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 a CCB 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
ARBs S/E
↑ K+
-sartans
names of CCBs? (4)
verapamil
diltiazem
amlodipine
nifedipine
how to monitor effectiveness when patient is on diuretics?
weight
if patient has rise in creatinine after starting ACEi?
continue ACEi, repeat U+E after 1 week
small rise in creatinine (<20%) is to be expected when starting ACEi (Ix or change not needed)
when put on high dose diuretics: what to bear in mind?
1) renal function (esp if they become ill/dehydrated)
2) time of day given - often weeing for 4-6 hours after
3) BP (Sx of collapse?)
if ACEi given to black pt?
angioedema (give ARBs)
S/E spirinolactone?
more K+
gynaecomastia
