Antihypertensives And Heart Failure Flashcards
Give three effects of hyperglycaemia and insulinaemia.
Increased ROS
Decreased NO
Endothelial dysfunction
Give four lifestyle changes for pre-hypertension
Less sodium More exercise Less caffiene Less stress Less smoking
Give four function of ANGII acting at AT1 receptor.
Vasoconstriction
ADH release
Aldosterone secretion
Cardiac and vascular cell growth
Give 4 side effects of ACEi.
Dry cough
Angioedema
Renal failure
Hyperkalemia
Name two ARBs.
Losartan
Candesartan
(Eprosartan)
(Irbesartan)
Why may ARBS be less effective in low renin hypertensives compared to ACEi?
Why are they more effective at inhibiting AngII mediated vasoconstriction?
Give two side effects.
They do not potentiate BK therefore you do not get BK induced NO formation leading to vasodilation.
ACEinhibitors still allow some AngII formation via chymase reaction.
Renal failure and hyperkalemia.
Name 2 DHP CCBs.
Name some ADRs.
What is their interaction with simvastatin?
High or low degree of protein binding?
Amlodipine
Nicardipine
Flushing Peripheral oedema Sweating Headache Gingival enlargement
Increased plasma concentration of simvastatin.
90% protein bound and metabolised by the liver.
Name a PA CCB.
Name 3 ADRs.
Verapamil.
Bradycardia
Constipation
Worsen heart failure (negative inotropy)
Name a BTP CCB.
Diltiazem
Bradycardia
Worsen heart failure (negative inotropy)
Give two thiazide diuretics.
Side effects?
Bendroflumethiazide
Indapamide
Hypokalemia Hyperuricaemia Increased urea levels Impaired glucose tolerance Increased TAGs and cholesterol RAAS activation
What should be firstlie in heart failure and diabetics?
ACEi
Hypertensive energy?
Nitrates (SNP)
Labetalol
Labetalol use?
Gestational hypertension
Can not use ACEi or ARBs.
Name an alpha 1 blocker.
Doxazosin
Postural hypotension (baroreceptor reflex blunted)
Headache
Fatigue
Oedema with DHP
Name some ADRs of bisoprolol.
Why may you give caution in diabetics?
Why cautious in asthmatics?
Another condition you dont give it in?
Bradycardia
Raynauds
Bronchoconstriction.
Mask tachycardia associated with hypoglycaemia.
Bronchoconstriction
2nd/3rd degree heart block
Give two causes of inherited cardiomyopathy.
Congenital hypertrophic CM
Arrhythmogenic RV CM
Give to initial lifestyle changes for heart failure.
What should you watch out for when giving spironolactone?
Decreased fluids
Decreased salt
Refractory hyperaldosteronism
Why do you want to give a low initial dose of ACEi or ARB in heart failure patients?
Reduce risk of sudden BP fall
Already reduced perfusion to tissues and decreased CO
Especially if taking diuretics.
In CHF what should be added in along with ACEi and ARBs.
Why are they used?
B blockers
Reduce heart rate and therefore increase filling time - increase EDV= greater output due to starlings law
