Hypertension Flashcards
ACE INHIBITOR
(Angiotensin Converting Enzyme Inhibitor)
Ending in “…pril” - Perindopril, Ramipril, Catopril”
MOA
Block the conversion of ANG1 to ANG2 reducing the effect og ANG2 induced vasoconstriction, sodium retention and aldosterone release.
It also inhibit the breakdown of bradykinin AND reduce the effect of ANG2 on sympathetic nervous activity and growth factor
Indication
* 1st line for Hypertension
* Chronic Heart failure
Side effect:
* Hypotension, headache, dizziness, hyperkalaemia
* Dry cough - can be tolerable but patients need to cease medication for symptom to improve than we can move them to **SARTANS **
Counsel
* Get up gradually as this medication can make you feel dizzy
* Stop taking potassium supplements/sparing diuretics as it increase risk of hyperkalaemia
* Start low dose
* Check renal function and electrolyte before starting an ACEI and review after 1-2 weeks
Notes
* ACEI can decrease lithium (which has a narrow therapeutic effect) excretion resulting in toxicity - monitor
* Thiazide diuretics may increase risk of severe hypotension with 1st dose of ACEI
* Review NSAIDS as it decrease effect of ACEI and may increase risk of renal impairment and hyperkaelemia
SARTANS
Angiotensin Receptor Blocker (ARB)
Ending in “…sartan” - Irbesartan, Candesartan, Telmisartan
MOA
Competiviely block binding of ANG2 to Type 1ANG receptor reducing ANG2 induced vasoconstriction, sodium reasborption, and aldosterone release.
Also reduce effect og ANG2 on sympathetic nervous activity and growth factors
Indication
* 1st line for Hypertension
Side effect:
* Dizziness, headache, hyperkalaemia
Counsel
* Get up gradually as this medication can make you feel dizzy
* Stop taking potassium supplements/sparing diuretics as it increase risk of hyperkalaemia
* Start low dose
Notes
* Review NSAIDS as it decrease effect of SARTAN and may increase risk of renal impairment and hyperkaelemia
Calcium Channel Blocker
Dihydropyridines end in “…dipine” - Amlodipine, Lercanidipine
Non-dihydropyridine - Diltiazem & Verapamil
MOA
Act on coronary arteriolar smooth muscle to decrease vascular resistance and myocardial oxygen requirement reliving angina symptoms.
Dihydropyridines: act mainly on arteriolar smooth muscle to reduce peripheral vascular resistance and BP
Non-dihydropyridines: act on cardiac AND arteriolar smooth muscles. They reduce cardiac contractility, heart rate and conduction.
Indication
*Add on with 1st line for Hypertension
Side effect:
* Nausea
* Dihydropyridines: vasodilatory effect subsides with continuous tx but may require reduced dose (headache, flushing, diziness, hypotension and peripheral oedema)
* Diltiazem: hypotension, bradycardia and slow cardiac conduction
Counsel
* Get up gradually as this medication can make you feel dizzy
* Take on empy stomach 1/2hr before food or 2hrs after food
Notes
CCBs are metabolised by CYP3A4 (avoid grapefruit)
BETA BLOCKER
“…olol” (pure BB) - Atenolol, Bisoprolol, Metaprolol, Propranolol
“…alol” “ilol” (alpha and beta blocker) - Carvedilol, Labetaolol
MOA
Competitively block beta receptors reducing heart rate, blood pressure and cardiac contractility. Also depress sinus node rate and slow conduction through the atrioventricular (AV) node and prolong atrial refractory period
Indication
* 1st line for hypertension
*Add on with 1st line for Hypertension
Side effect:
* bradycardia, hypotension, orthostatic hypotension
* transient worsening of heart failure (when treatment starts)
Counsel
* Get up gradually as this medication can make you feel dizzy
Notes
BB can decrease BP, cardiac contracility
NSAIDS may impair antihypertensive effect BB
Selective Alpha Blocker
Prazosin
MOA
* Normal function: Activation of a1 adrenoreceptor leads to a cascade that results in the activation of IP3 releasing CA2+ causing vasoconstriction resulting in increased BP
* With an alpha blocker, no Ca2+ is released therefore causing peripheral vasodilation decreasing BP
**INDICATION **
* Hypertension - 3rd line agent
Side effect
First dose hypotension, dizziness, drowsiness, oedema
Counsel
Get up gradually as this medication can make you fee dizzny
Potassium Sparing diuretic
Amiloride
MOA
Inhibit sodium reabsorption in the distal tubule by blocking sodium channels interfering with sodium/potassium exchange and reduce urinary potassium excretion
Indication
Add on for 2nd line Hypertension
Side effect is dose dependent
Dizziness, weakness, muscle cramps, polyuria, orthostatic hypotension, electrolyte disturbances, hyponatraemia, hypokalaemia
Counsel
Take in the morning
If taking twice a day, take 1st dose in the morning and second dose before 6pm to avoid constant urination at night
Get up gradually as this medication can make you feel dizzy
Thiazide
Hydrochlorothiazide
MOA
Inhibit sodium reabsorption in the distal tubule by blocking sodium channels interfering with sodium/potassium exchange and reduce urinary potassium excretion
Indication
Add on for 2nd line Hypertension
Side effect is dose dependent
Dizziness, weakness, muscle cramps, polyuria, orthostatic hypotension, electrolyte disturbances, hyponatraemia, hypokalaemia
Counsel
Take in the morning
If taking twice a day, take 1st dose in the morning and second dose before 6pm to avoid constant urination at night
Get up gradually as this medication can make you feel dizzy
Notes
Lithium: Thiazide diuretics may increase lithium concentration and risk of toxicity
Loop Diuretic: with thiazide may cause serious electrolyte disturbances
NSAIDS: with thiazide diuretic may decrease renal function and increase risk of nephrotoxicity
