Hypertension Flashcards
Cardiovascular Pharmacology
ACE Inhibitors (…prils)
Inhibits the conversion of Angiotensin 1 to Angiotensin 11
Decreases activity of ACE
Drug choice for young patients
causes a SMALL drop in BP in normotensive but a GREATER drop in BP in Hypertensive
Reduces cardiac load and arterial pressure
ACE Inhibitors (…prils) contraindications
Pregnancy (Foetal toxicity) Hyperkalaemia (Arrhythmias) Renal failure NSAIDS K supplements K-sparing diuretics (amiloride)
ACE Inhibitors (…prils) adverse effects
Dry cough 1st dose hypotension Higher doses can lead to: taste disturbances angioneurotic oedema (0.1%) Neutropaenia
Angiotensin II Receptor Antagonists (…sartans)
Competitively blocks the action of Angiotensin II NO COUGH Well tolerated Young Px Diabetics
Angiotensin II Receptor Antagonists (…sartans) Contraindications
same as ACE Inhibitors Pregnancy (Foetal toxicity) Hyperkalaemia (Arrhythmias) Renal failure NSAIDS K supplements K-sparing diuretics (amiloride)
B-Adrenoceptor Antagonists (…olols)
Cardio Selective Preferred: Atenolol, metoprolol
Act on beta-1 receptors found in Heart & Kidney
Decrease HR Contractility & Renin release
Improve filling time by slowing HT rate
Inhibition of Renin in KD, block of NAd release -> reduces sympathetic activity
Less Tolerated than ACE Inhibitors & ARBs
B-Adrenoceptor Antagonists (…olols) contraindications
Bradycardia
NEVER use non-selective B-blockers in asthmatics
B-Adrenoceptor Antagonists (…olols) adverse effects
Cold extremeties Tiredness / fatigue Mask sympathetic response to Hypoglycaemic events Bad dreams Postural hypotension
Calcium Channel Blockers (…dipines)
OFTEN used in conjunction with beta blockers as side effect profile is exact opposite
High compliance (helpful with elderly)
DO NOT stimulate Renin Release
Relaxation of large & small arteries leading to reduction of peripheral resistance and/or cardiac output
Calcium Channel Blockers (…dipines) drug types
Phenlalkylamines (verapamil)
Benzothiazepines (diltiazem)
Dihydropyridines (…dipines)
Calcium Channel Blockers (…dipines) adverse effects
Flushing (due to vasodilation) Headache Ankle oedema Bradycardia (verapamil & diltiazem) Constipation
Calcium Channel Blockers (…dipines) contraindications
Acute MI
Heart Failure
Bradycardia
CCB _Phenylalkylamines (verapamil)
Cardioselective
Used as antiarrhythmic
CCB _Benzothiazepines (diltiazem)
Non-selective
Little to no change in HR
Used as antianginal
CCB _Dihydropyridines (..dipines)
MAIN CCBs used as antihypertensives
Blood vessel selective
Can cause reflex tachycardia
Thiazide Diuretics (…thiazide)
FIRST line treatment in mild-moderate hypertensive ELDERLY patients
Dosed in morning to avoid nocturnal diuresis
Proven benefit in stroke & MI reduction
Thiazide Diuretics (…thiazide) adverse effects
Gout
Hypokalaemia
Hyponatraemia
Impotence
Thiazide Diuretics (…thiazide) drug types
Hydrochlorothiazide
Chlorthalidone
Indapamide
Metolazone (thiazide like)
Digoxin
Increases force of contraction
Increases Ca2+ release
Centrally acting agents
Methyldopa
Clonidine
Moxonidine
Methyldopa
Only drug of choice for pregnant women
Side effects: Sedation dry mouth nasal congestion orthostatic hypotension
Clonidine
Centrally acting alpha-2 and imidazoline agonist
Used acutely by IV injection (e.g hypertension by head trauma)
Moxonidine
Centrally acting imidazoline agonist
Causes less drowsiness than clonidine
HYPERTENSION DRUGS
ACE Inhibitors (...prils) Angiotensin II Receptor Antagonists (...sartans) B-Adrenoceptor Antagonists (...olols) Calcium Channel Blockers (...dipines) Thiazide Diuretics (...thiazide) Digoxin Centrally acting agents
