Hypertension Drugs Flashcards
Outline the treatment pathway for hypertension
Diabetic / non-diabetic under 55 yrs:
- ACEi/ARB first
- Add CCB OR thiazide diuretic
- Use all 3
Non-diabetic over 55 yrs / Non-diabetic Black:
- CCB first
- Add ACEi/ARB OR thiazide diuretic
- Use all 3
List the following for: ACE inhibitors
- Use
- Example drugs
- Drug class
- Mechanism of action
- Adverse effects
- Warnings / contraindications
- Important drug reactions
Hypertension
Lisinopril
Ramipril
ACE inhibitor
Limits conversation of Ang 1 -> Ang 2 (less Ang 2 produced)
- Vasodilation
- Reduced aldosterone release (reduced Na and H2O retention)
-Reduced ADH release (increased H2O release)
Smaller effect: increased bradykinin levels
- Vasodilation via NOS/NO and PGI2
- Dry cough
- Hypotension
- Hyperkalaemia
- Cause or worsen renal failure
- Angioedema (esp. Afro-Caribbean)
- Renal artery stenosis
- AKD
- CKD – use with caution
- Pregnancy
- Idiopathic angioedema
- Other hypertensive agents
- Other K+ increasing drugs
- NSAIDs
List the following for: Angiotensin Receptor Blockers
- Use
- Example drugs
- Drug class
- Mechanism of action
- Adverse effects
- Warnings / contraindications
- Important drug reactions
Hypertension
Candesartan
Losartan
Angiotensin receptor blocker
Blocks angiotensin II receptors (A1 receptor)
Prevents downstream actions of angiotensin II
- Vasodilation - better
- Reduced aldosterone release (reduced Na and H2O retention)
- Reduced ADH release (increased H2O release)
NO effect on bradykinin levels
- Hypotension
- Hyperkalaemia
- Cause or worsen renal failure
- Renal artery stenosis
- AKD
- CKD – use with caution
- Pregnancy
Idiopathic angioedema much less likely - Other hypertensive agents
- Other K+ increasing drugs
- NSAIDs
List the following for: Dihydropyridine Calcium Channel Blockers
- Use
- Example drugs
- Drug class
- Mechanism of action
- Adverse effects
- Warnings / contraindications
- Important drug reactions
Hypertension
Amlodipine
Nifedipine
Nimodipine
Calcium channel blocker
Target calcium initiated smooth muscle contraction – includes vascular smooth muscle cells and cardiac myocytes
Prevents entry of calcium into cells so reduced contraction of cells
- Selective for peripheral vasculature (little effect on heart)
- Ankle swelling
- Flushing
- Headaches
- Palpitations
- Unstable angina
- Severe aortic stenosis
- Amlodipine
- Simvastatin
List the following for: Non-dihydropyridine (Phenylalkylamines) Calcium Channel Blockers
- Use
- Example drugs
- Drug class
- Mechanism of action
- Adverse effects
- Warnings / contraindications
- Important drug reactions
Hypertension
Verapamil
Calcium channel blocker
Target calcium initiated smooth muscle contraction – includes vascular smooth muscle cells and cardiac myocytes
Prevents entry of calcium into cells so reduced contraction of cells
- Selective for heart (little effect vasodilation)
- Depresses SA node rate
- Slows AV node conduction
- Negative inotropy and chronotropy (reduced contractility and HR)
Used for:
- Arrhythmias
- Angina
- Hypertension
- Constipation
- Bradycardia
- Heart block
- Cardiac failure
- Poor left ventricular function
- AV node conduction delay
- Beta-blockers
- Caution with other anti-hypertensives
- Caution with other anti-arrhythmics
List the following for: Thiazide Diuretics
- Use
- Example drugs
- Drug class
- Mechanism of action
- Adverse effects
- Warnings / contraindications
- Important drug reactions
Bendroflumethiazide
Indapamide
Hypertension
Diuretic
Inhibits NaCl transported in DCT
Reduces Na entry, therefore increases Na and H2O excretion
- Hyponatraemia
- Hypokalaemia
- Hyperuricemia
- Arrythmia
- Increase glucose
- (Small) increase cholesterol and triglyceride
- Hyponatraemia
- Hypokalaemia
- Gout
- Other K+ reducing diuretics e.g. loop diuretics
- NSAIDs
