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CPT > Hypertension and HF > Flashcards

Hypertension and HF Flashcards

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1
Q

Name two ACE inhibitors

A

Lisinopril

Ramipril

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2
Q

What is the mechanism of action of ACEi?

A
  • Blocks AngII and therefore, lack of vasoconstriction of the EA. GFR not maintained and decreases.
  • Lack of ADH production so less water reabsorbed.
  • Lack of aldosterone production so less K+ secreted and less Na+ reabsorbed at the collecting ducts.
  • decreased sympathetic output = decreased chronotropy and inotropy of heart. Decreased renin release.
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3
Q

Common side effects of ACEi

A
  • ACE inhibited therefore bradykinin is not broken down into peptide fragments: dry cough and angioedema (bradykinin is a vasodilator so increased hydrostatic pressure)
  • Renal failure as GFR low and cannot be maintained
  • Hypotension from vasodilation
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4
Q

Avoid the use of ACEi in:

A
  • Renal artery stenosis (GFR is already decreased)
  • AKD (decreased perfusion)
  • Pregnancy and breastfeeding (ACEi are teratogenic)
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5
Q

Drugs to avoid with ACEi

A
  • K+ sparing diuretics = hyperkalaemia and bradycardia/ asystole.
  • NSAIDs = block prostaglandins resulting in vasoconstriction of AA so decreased GFR. Extreme GFR decrease leads to decreased perfusion and pre-renal AKD.
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6
Q

In which patients is ACEi used as first line treatment?

A
  • Hypertension with type II diabetes

- Hypertension without type II diabetes and is < 55 yrs old and not of African descent.

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7
Q

What added benefit does ACEi provide in those with type II diabetes?

A
  • Two pronged approach. ACEi causes vasodilation of the EA and also decreases BP resulting in a reduced intraglomerular pressure which is good for patients with type II diabetes as it can cause nephrotic syndrome (diabetic nephropathy) and CKD with proteinuria.
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8
Q

Name two AngII receptor blockers

A

Losartan

Candesartan

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9
Q

What is the mechanism of action of ARBs?

A
  • Block AT1 receptor (has vasoconstrictive effects).
  • Lack of vasoconstriction of VSM, heart and kidney.
  • Same effects are ACEi.
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10
Q

Are the side effects caused by presence of bradykinin experienced?

A

No. ACE is not being affected and so bradykinin will be broken down into its peptide fragments. No dry cough or angioedema.

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11
Q

Drugs to avoid when using ARBs: contraindications

A
  • K+ sparing diuretics

- NSAIDs

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12
Q

Avoid ARB usage in:

A
  • Renal failure patients - AKD
  • Renal artery stenosis
  • Pregnancy
  • Breastfeeding
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13
Q

Name drugs in the CCB class

A
  • Divided into two classes:
  • Dihydropyridines: amlodipine, nimodipine, nifedipine
  • Non-dihydropyridines: phenylalkylamines (Verapamil), benzothiazapines (diltiazem)
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14
Q

Mechanism of action of dihydropyridines.

A
  • Acts in peripheral vasculature and causes vasodilation.

- Decreased TPR and so CO increases to counteract this - patient becomes tachycardic.

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15
Q

Side effects of dihydropyridines

A
  • Ankle swelling
  • Palpitations (from compensatory tachycardia)
  • Flushing
  • Headaches
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16
Q

Avoid CCBs Dihydropyridines in patients with:

A
  • Unstable angina due to risk of arrhythmia; patient is already tachycardic.
  • Severe aortic stenosis - CO is already decreased so decreased BP - exacerbated by CCBs = hypotension risk.
17
Q

Contraindications of CCBs:

A
  • Amlodipine is metabolised by CYP3A4 and this is inhibited by Statins. Avoid statins.
  • Avoid other antihypertensive drugs (ACEi, BB, ARBs etc)
18
Q

For which patients is CCB used as a first line treatment?

A
  • Hypertension without type II diabetes in patients > 55 yrs and those of African Caribbean descent (have low renin levels naturally).
19
Q

Mechanism of action of phenylalkylamines.

A
  • Act on the myocardium causing decreased SAN and AVN conduction. Therefore, AV conduction decreases and you have negative chronotropy and inotropy of the heart.
  • Prolonged AP and effective refractory period.
  • Used for SVT rate control.
20
Q

Mechanism of action of benzothiazapines

A
  • Acts on both peripheral vasculature and myocardium
21
Q

Contraindications of non-dihydropyridines CCBs :

A
  • Beta blockers = also causes a decreased chronotropy and inotropy increasing risk of asystole.
22
Q

What are the main diuretics used in hypertension?

A
  • Thiazides or thiazide like diuretics
23
Q

Mechanism of action of Thiazides

A
  • Acts on the DCT and blocks NCCT (sodium-chloride co-transporter). Decreases sodium reabsorption from the lumen so intracellular [Na] is low. This causes up-regulation of the Na+/Ca2+ channel on the basolateral membrane so increased Ca2+ reabsorption occurs.
  • Increases uric acid reabsorption.
  • ENAC unregulated at the DCT distally and collecting duct so more K+ removed from blood.
24
Q

Side effects of thiazides:

A
  • Hypokalaemia = VF and arrhythmia risk
  • Hyponatraemia
  • Hyperuricaemia = Gout
  • Hypercalcaemia
25
Q

Contraindications of thiazide diuretics:

A
  • NSAIDs = both are nephrotoxic

- Hypokalaemic drugs

26
Q

Name drugs in Beta Blocker class.

A
  • Metoprolol
  • Bisoprolol
  • Labetalol
27
Q

Mechanism of action of Beta blockers

A
  • blocks the B1 receptor at the SAN.
  • Decreases slope of pacemaker potential in SAN. Decreased AV conduction so decreased supraventricular tachycardia.
  • Decreased chronotropy and inotropic effect - low HR and BP.
28
Q

Contraindications of BB:

A
  • Non-dihydropyridines CCBs as they also cause decreased chronotropy and inotropy of the heart, as well as SAN conduction to decrease.
  • Risk of asystole.
29
Q

At what stage are beta blockers used as part of treatment for hypertension in both emergency and non-emergency situations?

A
  • Emergency IV antihypertensive

- Step 4 hypertension is resistant hypertension - treat using spironolactone, alpha and beta blockers.

30
Q

Name a drug in the alpha blocker class

A
  • Doxazosin
31
Q

Mechanism of action of alpha blockers

A
  • Decreases TPR as it blocks alpha 1 receptor in the peripheral vasculature, causing vasodilation.
  • Used as treatment in BPH by relaxing smooth muscle of prostate and decreasing pressure on prostatic urethra, allowing urine to pass.
32
Q

In which patients should you avoid using AB:

A
  • Postural hypotensive patients
33
Q

Contraindications of alpha blockers:

A
  • Dihydropyridines as they cause vasodilation of peripheral vasculature too = excessive hypotension risk.
  • Risk of oedema with these drugs too
34
Q

What are the four treatments for heart failure?

A

1) Diuretics such as furosemide = for SYMPTOM RELIEF ONLY
2) ACEi
3) BB
4) ARBs if intolerant to ACEi.

35
Q

What effect do the ACEi, BB and ARBs have on treating heart failure?

A
  • They decreases the preload and afterload, treating the natural body’s neurohormonal pathway that exacerbates HF.
36
Q

What is the treatment for MI?

A
  • Aspirin
  • ACEi
  • BB
  • Statins

CPT (9 decks)

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