Drug Treatments for CVD Part 2

Question 1

ACE Inhibitor Side Effects

Answer 1

Dry cough
1st dose hypotension
Renal Impairment
Hyperkalaemia
No adverse effects on serum glucose or lipids
e.g. Ramipril

Question 2

Angiotensin Receptor Antagonists (ARBs)

Answer 2

Block actions of Ang on AT1-R
e.g. Losartan
Minimal side effects

Question 3

Aldosterone Antagonists

Answer 3

Spironolactone
Can be used as an add on for resistant hypertension
Frontline for hypertension in patients with primary aldosteronism

Question 4

Ca2+ Channel Antagonists

Answer 4

Main class: dihydropyridines - target L-type Ca2+ channels on smooth muscles of arterioles - relaxation
Phenylalkylamines and benzothiazepines target L-type channesl in the heart and decreased frequency/force of contraction

Question 5

Side Effects of Ca2+ channel antagonists

Answer 5

Peripheral Oedema
Flushing and Headaches
Combinations of Ca2+ channel antagonists not recommended
Grapefruit juices enhances action CYP3A4

Question 6

Thiazide and Thiazide-like Diuretics

Answer 6

Blocks the Na-Cl cotransporters present in the cells lining the DCT
Some diuretic action acts via activation of K(ATP) channels, allowing more K+ to leave the cell, meaning voltage gated Ca2+ channels are less likely to open -> decreasing peripheral resistance and BP

Question 7

Side Effects of Thiazide-like Diuretics

Answer 7

Hypokalaemia
Increase in urate
Increase in glucose (prevents release of insulin so not used in patients with diabetes)
Increase in blood lipids
E.g. bendroflumethiazide

Question 8

Beta Blockers

Answer 8

selective B1 antagonist
Non selective B1 and B2
Side Effects: fatigue (reduced CO), vasoconstriction/bronchoconstriction (careful of asthma and Raynaud’s disease), hypoglycaemia (low blood glucose activates release of adrenaline, mobilising glucose release from liver - blocked by beta blockers)

Question 9

Vasodilators

Answer 9

alpha1 antagonists: NA -> alpha 1 -> IP3 -> Ca2+ -> constriction
Treats hypertension in patients with benign prostatic hypertrophy
Other vasodilators open K+ channels