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Pharmacology > Antihypertensives > Flashcards

Antihypertensives Flashcards

1
Q

What determines blood pressure?

A

CO X TPR = mAP

CO= HR X SV

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2
Q

What defines pre-hypertension?

A

120/80-140/90 mmHg

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3
Q

What is the first line treatment for a pre-hypertensive patient?

A

Lifestyle modification: exercise and weight loss

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4
Q

What is the first line treatment offered to a Caucasian male with hypertension?

A

ACEi or AG II receptor inhibitor

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5
Q

What is the first line treatment offered to a hypertensive Afro-Caribbean male?

A

Calcium channel blocker

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6
Q

What numerical changes define the hypertensive categories?

A

140/90- stage 1
160/100- stage 2
>180 systolic or >120 diastolic - stage 3

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7
Q

How does an ACEi work?

A

It prevents ACE (angiotensin I converting enzyme) from cleaving Ag-I into Ag-II, decreasing the amount of Ag-II present and therefore its effects on water homeostasis.

(Ag-II is cleaved by chymases also and therefore there is still some present).

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8
Q

How do ARB’s work?

A

They prevent Ag-II from binding to its target sites (AT1) and therefore decrease its homeostatic effects.

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9
Q

How do calcium channel blockers work?

A

They bind to VOCC in smooth muscle and prevent them from opening, resulting in the vasculature remaining dilated.

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10
Q

What is the target blood pressure for a hypertensive under 80?

A

140/90

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11
Q

What is the target blood pressure for a hypertensive >80?

A

150/90

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12
Q

What is the target blood pressure for a type I diabetic with hypertension?

A

135/85

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13
Q

Why might a hypertensive be prescribed diuretics?

A

To decrease water reabsorption and therefore reduce SV, reducing BP. Additionally, it will help relieve oedema

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14
Q

Why might a hypertensive be placed on beta-blockers?

A

To reduce HR and therefore reduce BP. Useful in those with cardiac failure.

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15
Q

What side effects are experienced by those taking ACEi?

A

Dry, non-productive cough due to accumulation of bradykinins (usually cleaved by ACE).

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16
Q

Why are the first line treatments different between ethnicities?

A

Typically individuals of Black ethnicity have lower renin levels and therefore giving a drug which works on the RAAS pathway isn’t as beneficial as a CCB.

17
Q

What is the pathophysiology of hypertension?

A 
Remodelling and hypertrophy 
Increased vasoactive substances 
Hyperinsulinemia and hyperglycaemia 
Resulting in end organ damage
Hypertensive heart disease - LVH
18
Q

Give the name of an ACEi

A

Lisinopril or ramipril

19
Q

What are the side effects of ACEi?

A 
Hypotension 
Dry cough
Hyperkalaemia 
Renal failure 
Angioedema
20
Q

What population of patients would not receive an ACEi?

A 
Renal artery stenosis 
AKD 
Pregnancy 
Breastfeeding 
CKD- caution
21
Q

What drugs have interactions with ACEi?

A

K increasing drugs
NSAIDs
Other antihypertensives

22
Q

Why would a ARB be selected over an ACEi?

A

No effect on bradykinin and therefore there is no dry cough

Angioedema is decreased because ARBs are less effective in low renin individuals

23
Q

Name an ARB

A

Lorsartan or candesartan

24
Q

Name contraindications for use of ARBs

A

Renal artery stenosis
AKD
Pregnancy and breastfeeding
CKD caution

25
Q

What agents should you be cautious of when prescribing ARBs?

A

K increasing drugs
NSAIDs
Other antihypertensives

26
Q

What are the 3 classes of CCB?

A

Dihydropyridines- amlodipine, nifedipine, nimodipine

Non-dihydropyridines:

Phenylalkylamines- verapamil

Benzothiazapines - diltiazem

27
Q

Which class of CCB is used for an antihypertensive and why?

A

Dihydropyridines - they are selective for peripheral vasculature and have little chronotropic and inotropic effects. They also display peripheral and cerebral selectivity.

28
Q

Why might nimodipine be prescribed?

A

It has selectivity for cerebral vasculature and therefore can be used for sub-arachnoid haemorrhage.

29
Q

What are the side effects of drugs in the dihydropyridine class ?

A

Ankle swelling
Flushing
Headaches
Palpitations

30
Q

Which conditions would CCBs not be prescribed as an antihypertensive?

A

Unstable angina

Severe aortic stenosis

31
Q

What drug interactions should you be aware of when prescribing a dihydropyridines as an antihypertensive?

A
  • amlodipine and simvastatin (increases the effect of the statin)
    Other antihypertensives
32
Q

What drugs might be considered to treat resistant hypertension?

A

Spironolactone
Diuretics- thiazide and thiazide-like
Beta and alpha adrenoreceptor blockers

33
Q

What are the possible side effects of beta blockers?

A 
Bronchospasm 
Heart block 
Raynauds 
Lethargy 
Impotence 
Mask tachycardia (insulin induced hypoglycaemia)
34
Q

What group of patients should not be treated with b-blockers?

A

Asthmatics
COPD
Haemodynamically unstable
Hepatic failure

35
Q

Why shouldn’t beta-blockers and non-dihydropyridines be co-prescribed?

A

Leads to asystole

36
Q

Name an a-adrenoreceptor blocker

A

Doxazosin

37
Q

Which medical condition would you not prescribe a-blockers?

A

Postural hypotension

38
Q

Why should you be precautious about co-prescribing a-blockers and dihydropyridines?

A

oedema

39
Q

What drug should be offered to a patient post MI once haemodynamically stable?

A

ACEi

Pharmacology (22 decks)

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