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Pharm > Diuretics and antihypertensives > Flashcards

Diuretics and antihypertensives Flashcards

1
Q

K sparing diuretic examples

A

Amiloride hydrochloride

Triamterene

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2
Q

Use of k sparing diuretics

A

If k levels becoming low- retains K

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3
Q

Diuretic for pulmonary oedema

A

Furosemide and loop diuretics

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4
Q

Loop diuretics and where do they act

A

Furosemide
Bumeranide
Torasemide

Act in loop of henle NaK Cl transporter

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5
Q

Side effects of diuretics

A

Monitor K levels
Most diuretics - cause Na retention and K excretion –> hypokalaemic
K sparing - can cause hyperkalaemia

Nephrotoxic so stop in AKI

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6
Q

Nephrotoxic drugs

A 
Diuretic
ACE in
Aminoglycosides
Penicillins
Metformin
NSAIDs
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7
Q

Thiazides, example and when used

A

Bendroflumethiazide
Used in HTN
Don’t use in renal failure

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8
Q

Other thiazides

A

Chlortalidonel

Metolazine

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9
Q

Use of k sparing diuretics

A

Use with other diuretics to balance k levels

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10
Q

Where do k sparing diuretics act

A

ENAc channels in LDT and CD

Inhibits Na Channels

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11
Q

How do aldosterone antagonists work and when used

A

Antagonise aldosterone formation of ENAc channels in LDT and CD
Spironolactone
Eplernone

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12
Q

Cerebral oedema

A

Mannitol osmotic diuretic

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13
Q

Where does mannitol act

A

PCT and throughout by altering osmolarity (increases solute concentration in the nephron therfore promoting water to stay in the nephron and get excreted- it reduces its reuptake

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14
Q

Diuretic used to treat glaucoma

A

Acetazolamide

Carbonic anhydrase inhibitor-

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15
Q

Mechanisms of ca inhibitors

A

PCT prevents HCO uptake and Na

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16
Q

Which drugs should you monitor and use with caution with thiazides diuretics

A

Hypokalameia - digoxin and steroids

B blockers- hyperglycaemia

Carbamazepine- caution of low Na (epilepsy)

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17
Q

Diuretic for chronic HF

A

Loop furosemide bumetanide

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18
Q

Diuretic for uncontrolled HTN

A

Spironolactone

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19
Q

When would you not use furosemide or bumetanide

A

Liver cirrhosis
Renal failure
Hypercalcaemia
With other drugs causing hyponatraemia or hyperkalaemia

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20
Q

Effects of hyperkalaemia

A

6.5-8.0: Can cause a fib and ectopic beats. St elevation.

Later chases widening of QRS, and can cause ventricular fibrillation, bundle branch block and or axis deviation

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21
Q

ECG changes inn hyperkalaemia

A

Early: tall peaked t waves, prolonged PR

Mid: st elevation, loss of p waves, ectopic beats

Late: QRS widening, wide sine wave, axis deviation and ventricular fibrillation

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22
Q

Effects of hypokalamea

A 
Mild <3.5
Muscle cramps, weakness and fatigue, 
Delirium and psychological symptoms
Palpitations 
Severe: arrhythmias bradycardia, cardiovascular collapse
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23
Q

Signs of hypoklamaeia in ecg

A

Prolonged OR interval
ST depression
U wave
Shallow T wave

24
Q

First line treatment for >55 year old with HTN

A 
Ca channel blocker
Or diuretic (thiazides)
25
Q

Example of ca channel blocker

A

Dihydrooyridines e.g, amlodipine

Nifedipine

26
Q

First line treatment for under <55years with HTN

A

Ace in

Or ARB

27
Q

Ace in

A

Lisinopril

Ramopril

28
Q

ARB

A

Losartan

Valsartan

29
Q

Second line medications for hypertension

Name examples

A 
ACE in &amp; (Ca channel blocker or diuretic)
Lisinopril and (amiopidine or lorsartan)
30
Q

How would you manget HTN if first and second line treatments are ineffective

A

All three - acein calcium and diuretic

Then add in additional diuretic beta blocker or alpha blocker

31
Q

Which diuretic can be used in add on therapy for HTN

A

Aldosterone antagonists e.g. Spironolactone

32
Q

General management for HTN

A

Treat any underlying cause
Treat risk factor and co morbidities
Reduce salt limit alcohol excercise stop smoking etc
Then pharm

33
Q

When do you treat HTN?

A

Bp >160/80

Or over 140 if risk factors

34
Q

Why are certain drugs preferred to treat hypertension in elderly patients?

A

Ca banner blockers or diuretics preferred in elderly or Afro Caribbean because they don’t cause sodium retention and therfore fluid retention

Better if co morbidities such as renal failure, or heart failure, or Ischaemia heart disease

35
Q

How do ACEin work

A

Inhibit formation of ACE from the kidney and pulmonary endothelium,
Prevents formation of AT2 and its effects - symptwthetic, aldosterone secretion –> Na reabsorption and h20 retention, vasoconstriction, ADH secretion(post pit–> collecting duct h20 reabsoption)

36
Q

Use of ACEin

A

HTN in <55s or add on therapy
HF
HTN in pregnancy

37
Q

Side effects of ACEin and name some ACEin

A

Lisinopril
Ramopril

Dry cough, angio oedema, renal failure hyperkalaemia

38
Q

Drugs of choice in heart failure

A 
Treat cause- e.g. Valve disease, arrhythmias.
Treat exacerbating factors e.g. Infection, thyroid disease
Diuretic
Ace in/ARB
B blockers
Aldosterone antagonists
Digoxin
Vasodilators
39
Q

Examples of ARB and their use

A

Losartan, valsartan
HTN in the over 55/s
HF with lv systolic problems
Pregnancy HTN

40
Q

Mechanism of ca channel blockers

A

Act in the heart
Cardiac smooth muscle- vasodilation
Cardiac nodal tissue- slow conduction - slow chronotrohy
Myocardium- reduce contraction velocity- inotrophy

41
Q

What is verapamil and what is its use

A

Ca channel blocker - class 5 antihypertensives

Slightly different from amilopidine and less effective in HF. Use in a fib as more cardiac selective and slows the SAN and AVN conduction

42
Q

Side effects of ca channel blockers- how do they vary and when to use each

A

Amilopidine - SNS activation so palpitations, tachycardia, swearing, oedema. Can cause increased tachycardia as baroreceptor reflexes activation
Verapamil and benzothiazepines - bradycardia and worsen heart failure.

43
Q

Use of calcium channel blockers

A

Amilopidine- heart failure (Ischaemia) and HTN. Short acting , good in renal failure. Caution if tachycardic.

Verapamil- anti arrhythmic, used for atrial fibrillation and stable angina, Depresses SAN and slows av conduction. Can worsen heart failure, causes bradycardia.

Benzothiazepines- similar to above, reduce ca transport across myocardium and slows conduction. Causes bradycardia- can worsen HF

44
Q

Side effects of verapamil

A

Bradycardia
Constipation
Reduced contractility worsening heart block

45
Q

What drug should you not use with verapamil

A

Beta blocker s

46
Q

Side effects of thiazides like diuret it’s

A

Hypokalaemia- k excreted
Increased urea and Uric acid levels
Impaired glucose tolerance- unknown cause
Cholesterol and TAG levels increased- more converted from glucose
Don’t use with beta blockers cos glucose

47
Q

Side effects of beta blockers

A

beta blockers: reduced adrenaline, reduces gluconeogenesis and utilisation and can mask hypoglycaemia

48
Q

Example of alpha blocker and when used

A

Dizazosin
Last resort HTN.
BPH

49
Q

Side effects of doxazosin

A 
Use in BPH and can use in HTN
postural hypotension
Dizziness
Headache
Fatigue
Oedema
50
Q

Mechanism of alpha blockers

A

Selective antagonism NA in vascular smooth muscle. Reduce resistance,
Doesn’t effect lipids and glucose so fine in DM.

51
Q

New vasodilators used in HTN - name and mechanisms

A

Aliskrin
Bind to renin and prevent cleavage into AT–> AT1
Therfore reduces activity
Causes vasodilation

52
Q

Use of aliskrin

Contraindications of its use

A

Hypertension not responding to other treatments

Don’t use in heart failure renal problems
Don’t use with furosemide or K sparing diuretics - risk of hyperkalaemia

53
Q

Alternativeantihypretensives - centrally acting agents

A

Methyl dopa- HTN in pregnancy
Clonidine
Moxinidine

Se - tiredness depression lethargy

54
Q

Use of a GTN spray

A

Angina

Venous venodilation

55
Q

Use of digoxin

A

Cardiac glycoside used in AF

56
Q

Hydroalazine
And isobide finitrate

Use and mechanisms

A

Vasodilators

Used in HTN and or heart failure (if ACEin or ARB not working)

Pharm (6 decks)

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