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Pharmacology > Hypertension and Heart Failure > Flashcards

Hypertension and Heart Failure Flashcards

0
Q

ACE inhibitors mechanism

A

Competitive inhibitors of ACE
Reduce angiotensin II formation
Cause arteriolar dilation and some venodilation
Reduce aldosterone so promote diuresis

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1
Q

Hypertension first line therapy

A

ACE inhibitors or angiotensin receptor blockers
Calcium channel blockers
Diuretics

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2
Q

ACE inhibitors uses

A

HF, left ventricular dysfunction

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3
Q

ACE inhibitors ADRs

A

Dry cough due to increased bradykinin
Angio oedema
Renal failure
Hyperkalaemia

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4
Q

ACE inhibitor contraindications

A

Care - renal impairment, peripheral vascular disease

Not in pregnancy, renovascular hypertension

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5
Q

Lisinopril

A

ACE inhibitor

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6
Q

Ramipril

A

ACE inhibitor

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7
Q

Angiotensin receptor blockers mechanism

A

Bind to AT1 receptor

Inhibit vasoconstriction and aldosterone stimulation

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8
Q

Angiotensin receptor blockers ADRs

A

Renal failure

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9
Q

Angiotensin receptor blockers contraindications

A

Care - renal impairment, peripheral vascular disease

Not in pregnancy, renovascular hypertension

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10
Q

Losartan

A

Angiotensin receptor blocker

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11
Q

Valsartan

A

Angiotensin receptor blocker

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12
Q

Calcium channel blocker mechanism

A

Bind to specific alpha subunits of L type calcium channel
Reduces calcium entry
Vasodilation of peripheral, coronary and pulmonary arteries
Little effect on veins

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13
Q

Calcium channel blocker uses

A

Angina

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14
Q

Dihydropyridines

A

Class of calcium channel blocker

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15
Q

Dihydropyridines pharmacokinetics

A

Good oral absorption
>90% protein bound
Metabolised by liver
Few have active metabolites

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16
Q

Dihydropyridines ADRs

A

Oedema
SNS activation via baroreceptor reflex - tachycardia, palpitations
Flushing, sweating, headache
Gingival hyperplasia (rare)

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17
Q

Rifedipine

A

Dihydropyridine CCB

18
Q

Amlodipine

A

Dihydropyridine CCB

19
Q

Phenylalkylamines

A

Class of CCB
impede calcium transport across myocardial and vascular smooth muscle cell membranes
Peripheral vasodilation
Decreased preload
Decreased contractility
Class 4 anti arrhythmics- prolong refactory period
Verapamil depresses SAN and blocks AVN conductance

20
Q

Phenylalkylamines ADRs

A

Bradycardia
Constipation
Negative inotrope, worsens heart failure

21
Q

Verapamil

A

Phenylalkylamines
CCB
Also class 4 antiarrhythmic

22
Q

Benzothiazepines

A 
CCBs
Impede calcium transport across myocardial and vascular smooth muscle membranes 
Prolong AP and refactory period 
Peripheral vasodilation
Reduced preload
Reduced contractility
23
Q

Benzothiazepines ADRs

A

Negative inotrope, but less than verapamil

Bradycardia

24
Q

CCB contraindications

A

Care with beta blockers

Not in heart block or heart failure

25
Q

Diltiazem

A

Benzothiazepines

CCB

26
Q

Alpha blocker mechanism

A

Selective antagonism at post synaptic alpha 1 receptors
Antagonise NA
TPR reduced
More effective in upright position
Benign effects on plasma lipid and glucose

27
Q

Uses of alpha blockers

A

Safe in renal disease

BPH

28
Q

Contraindications for alpha blockers

A

Care in postural hypotension, heart failure

Not in urinary incontinence

29
Q

Doxazosin

A

Alpha blocker

30
Q

Beta blockers mechanism

A

Reduce HR and CO
Developed for angina but found to lower blood pressure
Inhibit renin release
TPR initially increases, later falls to normal

31
Q

Beta blocker ADRs

A 
Bradycardia
Lethargy
Impaired concentration 
Reduced exercise tolerance 
Cold hands
32
Q

Beta blocker contraindications

A

Care in HF, PVD, diabetes
Not in asthma, COPD, heart block
Not in pregnancy (low blood flow causes intrauterine growth retardation)

33
Q

Alskiren mechanism

A

Direct renin inhibitor, blocks angiotensinogen conversion to AT1
Reduces plasma renin activity 50-80%

34
Q

Alskiren pharmacokinetics

A 
Bioavailability 2.6%
T1/2~40 hrs
Steady state takes 5-8 days
Less than 1% renal excretion
78% unchanged in faeces
Not cyp450
35
Q

Alskiren contraindications

A

Care in HF, hyperkalaemia, Na/h2o deplete, renal impairment/ stenosis
Not in pregnancy

36
Q

Alskiren DDIs

A

Frusemide

37
Q

Centrally acting agents for hypertension

A

Methyldopa-alpha 2 receptor agonist
Moxonidine - imidazoline receptor agonist - alpha 2 effect
Cause tiredness, lethargy, depression

38
Q

Dobutamine

A

Beta receptor agonist
Positive inotrope
Used in cardiogenic shock or acute reversible heart failure to increase CO

39
Q

Treatment for hypertensive emergency

A

IV sodium nitroprusside (acts like NO)

40
Q

If stopping beta blockers

A

Come off slowly- triggers arrhythmia.

41
Q

Candesartan

A

ARB

42
Q

Target BPs

A

Systolic 130 in kidney disease
140 in diabetes
150 in normal

Pharmacology (20 decks)

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