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Pharmacology Drugs > Hypertension > Flashcards

Hypertension Flashcards

1
Q

What is hypertension?

A

Hypertension is defined as 140/90 mmHg

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2
Q

What is primary and secondary hypertension?

A
  • Primary hypertension is without single evident cause

- Secondary hypertension is high blood pressure with a discrete identifiable underlying cause and it is less common

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3
Q

What is the 1st line treatment for hypertension?

A
  • ACE inhibitors
  • Calcium Channel Blockers
  • Diuretics
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4
Q

What are some example of ACE inhibitors?

A
  • Lisinopril

- Ramipril

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5
Q

What is the mechanism of action demonstrated by ACE inhibitors?

A
  • Inhibition of Angiotensin Converting Enzyme activity

- Prevents generation of Angiotensin 2

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6
Q

What are the effects of ACE inhibitors?

A
  • Some venodilation
  • Mainly vasodilation
  • Circulating aldosterone is reduced
  • Potentiates the action of bradykinin

This cause lowering of Blood Pressure

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7
Q

What are the indications of ACE inhibitors?

A
  • Heart Failure
  • LV dysfunction
  • Myocardial infarction
  • Diabetes
  • Nephropathy
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8
Q

What are the side effects of ACE-inhibtors?

A
  • Dry Cough
  • Angio-oedema
  • Renal failure
  • Hyperkalaemia
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9
Q

What are some contraindications of ACE inhibitors?

A
  • Pregnancy
  • Renovascular Hypertension
  • Renal impairment
  • Pulmonary vascular disease
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10
Q

What are some examples of angiotensin receptor blockers?

A
  • Losartan

- Candesartan

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11
Q

What is the mechanism of action demonstrated by angiotensin receptor blockers?

A

Binds to angiotensin AT1 receptor

  • Inhibits Vasoconstriction
  • Inhibits aldosterone stimulation caused by angiotensin 2

This leads to blood pressure lowering

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12
Q

When are angiotensin receptor blockers used?

A
  • ACE inhibitor intolerance
  • Hypertension with LVH
  • Type 2 Diabetes Mellitus
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13
Q

What are the side effects of angiotensin receptor blockers?

A
  • Renal failure

- Hyperkalaemia

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14
Q

What are some contraindications of angiotensin receptor blockers?

A
  • Pregnancy
  • Renovascular hypertension
  • Renal impairment
  • Pulmonary vascular disease
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15
Q

What are the types of calcium channel blockers?

A
  • Dihydropyridines
  • Phenylalkylamines
  • Benzothiazepines
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16
Q

What are some examples of Dihydropyridines?

A
  • Amlodipine

- Nifedipine

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17
Q

What are the effects of Calcium Channel Blockers?

A
  • Vasodilates peripheral, coronary and pulmonary arteries

- No significant effect on veins

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18
Q

What are the properties of Dihydropyridines?

A
  • Good oral absorption
  • Protein bound >90%
  • Metabolised by the liver
  • Few have active metabolite
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19
Q

What are some uses of Dihydropyridines?

A
  • Blood pressure lowering
  • Short acting dihydropyridines affect the baroreceptor mediated tachycardia
  • Used in the elderly and ISH
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20
Q

What are some side effects of Dihydropyridines?

A
  • Oedema commonest
  • Sympathetic nervous system activation leading to tachycardia and palpitations
  • Flushing, sweating, throbbing headache
  • Gingival hyperplasia
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21
Q

What are the properties of Phenylalkylamines?

A
  • Impedes calcium transport across the myocardial and vascular smooth muscle cell membrane
  • Class 4 anti-arrhythmic agent/prolongs the action potential/effective refractory period
  • Peripheral vasodilation and a reduction in cardiac preload and myocardial contractility
22
Q

What are some properties of Benzothiazepines?

A
  • Impedes calcium transport across the myocardial and vascular smooth muscle cell membrane
  • Prolongs the action potential/effective refractory period
  • Peripheral vasodilation and a reduction in cardiac preload and myocardial contractility
23
Q

What are the uses of Phenylalkylamines?

A
  • Blood pressure lowering
  • Verapimil depresses the SA nodes and slows AV conduction
  • Used in Angina
24
Q

What are the main side effects of Phenylalkylamines?

A
  • Constipation
  • Risk of bradycardia
  • Reduce myocardial contractility (negative inotrope) - Worsen heart failure
25
Q

What are the contraindications of Phenylalkylamines?

A
  • Heart block
  • Heart failure
  • Careful with combination with beta-blockade
26
Q

What the uses of Benzothiazepines?

A

Bood pressure lowering

27
Q

What are the side effects of Benzothiazepines?

A
  • Risk of bradycardia

- Less negative ionotropic effect than verapamil - can worsen heart failure

28
Q

What are some examples of Thiazide/Thiazide Like diuretics?

A
  • Bendroflumethiazide

- Indapamide

29
Q

What are some effects of thiazide/thiazide like diuretics?

A
  • Reduce distal tubular sodium reabsorption
  • Sustained action
  • Blood pressure reduction complex. Has some vasodilator properties as well as venodilation
  • Dose-blood pressure response curve: flat
30
Q

What are some uses of thiazide/thiazide like diuretics?

A
  • Blood pressure reduction by several mechanisms by initial blood volume decrease and later total peripheral resistance falls
  • Used in elderly patients, heart failure patients and ISH
31
Q

What some side effects of thiazide/thiazide like diuretics?

A
  • Hypokalaemia
  • Increased urea and uric acid levels
  • Impaired glucose tolerance (especially with beta-blockers)
  • Cholesterol and triglyceride levels increased
  • Activates RAAS
32
Q

What are some contraindications of Thiazide/Thiazide like diuretics?

A

-Gout

33
Q

What are some examples of alpha blockers?

A

Doxazosin

34
Q

What are some effects of alpha blockers?

A
  • Selective antagonism at post-synaptic alpha 1 adrenoceptors and antagonise the contractile effects of noradrenaline on vascular smooth muscle
  • Reduce peripheral vascular resistance
  • More effect in upright position
  • Benign effect on plasma lipids/glucose
  • Safe in renal disease
35
Q

What are the uses of Alpha blockers?

A

Blood pressure reduction

36
Q

What are the side effects of alpha blockers?

A
  • Postural hypotension and dizziness
  • Headache and fatigue
  • Oedema
37
Q

What the contraindications of alpha blockers?

A
  • Urinary Incontinence
  • Postural hypotension
  • Heart Failure
38
Q

What are some examples of Beta Blockers?

A
  • Atenolol
  • Bisoprolol
  • Nebivol
  • Propanolol
  • Esmolol
39
Q

What are the physiological effects of Beta Blockers in heart failure?

A
  1. Reduce heart rate - Cardiac beta receptor
  2. Reduce blood pressure - Reduce cardiac output.

The combination of 1+2 leads to reduced myocardial oxygen demand

  1. Reduce mobilisation of glycogen
  2. Negative unwanted effects of catecholamines
40
Q

What are the effects of Beta Blockers?

A
  • Reduce heart rate and cardiac output
  • Inhibit renin release
  • Initially TPR increases later falls to normal
41
Q

What are uses of Beta Blockers?

A
  • Blood pressure reduction

- Used in MI/Angina

42
Q

What are the side effects of beta blockers?

A
  • Lethargy impaired concentration
  • Reduced exercise tolerance
  • Bradycardia
  • Cold hands - Raynaud’s
  • Impaired glucose tolerance
43
Q

What are the contra-indications of Beta blockers?

A
  • Asthma
  • Heart block
  • Heart failure
  • PVD (caution)
  • Diabetes except with CHD
44
Q

What is the mechanism of action demonstrated by Aliskeren?

A
  • Direct renin inhibition by suppression at the point of activation
  • Reduces plasma renin activity by 50% - 80%
  • Blood pressure reduction by vasodilation
45
Q

What are the types of Centrally acting agents and how do they work?

A

Reduce sympathetic outflow

  • Methydopa: converted to alpha methyl noradrenaline - a potent alpha-2 adrenoceptor agonist
  • Clonidine: Direct pre-synaptic alpha 2 adrenoceptor agonist
  • Moxonidine: imidozoline receptor agonist and some alpha 2 agonist effect
46
Q

What are the uses of centrally acting agents?

A

-Used in hypertension however less commonly

47
Q

What are the side effects of centrally acting agents?

A
  • Tiredness/lethargy

- Depression

48
Q

How are combination therapies used effectively in hypertension?

A
  • Hydrochlorthiazide: Thiazide diuretic which lowers BP and raises glucose as well as lowering K+
  • Amiloride: K+ sparing diuretic which lowers BP and has no effect on glucose

Combination of the 2 at half dose result in greater decrease in BP with no effect on K+ and glucose

49
Q

What are the principles of managing heart failure?

A

Correct underlying cause

Non-pharmacological measures

Pharmacological therapy

  • Symptomatic improvement
  • Delay progression of heart failure
  • Reduce mortality

Treat complications/associated conditions/cardiovascular risk factors

50
Q

How are beta blockers administered in heart failure?

A
  • Care need to be taken. Failing myocardium dependant on heart rate
  • Initiate at low dose and titrate slower. May have to alter concomitant medication such as diuretics
51
Q

What are examples of Phenylalkylamines?

A

Verapamil

52
Q

What are examples of Benzodiazepines?

A

Diltiazem

Pharmacology Drugs (22 decks)

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