic
What is the mechanism of action of calcium channel blockers?
Blocks calcium channels to reduce force of contraction, conductivity and vascular tone
What are the vasodilatory CCBs?
Dihydropyridines: Amlodipine Felodipine Lacidipine Nifedipine (maintain same MR brand) Lercanidipine
What are the rate limiting CCBs?
Verapamil
Diltiazem
When should rate limiting CCBs be avoided?
In heart failure
What is a side effect of verapamil?
Constipation
It’s the only CCB licensed in arrhythmia
What is an important point to remember about diltiazem preparations?
Should maintain in the same brand when doses > 60mg
What are the common side effects of CCBs?
Ankle swelling
Flushing
Headaches
What is the interaction between amlodipine and grapefruit juice?
It increases the CCB concentration
What is the maximum recommended dose of simvastatin when used with amlodipine or diltiazem?
20mg/day
