Hypertension Flashcards
What is the function of an ACE inhibitor?
It inhibits angiotensin converting enzyme, and thus the production of angiotensin II.
Give an example of an ACE inhibitor.
Ramipril
Main adverse effects of ACE-I related to reduced angiotensin II production.
- Hypotension
- Acute renal failure
- Hyperkalaemia
- Teratogenic effects
What causes cough in ACE-I use?
ACE normally breaks down bradykinin, inhibition of ACE increases bradykinin levels leading to cough.
Give an example of angiotensin II receptor blocker (ARB).
Ends in -sartan e.g Candesartan, Losartan
What receptor does ARB work on?
AT-1
Main adverse effects of ARB?
- Hypotension
- Hyperkalaemia
- Rash
- contraindicated in pregnancy
Which calcium channel blockers don’t end in -pine?
- Diltiazem
- Verapamil
Give examples of CCB.
- Amlodipine
- Felodipine
How do CCB act?
Block L-type calcium channels
Adverse effects of CCB.
- headache, oedema, palpitations (peripheral vasodilation)
- Bradycardia (conduction tissue)
- Constipation (by verapamil)
Give examples of three Beta blockers.
- Bisoprolol
- Atenolol
- Propanolol
Why is it better to say beta-1 selective rather than ‘cardioselective’ beta blockers?
Because half the beta adrenoceptors in the heart are beta-2.
Adverse effects of beta blockers.
- fatigue, headache, sleep disturbance
- Bradycardia, hypotension, cold peripheries, erectile dysfunction
What conditions can be worsened by use of beta blockers? i.e. contraindications.
- Asthma and COPD
- Peripheral vascular disease
- Heart failure
Give an example of a thiazide (distal tubule diuretic).
bendroflumethiazide
Give an example of a loop diuretic.
furosemide/ bumetanide
Main adverse effects of diuretics.
- Hypovalaemia
- Hypotension
- Low serum K+, Na+, Ca2+, Mg2+
- Raised uric acid
- Erectile dysfunction
Give an example of an alpha-1-adrenoceptor.
Doxazosin
Give an example of a direct renin inhibitor.
Aliskiren
What is the first line of therapy for a patient with hypertension (<55y)?
ACE-I or ARB
What is the first line of therapy for a patient with hypertension (>55y or afro-carribean of any age)?
CCB
What is the second line of therapy for hypertension (any age)?
Combine ACE-I/ARB with CCB
What is the third line of therapy for a patient with hypertension (if steps 1 and 2 fail to work)?
ACE-I/ARB + CCB + thiazide-like diuretic
What is the final step of treating ‘resistant hypertension’?
Consider addition of spironolactone, high dose thiazide-like diuretic, alpha blocker, beta blocker.
