Cardiovascular 4 Flashcards
State the drugs used in hypertension
ACDDB
Ace/ARB
CCB
Thiazide diuretics
Low dose spironolactone
Beta blockers
What antihypertensive is preferred for adults of black African origin
ARBs
What antihypertensive should be offered to all patients with diabetes regardless of origin and age
ACEi/ARbs
State what antihypertensive is suitable for patients that are unable to tolerate CCB due to oedema or heart failure
THIAZIDE LIKE DIURETICS eg Indapamide over Bendroflumethazide(Thiazide diuretics)
State when to avoid /use with caution ACE inhibitors and ARB in HTN
Afro-Caribbean unless diabetic
Severe renal disease
Pregnancy and BF
Angioedema
Aliskiren with EGFR <60 or- diabetic- Avoid
What are the side effects of ACE inhibitors
Angioedema
Cough
Hyperkalaemia
Alopecia
GI
Hypotension
Sleep disorders
Taste altered
Tinnitus
What are the side effects of ARBs
Hyperkalaemia
Angioedema
Abdominal pain
Renal impairment
Cough
Diarrhoea
Dizziness
Nausea
Back pain
State when to avoid CCB in HTN
Oedema
Heart failure except amlodipine
Unstable Angina-CI
, uncontrolled HF
Cardiogenic shock- CI
Significant aortic stenosis- CI
What’s the side effect of CCB
Oedema
Skin reactions
Drowsiness dizziness
Flushing
Headache
Tachycardia
Vomiting
Nausea
Palpitations
State when to avoid /caution Thiazide like diuretics
Diabetes- caution
Gout- Caution
Egfr <30
Addison disease- Avoid
Hyponatraemia - avoid
Refractory hypokalaemia- avoid
Hypercalcaemia-Avoid
Side effect Thiazide diuretics
Hypokalaemia
Hyperuricaemia
Hypercalcaemia
Hyponatraemia
Hyperglycaemia
Postural hypotension
Erectile dysfunction
State when to avoid spironolactone
Addison’s Disease
Hyperkaelamia
Anuria
Side effect of spironolactone
Hyperkalaemia
Gyneacomastia
State when to avoid BB in HTN
COPD
Asthma
Unstable HF
Side effect of BB
Bradycardia
State when to avoid alpha blocker in HTN
Hx of syncope in BPH or postural hypotension
Side effect of alpha blocker
Orthostatic hypotension
Drug tx for HTN with type 1 Diabetes
First line- ACEi/ARB
BB
CCB( only long acting eg Nifidipine or amlodipine)
Diuretics ( low dose in combination) with BB
What’s the target clinical BP in renal disease
<140/90 or < 130/80 in patients with CKD and diabetes or if urine:albumin exceeds 70mg/mmol
What is the first line tx of HTN in pregnancy
Labetolol
2nd line tx of HTN in pregnancy
MR nifidipine(unlicensed)
3rd line tx of HTN in pregnancy
Methyldopa (unlicensed)
Stop methyldopa 2days after birth and continue with regular HTN tx
Drug used to tx severe HTN in pregnancy
IV magnesium
What’s the dose of Labetolol in pregnancy
Initially 100mg BD , increased at intervals of 14days
Usual dose = 200mg BD , increased up to 800mg daily in 2 divided doses
To be taken with food
Higher doses tobe given in 2-3 divided doses
Max 2.4g/day
MOA of BB
Block beta adrenoceptors in the heart, pancreas , liver and blood vessels outside the heart
They slow the heart and can depress the myocardium
Which beta blockers are found in the lungs?
B2
Which BB are found in the heart?
B1
What is ISA activity
Intrinsic Sympathometic Activity is the ability of a beta blockers to stimulate and block adrenergic receptors
ISA causes less bradycardia and less coldness of extremities
Examples of BB that will not cause extreme coldness of extremities and less bradycardia
ICE PACO
Pindolol
Acebutol
Celiprolol
Oxprenolol
What are examples of water soluble beta blockers
CANS
Celiprolol
Atenolol
Nadolol
Sotalol
Examples of cardioselective BB
Be a man
Bisoprolol
Atenolol
Metoprolol
Acebutol
Nebivolol
Example of Non cardioselective BB
Sotalol
Examples of long duration Beta blockers
BACN
Bisoprolol
Atenolol
Celiprolol
Nadolol
Side effect of BB
Mask symptoms of hypoglycaemia
Cause hypoglycaemia or hyperglycaemia
Hypotension
Bradycardia
Sleep disturbance with nightmares
Coldness of extremities (less common with ISA)
Fatigue
What BB should be offered to diabetic and asthmatic pat?
Cardioselective
Be a man
Some of the uses of beta blockers
See BNF
Contraindications of BB
Asthma, COPD and bronchospasm- give cardioselective if no alternative
Marked bradycardia
Prinzmetal’s Angina
2nd and 3rd degree AV block
Uncontrolled HF
BB Cautions
Diabetes
Ist degree AV block
Symptoms of thyrotoxicosis and hypoglycaemia may be masked
Verapamil and Diltiazem can cause AV block
May reduce response to adrenaline
Important interaction of BB
IV verapamil and bradycardia
Risk of hypotension and bradycardia
List examples of Dihydropyridines CCB
Amlodipine
Nifedipine( maintain same brand for MR)
Lercanidipine
Lacidipine and felodipine
MOA of dihydropyridine CCB
Relax vascular smooth muscle
Have no antiarrhythmic property
Example of phenylalkamines
Verapamil
Facts about Verapamil
Used to treat hypertension, angina and arrhythmia
Highly negatively ionotropic
Minimal vasodilatory effect
Cause constipation
Has profound cardio depressant effect
Example of benzothiazepine
Diltiazem
Facts about Diltiazem
Have both cardiac depressant and vasodilatory effects
Effective in most form of Angina
Long acting formulations used for HTN
May be used for patients in whom BB are contraindicated or ineffective
Less negative ionotropic effect than Verapamil
Use with caution with BB because of risk of bradycardia
Prescribing and dispensing information for Diltiazem
MR preparation containing more than 60 g Diltiazem may not have the same clinical effect
Prescribers should prescribe by brand to prevent confusion
Facts about Nicorandil
Licensed for long term tx of angina
Has both arterial and Venous vasodilatory effects
Potassium Channel activator with nitrate component
Examples of anti-Anginal drugs
Ivabradine and ranolazine
Side effects of CCBs
Dizziness
Flushing
Headache
Postural hypotension
Gastro intestinal disorder
Ankle Swelling
Skin reactions
Sudden withdrawal of CCB may exacerbate myocardial Ischaemia
