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CPT > Hypertension drugs > Flashcards

Hypertension drugs Flashcards

1
Q

What is desired blood pressure in adults?

A

120/80 mmHg “desired”

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2
Q

Define stages of hypertension

A

1: 140/90 mmHg to 159/99 mmHg
2: 160/100 mmHg to 180/120 mmHg
3: higher than 180/120 mmHg

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3
Q

Where is ACE found?

A

luminal surface of capillary endothelial cells, predominantly in the lungs

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4
Q

What are the steps of angiotensinogen?

A

angiotensinogen from liver, renin from kidney converts it to angiotensin I. ACE from lungs converts that to angiotensin II,

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5
Q

what are the actions of angiotensin II?

A

acts at AT1, vasoconstriction
stimulation of aldosterone which acts at distal renal tubule
cardiac and vascular muscle cell growth
vasopressin (ADH) release from posterior pituitary

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6
Q

How is angiotensin II created?

A

converted from. the angiotensin I via ACE or chymases

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7
Q

How do ACEi cause hypotension and dry cough

A

potentiates bradykinin

- vasodilatation via NOS/NO

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8
Q

What are the ACEi names?

A

lisinopril, ramipril

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9
Q

What is the mechanism of action for ACEi?

A

inhibiting circulating and tissue ACE •
A reduction in Angiotensin-II activity,
vasodilation (↓ peripheral resistance: ↓ afterload)
reduction in aldosterone release (↑ Na + H2O excretion)
reduced vasopressin (ADH) release (↑ H2O excretion)
reduced cell growth and proliferation

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10
Q

ACEi

A

Hypotension, Dry cough (10-15% - bradykinin association)
hyperkalaemia (lower aldosterone - ↑[K+])
cause or worsen renal failure
angioedema

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11
Q

X ACEi

A

Renal artery stenosis, AKD,, (CKD - caution),
idiopathic angioedema
pregnancy

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12
Q

^ACEi

A

↑K+ drugs,
NSAIDs,
other antihypertensive agents

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13
Q

ARB names

A

candesartan, losartan

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14
Q

ARB mechanism

A

AT 1 and AT2 receptors antagonist, no effect on bradykinin

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15
Q

ARB

A

Hypotension!
hyperkalaemia (low aldosterone ↑K+)
cause or worsen renal failure

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16
Q

X ARB

A

Renal artery stenosis, AKD,, (CKD

pregnancy

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17
Q

^ARB

A

↑K+ drugs,

NSAIDs

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18
Q

What do CCB do?

A

target calcium initiated smooth muscle contraction, primary choice for low renin patients

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19
Q

What are the 2 groups of CCB

A

dihydropyridines

- non-dihyropyridin

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20
Q

What are dihydropyridines?

A 
amlodipine (long half life) 
nifedipine 
nimodipine (selective for cerebral vasculature)
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21
Q

dihydropyridine

A

Ankle swelling, flushing, headaches (vasodilation)

Palpitations

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22
Q

mechanism for dihydropyridine

A

little chronotropic or inotropic effects

cerebral vs peripheral selectivity

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23
Q

x dihydropyridine

A

Unstable angina, severe aortic stenosis

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24
Q

^ dihydropyridine

A

amlodipine + simvastatin (increased effect of statin)

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25
Q

non-dihydropyridine examples

A

phenylalkylamines =verapamil and benzothiazapines=diltiazem

26
Q

phenylalkylamines mechanism

A

depresses SA node and slows AV conduction, prolongs the action potential
Class IV anti-arrhythmic agent
Less peripheral vasodilatation,
negative chronotropic and inotropic effects

27
Q

Phenylalkylamines

A

Constipation,

bradycardia (i .v. ), heart block and cardiac failure

28
Q

X Phenylalkylamines

A

Poor LV function (caution), AV nodal conduction delay

29
Q

^ Phenylalkylamines

A

β-blockers,

other antihypertensive and antiarrhythmic agents

30
Q

thiazide examples

A

bendroflumethiazide

indapamide

31
Q

thiazide mechanism

A

• Inhibit N+/Cl- co-transporter in distal convoluted tubule

↓Na+ and H2O reabsorption

32
Q

thiazide

A 
Hypokalaemia, hyponatraemia, 
hyperuricemia (gout), 
arrhythmia
↑glucose (especially with beta-blockers) 
small ↑cholesterol and triglycerid
33
Q

X thiazide

A

Hypokalaemia, hyponatraemia, gout

34
Q

^ thiazide

A

NSAIDs, ↓K+ drugs such as loop diuretics

35
Q

aldosterone antagonist example

A

spironolactone

36
Q

mechanism of spironolactone

A

K sparing, mineralcorticoid aldosterone antagonist

37
Q

spironolactone

A

Hyperkalaemia, gynaecomastia (moobs)

38
Q

Xspironolactone

A

Hyperkalaemia, Addison’s

39
Q

^spironolactone

A

↑K+ drugs (monitoring), pregnancy

40
Q

β-adrenoceptor blockers examples

A

labetalol
bisoprolol
metoprolol

41
Q

β-adrenoceptor blockers mechanism

A

Decrease sympathetic tone
reducing myocardial contraction
bisoprolol resulting in reduced cardiac output

↓ renin secretion β1

42
Q

β-adrenoceptor blockers

A

Bronchospasm, heart block, Raynaud’s (cold hands), lethargy, impotence
Mask tachycardia – sign of insulin induced hypoglycaemia

43
Q

X β-adrenoceptor blockers

A

Asthma, (COPD), haemodynamic instability, hepatic failure

44
Q

^β-adrenoceptor blockers

A

non-dihydropyridine CCBs - verapamil and diltiazem – asystole!

45
Q

α-adrenoceptor blockers examples

A

doxazosin,

tamulosin(renal, BPH)

46
Q

α-adrenoceptor blockers mechanism

A

Selective antagonism of α-1 adrenoceptors •
Reduce peripheral vascular resistance •
Urinary tract including bladder neck and prostate – benign prostatic hyperplasia (tamsulosin), Relatively safe in renal disease

47
Q

α-adrenoceptor blockers

A

Postural hypotension

dizziness, syncope, headache and fatigue

48
Q

Xα-adrenoceptor blockers

A

postural hypotension

49
Q

^ α-adrenoceptor blockers

A

dihydropyridine CCB - ↑oedema

50
Q

What is MAP?

A

DBP+(SBP-DBP)/3)

51
Q

loop diuretics example

A

bumetanide

furosemide

52
Q

loop diuretics mechanism

A

• Inhibit N+/K+/2Cl- co-transporter in ascending limb of LoH,
↓ N+ K+ 2Cl- into epithelium H2O follows by osmosis
Direct dilation of capacitance veins – reduces preload
For :pulmonary oedema, fluid overload in HF, adjunct in nephrotic syndrome

53
Q

loop diuretics

A

Dehydration, hypotension!
Hypokalaemia, hyponatraemia, hyperuricemia (gout) with chronic treatment, arrhythmia, tinnitus ↑cholesterol and triglyceride

54
Q

X loop diuretic

A

Hypokalaemia, hyponatraemia, gout, hepatic encephalopathy

55
Q

^ loop diuretic

A

aminoglycosides, digoxin, lithium

56
Q

K sparing diuretic example

57
Q

K sparing diuretic mechanism

A

Block ENaC

↓Na+ reabsorption in DCT and reduce K+ excretion, adjunct to loop or thiazide like in HF to limit ↓K+

58
Q

K sparing diuretic

A

Hyperkalaemia, potential arrhythmia

59
Q

X K sparing diuretic

A

Addison’s, potassium supplement

60
Q

^ K sparing diuretic

A

K+ sparing drugs, ACEi, ARBs

CPT (19 decks)

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