Antihypertensives Flashcards
ACEi S/E
↓Na+ and ↑K+
- dry cough
- AKI (beware RAS) (creatinine transiently rises <20% from baseline)
- postural hypotension
- angioedema (afro-american)
CCB S/E
flushing
peripheral oedema
severe bradycardia with B-blocker (verapamil)
(avoid in biventricular HF)
B-blockers S/E
wheeze in asthmatics worsening HF fatigue nightmares cold extremities severe bradycardia (verapamil)
avoid in PVD
diuretics S/E
- hypo K+ and Na+
- if K+ sparing, HYPER K+ and gynaecomastia
- (gout - loop diuretics “furosemide”)
- AKI/renal failure
main 3 categories of anti-HT S/Es?
1) hypotension
2) ↓ HR with B-blockers + some CCBS // or electrolyte disturbance with ACEi + diuretics
3) individual specific S/E
effect of loop and thiazide diuretics on K+?
↓ K+
(↑ K+ excretion via kidneys)
don’t give two loops together!
effect of ACEi on K+?
↑
↓ aldosterone production + thus ↓ K+ excretion in the kidneys
effect of ACEi with NSAID?
can lead to RF
NSAIDs ↓ prostaglandin synthesis which ↓ renal artery diameter (and ↓ blood flow)
thereby ↓ kidney perfusion and function
ACE-i ↓ angiotensin-II production necessary for preserving glomerular filtration when the renal blood flow is ↓
S/E that all diuretics can have in common?
↓ Na+
important S/E of amlodipine (CCB)?
peripheral oedema
can you prescribe verapamil alongside a B-blocker?
no! due to the risk of
1) ↓ HR (or at worst asystole)
2) ↓ BP
antihypertensives contraindications?
hypotension
bradycardia
cough
renal distrurbance
what is the pathway for prescribing antihypertensives?
A=ACEi/ARB
C=CCB
D=thiazide-like diuretic
1) <55 A, >55 or black C
2) A+C
3) A+C+D
4) A+C+D+further D+B-blocker
when to avoid ACEi?
RAS
PVD (CLI)
GFR<30
↑ K+
what time of day best to give ACEi?
at night
postural hypotension
