Antihypertensives Flashcards
What is high normal?
120/80 to 139/89
Draw the table of hypertension grades
Check the doc.
You only need to know that “high normal” starts at 120/80 and ends at 139/89.
For each grade starting with mild (140/90), we know that systolic moves up 20 points and diastolic moves up 10.
Who makes ACE?
The lungs.
Who makes angiotensin?
The liver.
What does renin catalyse?
Angiotensinogen to angiotensin I.
ACE does what?
Angiotensin I to Angiotensin II
What four effects of Angiotensin II raise blood pressure?
Vasoconstriction
Anti-natriuretic
Aldesterone secretion (anti-natriuretic)
Vascular hypertrophy
ACE converts angiotensin I to angiotensin II. What’s the other thing it does?
Metabolises bradykinin.
ACE inhibiting drugs all end in….
… ‘-pril’
ACE inhibitors are more effective when ___, especially when ____.
When blood pressure is high, especially when the RAAS system is active.
What two [immediately related] effects do ACE inhibitors have on the heart?
Reduction of CARDIAC LOAD
Reduction of PERIPHERAL RESISTANCE
Because they are more angiotensin II sensitive, ACE inhibitors are more selective for the H,B,K
Heart, brain, kidneys.
ACE inhibitors are NOT for three kinds of people. They are…
(One is a disease, one relates to side effects)
- pregnant ones (category D)
- ones with bilateral renal stenosis (think about it: reduced GFR plus lower BP… bad).
- Hyperkalaemics.
How do ACEIs decrease K+ excretion?
Fewer Na+ ions and ENaC channels to reabsorb them with in the CD, meaning less loss of K+ via exchange with.
Which ACE inhibitor is known to sometimes cause neutropaenia at high doses?
It captures the hell out of those neutrophils.
Captopril.
What ends in -pril?
ACE inhibitors
What ends in -sartan?
Angiotensin II receptor blockers
If you’re name ends in -sartan, where are you cleared?
ARBs: HEPATIC CLEARANCE
If your name ends in -olol, what are you?
A beta blocker.
What do all beta blockers end in?
-olol
What two places do you mainly find B1 receptors?
Hong Kong #1
Heart and Kidney
Which beta receptors do you mainly see in arterial smooth muscle?
Bonus: what other two places
B2.
Bonus: liver and LUNGS.
How is it beta blockers also influence the RAAS system?
The kidney (juxtaglomerular cells) have B1 receptors.
Which beta blockers are the most cardiac (B1) selective?
I give that metal bison statue a 10/10.
Atenolol,
metoprolol
Bisoprolol
Which beta blockers are the most cardiac selective?
Atenolol,
Metaprolol
Bisoprolol
Which group of diseases is totally contraindicated for non-selective beta blockers
Respitory (COPD, asthma)
Even selective ones can be a problem since they lose selectivity at higher doses.
Two blood-flow problems contraindicated with beta blockers?
Claudication (intermittent cramping) and Raynaud’s disease.
Which CCBs would you want if you were just treating hypotension?
Vascular selective ones.
Low importance:
Vascular CCBs
Cardiac CCBs
Vascular+Cardiac CCBs
DeFenestrate Bush.
Dihydropyridine
Phenylalkylamine
Benzothiazapene
Low importance:
Dihydropyridine
Phenylaklylamine
Benzothiazepine
Give the drugs for each class
Miodipine, nifedipine
Verapamil
Diltiazem
Which class of CCBs would we use for hypotension and what are the two drugs called?
Ah, my darling knife (Italian).
Dihyropyridine;
Amiodipine, nifedipine
What are three benefits of CCBs for high BP?
High compliance
No renin release
Side effects cancel out B-blocker side effects.
Crossover with angina: Who would you NOT give amiodipine or nifedipine to?
MI or angina patients (vascular steal).
What two unwanted effects of CCB are paradoxical?
constipation and flushing.
With thiazide diuretics you’ll get an initial fall in BP from peeing. What’s the more long term mechanism?
They desensitise smooth muscle to calcium.
What antiquated antihypertensives might we use in a hypertensive crisis? (not too important)
Hydralazine, miloxidil
Miloxidil and hydralazine are antiquated antihypertensives used in hypertensive crisis, but they have a limiting factor -
reflexive tachycardia.
What is the only drug for hypertension during pregnancy?
methyldopa
Bob’s CV risk is low-moderate. What is the response?
Tell him to stop being such a fatty. Check to see if he hasn’t stopped being such a fatty within 6 (moderate) or 12 (mild) months.
We check blood pressure. At grade ___ we’d always to an absolute CV risk assessment.
If they’re at grade ___ we start an antihypertensive straight away.
1 or 2 (mild or moderate)
3 (severe)
Which group that we’ve looked at in detail isn’t used until, like, the fourth round of attempts to reduce hypertension?
beta blockers.
First line for antihypertensive treatments depends on age.
In the young (<55) it’s ___
In the old it’s ___ or ____
Young: ACEIs or ARBs.
Old: CCBs or Diuretics.
If monotherapy fails, we try a combination of A + ___ or ___
A with CCBs or Diuretics.
Third step combination therapy is…
If that fails then we think about beta blockers or more diuretics.
A+C+D
