CVS Flashcards
What are the primary hypertension therapeutic agents?
- ACEi
- ARBs
- CCBs
- Diuretics thiazide and thiazide-like)
Lisinopril
- ACEi
- given orally
- for hypertension
- short-term treatment following MI
- for type 2 diabetes
- NOT for patients of Afro-Caribbean descent or over 55
- side effects: hypotension, dry cough, hyperkalaemia, renal failure, POSTURAL disorder
- renal function and electrolytes should be checked beforehand
- warnings: renal artery stenosis, AKD, pregnancy, breastfeeding, CKD
- important interactions: increases with K+drugs, NSAIDs, other antihypertensive agents
Ramipril
- ACEi
- side effects: hypotension, dry cough, hyperkalaemia, renal failure, angioedema, MuSCLE SPASMS, GI disorders
- warnings: renal artery stenosis, AKD, pregnancy, breastfeeding, CKD, can cause hepatic impairment
- important interactions: increases with K+ drugs, NSAIDS, other antihypertensive agents
- give orally
- for patients with heart failure, nephropathy
- to prevent CVS events in patients with type 2 DM or atherosclerosis
- not for Afro-Caribbean or over 55
Candesartan
- ARB
- AT1 receptor blocker
- no effect on bradykinin
- side effects: hyperkalaemia, hypotension, cough, increased risk of infection
- oral
- warnings: renal artery stenosis, AKD, pregnancy, breastfeeding, CKD, hepatic impairment
- important interactions: increases with K+ drugs, NSAIDS, other antihypertensive
- used for hypertension with intravascular volume depletion, heart failure with impaired left ventricular systolic function, migraine prophylaxis
- not for Afro or over 55
Losartan
- ARB
- no effect on bradykinin so decrease in dry cough and angioedema
- warning: renal artery stenosis, AKD, pregnancy, breastfeeding, CKD, hepatic impairment
- important interaction: increases with K+ drugs, NSAIDs, other antihypertensive
- side effects: hypotension, hyperkalemia, dizziness, ANAEMIA, HYPOGLYCAEMIA
- oral
- used for diabetic nephropathy in type 2, chronic heart failure when ACEi dont work, hypertension with intravascular volume depletion
- not for Afro or over 55
What are the different classes of CCB?
Dihydropyridines
- selective for peripheral vasculature
- little chronotropic or inotropic effects
- first line CCB for hypertension
- cerebral vs peripheral selectivity
Phenylalkyamine
- depresses SA node and slows AV conduction
- negative inotropy
Benziothiazapines
- have action on myocardium and some on pacing cells
- effects on vascular smooth muscle
PRIMARY CHOiCE ANTIHYPERTENSIVE IN LOW RENIN PATIENTS
Amlodipine
- CCB
- long half-life compared to others
- oral
- used for prophylaxis of angina, hypertension
- side effects: ankle swelling, flushing, headaches (vasodilation), palpitations, (compensatory tachycardia), VISION DISORDERS
- warnings: unstable angina, severe aortic stenosis, hepatic impairment, pregnancy, breastfeeding
- important interactions: with Siva statin (will increase statin effect), other antihypertensive
- stop treatment if there is exacerbation of myocardial ischaemia
Nifedipine
- CCB (dihydropyridine)
- side effects: ankle swelling, flushing, headaches (vasodilation), palpitations, constipation
- warnings: unstable angina, severe aortic stenosis, hepatic impairment, pregnancy, breastfeeding
- important interactions: other antihypertensive
- oral, take with a meal
- stop if exacerbation of myocardial ischaemia
- used for Raynauds syndrome, postponement of premature labour, chronic anal fissure
- not for diabetics, over 55 or heart failure
Nimodipine
- CCB (dihydropyridine)
- selectivity for cerebral vasculature (sub-arachnoid haemorrhage)
- side effects: ankle swelling, flushing, headaches (vasodilation), palpitations, thrombocytopaenia
- monitor drug in renal impairment
- stop if exacerbation of myocardial ischaemia
- warnings: unstable angina, severe aortic stenosis, hepatic impairment, renal impairment, pregnancy, breastfeeding
- important interactions: other antihypertensive
- oral
- use for defects following subarachnoid haemorhhage,
Verapamil
-CCB (phenylalkylamine)
-prolongs the action potential
-less peripheral vasodilation, negative chronotropic and inotropic effects
-used for: arrhythmia, angina, hypertension
-side effect: constipation, bradycardia (IV), heart block and cardiac failure, hypotension
-stop if exacerbated myocardial ischaemia
-warning: poor LV function, AV nodal conduction delay, hepatic impairment, pregnancy, breastfeeding
-important interactions: B blockers, other antihypertensive and antiarrhythmic
-oral or IV
-
Diltiazem
- CCB (benzothiazipine)
- oral
- used for angina and chronic anal fissure
- avoid if bradycardia
- side effect: palpitation, drowsiness, headache, malaise, constipation
- stop if exacerbated myocardial ischaemia
- warning: hepatic impairment, renal impairment, pregnancy, breastfeeding
Bendroflumethiazide
- thiazide diuretic
- inhibits Na/Cl co-transporter in DCT
- more useful over CCB in oedema, used for hypertension
- side effects: hypokalaemia, hyponatremia, hyperuricaemia, arrhythmia, increase in glucose cholesterol and triglyceride
- warnings: hypokalaemia, hyponatremia, gout, hepatic and renal impairment, pregnancy, breastfeeding
- important interactions: NSAIDS, decrease in K+ drugs
Indapamide
- thiazide diuretic
- useful for oedema and hypertension
- side effects: hypokalaemia, hyponatremia, hyperuricaemia, arrhythmia, increase in glucose, cholesterol and triglyceride, skin reactions
- don’t use if sensitive to sulfonamides
- warning: hypokalaemia, hyponatremia, gout, Addison’s disease, hepatic and renal impairment, pregnancy, breast-feeding
- important interaction: NSAIDs, decrease with K+ drugs
Spironolactone
- for resistant hypertension
- aldosterone receptor antagonist
- warning: hyperkalaemia, addisons, renal impairment, pregnancy, breast-feeding
- important interaction: increase with K+ drugs, ACEi and ARB
- oral
- use for oedema, ascites, nephrotic syndrome, primary hyperaldosternosim
- side effects: leg cramps, menstrual disorder, malaise, breast neoplasm
- use a and b blockers if high K+
Labetalol
- B blocker
- decreases CO by reducing myocardial contraction
- decreases renin secretion in B1
- warning: asthma, COPD, haemodynamic instability, hepatic failure, hepatic and renal impairment, pregnancy, breastfeeding
- important interaction: non-di CCB, asystole
- side effects: bronchospasm, heartblock, raynauds (cold hands), lethargy, impotence, liver damage, ejaculation failure
- when stopping b blockers, it must be gradual
- oral or IV
- used for hypertension in PREGNANCY, hypotension in anaesthesia, hypertension following MI