Hypertension Flashcards
4 classes of hypertension drugs
Angiotensin converting enzyme inhibitors
Calcium channel blockers
Thiazide or thiazide like diuretics
Angiotensin receptor blockers
Name three types of angiotensin converting enzyme inhibitors
Ramipril
Lisinopril
Perindopril
Name two types of calcium channel blockers
Amlodipine
Felodipine
Name 2 examples of thiazide or thiazide-like diuretics
Bendro- flumethiazide
Indapamide
Name 3 types of angiotensin receptor blockers
Losartan
Irbesartan
Candesartan
What is the primary mechanism of action of angiotensin converting enzyme inhibitors?
Inhibit the angiotensin converting enzyme. Prevent the conversion of angiotensin I to angiotensin II
What is the primary mechanism of action of calcium channel blockers?
Block L type calcium channels - predominantly on vascular smooth muscle
Decrease in calcium influx, with downstream inhibition of myosin light chain kinase and prevention of cross bridge formation.
What is the primary mechanism of action of thiazie or thiazide like diuretics?
They block Na+, Cl- co transporter in the early DCT. Therefore Na+ and Cl- reabsorption is inhibited.
Decreasing osmotic gradient for water reabsorption
What is the primary mechanism of angiotensin receptor blockers?
Act as non competitive antagonists at AT1 receptor ( found on kidneys and vasculature)
What is the drug target of angiotensin converting enzyme inhibitors?
Angiotensin converting enzyme
What is the drug target of calcium channel blockers?
L- type calcium channel
What is the drug target of thiazide or thiazide like diuretics?
Sodium/ Chloride co transporter in early DCT
What is the drug target of angiotensin recpetor blockers?
Angiotensin recpetor found on kidneys and on the vasculature
What are the main side effects of angiotensin converting enzyme inhibitors?
Cough
Hypotension
Hyperkalaemia
Foetal Injury (avoid in pregnant women)
Renal failure ( in patients with renal artery stenosis)
Urticaria/ Angioedema
What are the main side effects of calcium channel blockers?
Ankle oedema
Constipation
Palpitations
Flushing/Headaches
What are the main side effects of thiazide or thiazide like diuretics?
Hypokalemia
Hyponatremia
Metabolic alkalosis (increased hydrogen ion excretion)
Hypercalcemia
Hyperglycaemi (hyper polarised pancreatic beta cells)
Hyperuricemia
What are the main side effects of angiotensin recpetor blockers?
Hypotension
Hyperkalaemia
Foetal Injury ( avoid with pregnant women)
Renal failure ( renal artery stenosis patients)
What extra information should you note about angiotensin converting enzyme inhibitors?
Most ACE inhibitors ( no lisinopril) ar epro drugs. Therefore require hepatic activation.
eGFR and serum potassium must be regularly monitored
ACE inhibitors are typically used ahead of angiotensin 2 receptor blockers (partly due to cost/partly due to evidence that ACE Is are more effective).
ARBs for patients of African or Caribbean descent
What extra information should you note about calcium chaannel blockers?
Dihudropyridine type calcium channel blockers demonstrate a higher degree of vascular selectivity
What extra information should you note about thiazide or thiazide like diuretics?
Both lose their therapeutic effect within 1-2 weeks of treatment
What extra information should you note about angiotensin recpetor blockers?
Most trials suggest not as effective as ACE inhibitors
Losartan and Candersatan are pro drugs
What scoring is used to measure the risk of a patient having a heart attack or stroke in the next 10 years?
QRISK3
Define Clearance
Clearance is the measure of the ability of the body to eliminate a drug.
Define Elimination half-life
Elimination half-life is the length of time required for the concentration of a particular drug to decrease to half of its starting dose in the body
What influences Time to peak plasma plasma levels
faster the absorption rate, the lower is the time to peak plasma concentration
Differences between treating with amlodipine and felodipine
Amlodipine has slow onset and longer half life - mitigate reflex tachycardia
Felodipine results in dose dependent reduction in systolic and diastolic bp
What is the order of hypertension drugs?
Calcium channel blocker
ACEi for most but ARB for THE BLACKS
If not Thiazide like diuretics
What checks should be made following ACEi onset?
check renal function (eGFR), serum electrolytes (especially blood potassium) and blood pressure 1-2 weeks after starting treatment.
