Antihypertensives

Question 1

-pril drugs

• Class
• MoA
• Indications
• Side effects
• Contraindications
• Pregnancy
• Monitoring
• Extra info

Answer 1

Class:
ACE inhibitor

MoA:
Inhibit ACE, reducing vasoconstriction and vasopressin and aldosterone release

Indications:
Hypertension, angina, diabetic nephropathy

Side effects:
Cough, angioedema, proteinuria, teratogenic, taste disturbance, hyperkalemia,** renal impaiment**, itch, hypotension, worsen psoriasis

Contraindications:
Aortic stenosis

Pregnancy rules:
**Not safe **for pregnancy or breastfeeding

Monitoring:
Creatinine and potassium - up to 30% rise and 5.5mmol/L is acceptable

Extra info:
Sudden renal impairment on starting may indicate renal artery stenosis

Question 2

-dipine drugs

• Class
• MoA
• Indications
• Side effects

Answer 2

Class:
Dihydropyridine calcium channel blockers

MoA:
Blocks L-type calcium channel preventing cross bridge formation resulting in vasodilation

Indications:
Hypertension, angina, raynauds, subarachnoid haemorrhage (nifedipine)

Side effects:
Ankle oedema, flushing, headache

Question 3

Indapamide

• Class
• MoA
• Side effects
• Extra info

Answer 3

Class:
Thiazide like diuretic

MoA:
Inhibition of sodium chloride co-transporter in DCT meaning less water reabsorption.

Side effects:
Hypokalemia, hyponatremia, hypercalcemia/hypocalciuria, hyperglycaemia, hyperuricemia, postural hypotension, dehydration, gout, impotence, thrombocytopenia, agranulocytosis, photosensitivity rash, pancreatitis

Extra info:
Diuretic effects only last 1-2 weeks. Chlorothiazide can be used for nephrogenic diabetes insipidus

Question 4

-olol drugs

• Class
• MoA
• Indications
• Interactions
• Side effects
• Contraindications
• Extra info

Answer 4

Class:
Beta blockers

MoA:
Bind to and block B1 adrenergic receptors, inhibiting the sympathetic nervous system

Indications:
Angina, arrhythmias, thyrotoxicosis, migraine and cardiac prophylaxis

Interactions:
Non-dihydropyridine calcium channel blockers

Side effects:
Bronchospasm, fatigue/insomnia, cool peripheries, can exacerbate plque psoriasis, bizarre dreams, erectile dysfunction

Contraindications:
Asthma

Extra info:
Bisoprolol and atenolol are highly cardioselective