Hypertension Drugs Flashcards
Name some first line drugs used for hypertension
ACE inhibitors/Angiotensin II receptor blocker
Calcium channel blockers
Diuretics
Name a diuretic that could be used in first line treatment of hypertension
Thiazides/thiazide like
What are some second line drugs used for hypertension?
Diuretics (K+ sparing) Alpha and beta blockers Direct renin inhibitor Centrally acting agents Vasodilators
Describe the treatment flow chart used when dealing with hypertension
Age: <55 ACE inhibitor, >55/black calcium channel blocker
First line doesnt work? add alternative treatment (ACEi +CCB)
Still not working? Add thiazide like diuretic
Last effort? Add second line drug
What drugs is given for hypertensive emergencies?
Sodium nitroprusside
What is the action of ACEi?
Competitive inhibitors of ANG1
Causes (Arteriole) vasodilation
Decreases circulating aldosterone
Stop bradykinin breakdown
Give an example of an ACEi
Ramipril
Lisinopril
What are the side effects of ACEi?
Dry cough (bradykinin in the lung)
Angioedema (black pop.)
Renal failure
Hyperkalaemia
What is the action of ARBs?
Blocks AT1 receptor More Ang binds to AT2 receptor More Nitric oxide release Decreases vasoconstriction Decreases aldosterone stimulation
What are the side effects of ARBs?
Well tolerated (compared to ACEi) No dry cough
Renal failure
Hyperkalaemia
Give an example of a ARB?
Losartan
Candersartan
What is the action of thiazides?
Block Na-C transport on DCT (less sodium reabsorption)
Decreases blood volume (and then TPR)
What are side effects of thiazides?
Hypokalaemia, hyponatraemia, hypercalcaemia
Gout (also contraindication)
Hyperglycaemia (contraindication-diabetes)
Alkalosis
Increase cholesterol
RAAS activation
ED
Give some examples of thiazide/thiazide like drugs
Bendroflumethiazide
Indopamide
What is the action of K+ sparing sparing diuretic?
Indirect/direct inhibition of ENaC
reduces ROMK action preventing K+ loss
Give examples of K+ sparing diuretics
Spironolactone (Aldosterone receptor blocker- indirect effects on ENaC)
Amiloride (direct ENaC)
What are some side effects of spironolactone?
Hyperkalaemia
ED
Painful gynaecomastia (enlargement of man boobs)
What are some side effects of amiloride?
Hyperkalaemia
What is the action of alpha blockers?
Selective antagonism at post-synaptic a1 receptors
Blocks contractile effects of NA on vascular SM
Decreases TPR
(More effect when upright)
Benign effect on glucose and plasma lipids
What are the adverse effects of alpha blockers?
Postural hypotension- dizziness
Headaches
Fatigue
Oedema (peripheral pooling of blood)
What is a contraindication of alpha blockers?
Urinary incontinence
Give an example of an alpha blocker
Doxazosin
What is the action of a direct renin inhibitor? (Aliskiren)
Blocks renin and prevents cleavage of Ang
Some vasodilator properties
Why is sodium nitroprusside used for hypertensive emergencies?
Mimics the action of nitric oxide
Is potent vasodilator
Has rapid onset and offset when given IV
*avoid chronic use
