Hypertension + Heart Failure Flashcards
Lisinopril/ramipril
Indication: hypertension and heart failure
Class: ACEi
Actions:
- inhibit angiotensin I to angiotensin II
- build up of bradykinin - vasodilation via NO
Adverse effects:
- dry cough (bradykinin)
- hyperkalaemia (low aldosterone)
- cause/worsen renal failure (dont give renal artery stenosis)
- angiodema (afro-carribean patients)
- exaggerate Psoiasis
Warnings:
- preganncy - may cause newborn hypotension via breastfeeding
- dont give in low renin patients - loss of RAAS and become hypotensive
- renal artery stenosis
- afro-carribean
- severe aortic stenosis - aortic stenosis afterload fixed and preload dependent. Contraindicated against all afterload reducing agents (ACEi, ARBs, CCBs)
Interactions: - potassium increasing drugs (amiloride, ARBs)
- NSAIDs
- other antihypertensives
Other:
- less effective than ARBs as angiotensin II produced from angiotensin I independently of ACE via chymases
- used in hypertension with type II diabetes - decreases peripheral vascular resistance and dilates efferent arteriole so reduces glomerular pressure
Losartan
Inidication: hypertension and heart failure
Class: Angiotensin receptor II antagonist - AT1 receptor
Adverse effects:
- hypotension
- hyperkalaemia (low aldosterone)
- cause/worsen renal failure (dont give w/ renal artery stenosis)
Interactions:
- potassium increasing drugs (amiloride, ACEi)
- NSAIDs
Warnings:
- pregnancy
- low renin patients - loss of RAAS so become hypotensive
- severe aortic stenosis - aortic stenosis afterload fixed and preload dependent. Contraindicated against all afterload reducing agents (ACEi, ARBs, CCBs)
Other:
- more effective at inhibiting angiotensin II mediated vasoconstriction - block further down stream
- no effect on bradykinin and angiodema less likely than with ACEi
Amlodipine/nimodipine
Indication: hypertension
Class: dihydropyridine calcium channel blocker
Action:
- amlodipine selective for peripheral calcium initiated vascular smooth muscle contraction
- nimodipine selective for cerebral vasculature - useful for ischaemic effects of subarachnoid haemorrhage
Adverse effects:
- ankle swelling
- flushing + headaches (vasodilation)
- palpitations (compensatory tachycardia)
- gum damage
Contraindications:
- unstable angina - reflex tachycardia can worsen symptoms
- severe aortic stenosis - aortic stenosis afterload fixed and preload dependent. Contraindicated against all afterload reducing agents (ACEi, ARBs, CCBs)
Interactions:
- simvastatin (increases statin effect)
Other:
- give instead of ACEi for low renin patients
- amlodipine has long half life
Verapamil
Indication: arrythmia, angina
Class: phenylalkylamines - non dihyropyridine CCB
Actions: negative chronotropic and inotropic effects
Adverse effects:
- constipation
- bradycardia (dont give w/ AV nodal delay)
- heart block and cardiac failure (dont give with poor LV function)
Interactions:
- beta blockers - risk of complete heart block
- other antihypertensives and atiarrythmics
Indapamide
Indication: hypertension
Class: thiazide like diuretic
Action:
- inhibit Na+/Cl- transporter in distal convoluted tubule - decrease Na+ and h20 reabsorption
- Long term - sensitivty of vascular smooth muscle to vasoconstrictors (calcium and noradrenaline)
Adverse effects:
- hypokalaemia, hyponatreamia, hyperuricemia (gout)
- increase glucose
- increase cholesterol and triglyceride
Interactions:
- NSAIDs
- K+ decreasing drugs e.g loop diuretics
Other:
- useful over calcium channel blockers in oedema
- single dose in morning - causes you to urinate so could disrupt sleep if taken later in the day
Doxazosin/tamulosin
Indication: resistant hypertension
Class: alpha adrenoreceptor blocker
Action:
- reduce peripheral vascular resistance
- tamsulosin used in BPH - dilation of bladder neck and prostate
Adverse effects:
- postural hypotension, dizziness, syncope, headache
Warnings:
- sever aortic stenosis
- unstable angina - decrease bp, reflex tachycardia, worsen symptoms
Interactions:
- dihydropyridine CCB - increase oedema
Labetalol/bisoprolol
Indication: resistant hypertension and heart failure
Class: beta blocker
Action:
- decrease sympathetic tone by blocking NAd
- reduce myocardial contraction, decreasing CO
- decrease renin secretion - beta 1
Adverse effects:
- bronchospasm (dont give w/ asthma)
- heart block (dont give w/ Haemodynamic instability)
- raynauds
- mask tachycardia (insulin induced hypoglycaemia)
- exacerbate psoriasis
- hyperlipidaemia
Interactions: non-dihydropyridine CCBs e.g verapamil - heart block
Other:
- used in resistant hypertension
- used in gestational diabetes and pregnancy hypertension
Spirinolactone
Indication:
Oedema and ascites in cirrhosis
Maligannt asicites
Nephrotic syndrome
resistant hypertension
heart failure
Class: aldosterone receptor antagonist - block transcription (dont give w/ addisons)
Adverse effects:
- hyperkalaemia
- gynaecomastia (anti-androgen)
Interactions:
- K+ increasing drugs
- pregnancy
Furosemide
Indication: heart failure
Acute heart failure dose = 40mg IV
Class: loop diuretic
Action: inhibit N+/K+/2Cl- in ascending LoH, decrease H20 absorption
Adverse effects:
- dehydration and hypotension
- hypokalamia, hyponaetreamia, hyperuricemia (gout)
- tinnitus (ototoxicity)
- increase glucose (less than thiazide)
- increase LDL cholesterol and cholesterol
Interactions:
- aminoglycosides (gentamicin) - ototoxicity
- digoxin - hypokalaemia
- lithium
Amiloride
Indication: heart failure
Class: potassium sparing diuretic
Action: directly block ENaC - decrease sodium reabsoprtion and decrease potassium excretion (dont give w/ addisons)
Adverse effects: hyperkalaemia
Interactions: other K+ sparing drugs (ACEi, ARBs)
Other:
- often used w/ loop or thiazide diuretics to decrease potassium loss
