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Pharmacology > Antihypertensives > Flashcards

Antihypertensives Flashcards

ACDE

1
Q

What are the therapeutics effects of ACE inhibitors?

A

Vasodilations, increase in Na and water secretion

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2
Q

What are the indications of ACE inhibitors?

A

Hypertension, heart failure, preserve renal function in diabetes

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3
Q

What are some clinical considerations of ACE inhibitors?

A

Low renin in African patients reduces effect
Not in bilateral renal artery stenosis
Avoid in pregnancy

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4
Q

List side effects of ACE inhibitors

A 
Cough - reduced bradykinin breakdown
Hypotension, hyperkalaemia
Tachycardia, palpitations, anginal pain
Renal impairment
Head ache, nausea, angio-oedema, tase disturbace, vomiting, abdominal pain
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5
Q

What are the therapeutics effects of AT1R antagonists?

A

Inhibit angiotensin-induced vasoconstriction and aldosterone release
Increase Na, water excretion

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6
Q

What are the indications of AT1R antagonists?

A

Hypertension, heart failure, diabetic nephropathy, intolerance to ACE inhibitors

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7
Q

List side effects of AT1R antagonists.

A

As ACE inhibitors

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8
Q

What are some clinical considerations for AT1R antagonists?

A

Avoid in pregnancy and renal artery stenosis.

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9
Q

What is the mechanism of action of Ca2+ channel blockers?

A

Block L-type (voltage-gated) Ca2+ channels, reducing Ca2+ entry into vascular and cardiac cells.

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10
Q

What are the clinical effects of Ca2+ channel blockers?

A

Vasodilation, reduced cardiac contractility and atrio-ventricular conduction.

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11
Q

Which group of Ca2+ channel blockers has predominantly vascular effects?

A

Dihydropyridines, e.g. nifedepine, amlodipine

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12
Q

Which group of Ca2+ channel blockers has predominantly cardiac effects?

A

Non-dihydropyridines, e.g. verapamil, diltiazem

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13
Q

What are the contraindications of Ca2+ channel blockers?

A

Hypertension, angina, tachydysrhythmia

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14
Q

What are the side effects of Ca2+ channel blockers?

A

Orthostatic hypertension
Reduced myocardial workload, bradycrdia, dysrhythmia
Oedema, headache, syncope, nausea, face and neck flushing, diarrhoea

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15
Q

What are the most commonly used diuretics in hypertension?

A

Thiazides

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16
Q

What are the short term and long term effects of diuretics?

A

Short term: decrease blood volume, reducing CO

Long term: Normalise CO and decrease TPR

17
Q

What is the site of action of thiazides?

A

Na+/Cl- transporter in distal tubule.

18
Q

What is the site of action of loop diuretics?

A

Na+/2Cl- transporter in the loop of Henle

19
Q

What are the side effects of diuretics?

A

Hypokalaemia, hyperuricaemia, glucose intolerance, hypercholesteraemia, rash

20
Q

What are the side effects more common to loop diuretics?

A

Hypovolaemia, hearing impairment

Increased Mg2+, Ca2+ excretion

21
Q

What are the side effects of thiazides?

A

Dehydration, electrolyte imbalance, hypotension, dizziness

Pruritus, anorexia, urinary frequency, erectile dysfunction, reduce oedema.

22
Q

What is the first line pharmacological treatment for hypertension?

A

ACE inhibitors or AT1R or Ca2+ channel blocker or low-dose thiazide diuretic for > 65yo

23
Q

What is the second line treatment for hypertension?

A 
ACE inhibitor (or AT1R) + Ca2+ channel blocker or
ACE inhibitor (or AT1R) + low-dose thiazide diuretic
24
Q

What is the third line treatment for hypertension?

A

ACE inhibitor (or AT1R) + Ca2+ channel blocker + low-dose thiazide diuretic

25
Q

What are the actions of beta-blockers in hypertension?

A

Decrease SNS in heart - reduce CO, HR and TPR
Inhibit renin release, decreasing angiotensin II
Reduces SNS outflow from CNS if lipid-soluble

26
Q

What are the indications for beta-blockers?

A

Angina, post-myocardial infarct, dysrhythmia, clinically stable heart failure

27
Q

What are the side effects of beta-blockers?

A

Reduced HR, force of contraction, cardiac disturbances
Bronchoconstriction
Hypotension, reduced blood glucose
Increased peristalsis, flatulance
Lassitude, nightmares, depressed mood, loss of libido.

28
Q

List SNS inhibitors that can be used in hypertension.

A

Beta-blockers
CNS-acting: alpha2 receptor agonists, methyldopa (false transmitter with no post-ganglionic effect, alpha2 agonist)
Alpha1 antagonists

29
Q

Give example of CNS-acting alpha2 receptor agonists.

A

Clonidine, methyldopa

30
Q

What is the mechanism of action of methyldopa (alpha-methyl NA)?

A

Alpha-2 receptor agonist in CNS, methylates NA at presynaptic terminals.

31
Q

What are the side effects of methyldopa?

A

Sedation, depression, fatigue, rebound hypertension on withdrawal.

32
Q

What are the indications for methyldopa?

A

Pregnancy

33
Q

What are the indications for clonidine?

A

Emergency hypertension, menopausal flushing

34
Q

What are the side effects of alpha1 receptor antagonists?

A

First dose syncope, postural hypotension, reflex tachycardia (less with selective), urinary urgency

35
Q

What are the indications of alpha1 receptor antagonists ?

A

Co-treatment in hypertension and benign prostatic hyperplasia (BPH)

36
Q

List “other” vasodilators used in hypertension.

A 
Hydralazine (arteriolar)
Cromokalim, minoxidil (arteriolar) - increase K+ channel permeability and hyperpolarisation
Sodium nitroprusside (arterial and venous) - donates NO
37
Q

What are the indications for “other” vasodilators, e.g. hydralazine, cromokalim, minoxidil, sodium nitroprusside?

A

I.V. for emergency hypertension, resistant hypertension as adjuncts

Pharmacology (14 decks)

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