Antihypertensives Flashcards
1st line antihypertensive in someone who is under 55 and is caucasian / brown
ramipril (ACE inhibitor)
How does ramipril work
stops conversion of angiotensin one to angiotensin two
no release of aldosterone and less ADH
how does aldosterone work
it causes more Na retention
so increases fluid in the body
and so works to increase the blood pressure
where does aldosterone work
in the CD
a patient is on antihypertensives and is complaining of a dry cough?
ACE inhibitors can cause a buildup of bradykinin
if someone isn’t responding that well to ACE inhibitors what can you prescribe instead
Angiotensin 11 receptor antagonist
what are some examples of angiotensin 2 receptor blockers
losartan, eprosartan
what is a pro of using AT2RB
they dont cause a build up of bradykinin so no dry cough
which is better at vasoconstriction ACEi or AT2RB
AT2RB as the target the receptor directly
if someone is not responding well to both ACE I and AT2RB what other medication could you prescribe
thiazide
how do thiazide diuretics work
they are Na/Cl receptor blockers so prevent reabsorption in the DT
what is BP is stage one of hypertension
140/90
what BP is stage two of hypertension
160/100
what BP is stage three of hypertension
180/110 (120)
if the three main drugs dont work what is the final drug to resort to
spironolactone
what drug class is spironolactone
aldosterone receptor blocker
How does aldosterone receptor blocker work
it blocks aldosterone at the collecting duct
it increases the Na and H20 excretion
what are some side effects of spironolactone
gynaecomastia
hyperkalemia
what drug class is amlodipine
dihydropyridine
how does amlodipine work
it is a calcium channel blocker and works across all peripheral vasculature
what are three side effects of amlodipine
facial flushing
swelling in legs
headaches
what class of drug is verapamil
it is a non dihydropyridine
Ca channel blocker
how does verapamil work
it is a calcium channel blocker that slows the electrical activity of the heart and decreases the force of contraction
what are some side effects of verapamil
- risk of bradycardia
- worsen heart failure as it slows AV conduction and can delay LV function
in people of afro- Caribbean descent what would you prescribe
calcium channel blocker first because they are said to have low renin levels so dont want to give ACE inhibitor
apart from verapamil what is another calcium channel blocker that could be used when treating hypertension
diltiazem
what is another thiazide diuretic that you can give to people
bendroflumethiazide
amiloride can be used as an antihypertensive what class of drug is it and where does it act
K sparing diuretic that acts on the DCT
what are some drugs you should be cautious of when prescribing amiloride
ramipril
trimethoprim (hyperkalemia)
furosemide (hyponatremia)
Doxazosin is also used as an antihypertensive medication
what class of drug is it
alpha adrenoreceptor blocker
how does doxazosin work
it is a selective antagonist at the post synaptic a1 adrenoreceptors and antagonises the contractile effects of NA on smooth muscle and reduces TPR
bisoprolol can be used to treat hypertension what is its drug class and how does it work
b blocker
reduces sympathetic tone by blocking NAD and reducing myocardial contraction
reduces CO, slows HR
what are some side effects of bisoprolol
raynauds
bradycardia
who should you be careful about when prescribing B BLOCKERS
asthmatics as it can cause bronchoconsyrictoon
what would prescribe when someone is suffering from heart failure
furosemide
