core drugs of hypertension Flashcards
what are some examples of ACEi?
Ramipril
Lisinopril
Perindopril
what is the primary mechanism of action of ace inhibitors?
Inhibit the angiotensin converting enzyme. Prevent the conversion of angiotensin I to angiotensin II by ACE.
what is the drug target of ace inhibitors?
Angiotensin converting enzyme
what are the main side effects of ace inhibitors?
Cough
Hypotension
Hyperkalaemia (care with K+ supplements or K+-sparing diuretics)
Foetal Injury (AVOID IN PREGNANT WOMEN)
Renal failure (in patients with renal artery stenosis)-
Urticaria/Angioedema
what are some facts about ace inhibitors?
Most ACE inhibitors (not lisinopril) are pro-drugs. They require hepatic activation to generate the active metabolites required for therapeutic effects.
eGFR and serum potassium must be regularly monitored when prescribing ACE inhibitors.
Most trials indicate that angiotensin receptor blockers are not as effective anti-hypertensive agents as ACE inhibitors.
Losartan and candesartan are pro-drugs. They require hepatic activation to generate the active metabolites required for therapeutic effects.
In 2020, losartan was the 13th, irbesartan the 57th and candesartan the 80th most commonly prescribed drugs in the West London area
what are examples of calcium channel blockers?
Amlodipine
Felodipine
what is the primary mechanism of action of calcium channel blockers?
Block L-type calcium channels – predominantly on vascular smooth muscle. This results in a decrease in calcium influx, with downstream inhibition of myosin light chain kinase and prevention of cross-bridge formation. The resultant vasodilation reduces peripheral resistance.
what is the drug targets of calcium channel blockers?
L-type calcium channel
what are the main side effects of calcium channel blockers?
Ankle oedema
Constipation
Palpitations
Flushing/Headaches
what are some facts about calcium channel blockers?
Dihydropyridine type calcium channel blockers demonstrate a higher degree of vascular selectivity
In 2020, amlodipine was the 2nd and felodipine the 98th most commonly prescribed drugs in the West London area
what are some examples of Thiazide or thiazide-like diuretics?
Bendro-flumethiazide (thiazide)
Indapamide (thiazide-like)
what is the primary mechanism of action of Thiazide or thiazide-like diuretics?
They block the Na+, Cl- co-transporter in the early DCT.
Therefore Na+ and Cl- reabsorption is inhibited.
As a result the osmolarity of the tubular fluid increases, decreasing the osmotic gradient for water reabsorption in the collecting duct.
what is the drug target of Thiazide or thiazide-like diuretics?
Sodium/chloride
cotransporter
what are the main side effects of Thiazide or thiazide-like diuretics?
Hypokalemia
Hyponatremia.
Metabolic alkalosis (increased hydrogen ion excretion)
Hypercalcemia.
Hyperglycemia (hyperpolarised pancreatic beta cells).
Hyperuricemia.
what are some facts about Thiazide or thiazide-like diuretics?
Thiazide and thiazide-like diuretics both lose their diuretic effects within 1-2 weeks of treatment. Continuing anti-hypertensive action appears to be due to vasodilating properties (these are more pronounced for the thiazide-like diuretics)
In 2020, bendro-flumethiazide was the 38th and indapamide the 46th most commonly prescribed drugs in the West London area
