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Pharmaco ++ > Antihypertensives > Flashcards

Antihypertensives Flashcards

1
Q

What is hypertension (primary vs secondary)?

A

BP > 140/90 mmHg

Primary hypertension: idiopathic, >90%
Secondary hypertension: specific causes like renal artery stenosis, adrenaline-producing adrenal tumour, <10%

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2
Q

What are the complications of hypertension?

A

Congestive heart failure
MI
Ischemic heart disease
Renal damage
Stroke

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3
Q

What are the 4 main categories of 1st line antihypertensives?

A

Diuretics
Beta-blockers
ACE inhibitors
Calcium channel blockers

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4
Q

What are the subcategories of diuretics?

A

Thiazides
Loop diuretics

Loop diuretics are more potent, often given as acute diuretics for patients for acute cardiac failure/emergencies but not for chronic usage as antihypertensives

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5
Q

What happens at the nephron DCT?

A

Impermeable to water

Na+Cl- cotransporter reabsorbs NaCl, diluting tubular fluid

Ca2+ is actively reabsorbed

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6
Q

What are thiazides?

A

The most widely used diuretic agents

E.g. hydrochlorothiazide

Inhibits NaCl cotransporter and thus reduces NaCl reabsorption in the PCT

Enhances Ca reabsorption in the DCT

Enhances urea reabsorption and inhibits urea excretion (exacerbates gout)

Dependent on PG synthesis, so NSAIDs reduce thiazide action

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7
Q

What are thiazides used for?

A

Hypertension

Congestive heart failure

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8
Q

What are the adverse effects of thiazides?

A

Hypokalemia

Hyponatremia

Hyperglycemia

Hyperlipidemia

Hyperuricemia

Hypercalcemia

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9
Q

What are two important beta-blockers?

A

Propranolol (non-selective)

Atenolol (beta-1 selective)

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10
Q

What does beta 1 receptor activation in the heart do?

A

Stimulates increased cAMP
Induces increased heart contractility and speed

Beta blockers therefore reduce rate and force and BP

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11
Q

What are the clinical uses of beta blockers?

A

Hypertension
Angina
Following MI

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12
Q

What are the adverse effects of beta blockers?

A

Bradycardia
Bronchospasm
Sedation
Vivid dreams

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13
Q

What are the contraindications for beta-blockers?

A

Asthma, COPD

Bradycardia

Reflex tachycardia

History of hypoglycemia/diabetes (beta blockers mask symptoms of hypoglycemia such as sweating, increased HR, tremors and dizziness)

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14
Q

What is the function of ACE?

A

Converts Ang I to Ang II, where Ang II stimulates vasoconstriction and aldosterone release to increase BP

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15
Q

What are some ACE inhibitors?

A

Captopril, enalapril, lisinopril

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16
Q

How do ACE inhibitors work?

A

Prevent conversion of Ang I to Ang II, preventing Ang II-induced vasoconstriction, aldosterone release, and BP increase

Inhibits breakdown of bradykinin, causing vasodilation to decrease BP

Too much bradykinin causes cough, may have to switch medication

17
Q

What are the clinical uses of ACE inhibitors?

A

Hypertension

Cardiac failure

Following MI

18
Q

What are the adverse effects of ACE inhibitors?

A

Severe hypotension
Hyperkalemia
Angioedema
Dry cough due to accumulation of bradykinin
Acute renal failure
Contraindicated in pregnancy

19
Q

What are 3 calcium channel blockers?

A

Verapamil, diltiazem, nifedipine

20
Q

Why are calcium channel blockers more used than antihypertensives?

A

They are also anti-angina and anti-arrhythmia, similar to beta blockers

They reduce the hyperactivity of the SA node

21
Q

Verapamil/diltiazem vs Nifedipine?

A

Verapamil and diltiazem reduce overactivity of the SA and AV nodes to treat arrhythmia

Nifedipine reduces myocardial contractility and smooth muscle tone to treat angina and hypertension

22
Q

Why is it important to step up dosages for calcium channel blockers?

A

If BP drops very quickly you may get stroke/hypotension

23
Q

What are the side effects of lowering calcium concentrations?

A

Vasodilation, leading to flushing, headache, reflex tachycardia due to compensation for decreased blood pressure

24
Q

What are the adverse effects of calcium channel blockers?

A

Constipation
Headache
Tachycardia
Severe hypotension
Dizziness
Flushing

25
Q

What antihypertensive should you not prescribe to a patient with gout?

A

Thiazides

26
Q

What antihypertensive should you not prescribe to a patient with diabetes?

A

Beta-blockers

Pharmaco ++ (7 decks)

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