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CPT > Hypertension + Heart Failure > Flashcards

Hypertension + Heart Failure Flashcards

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1
Q

List 5 types of drugs used to treat hypertension

A
  • ACE inhibitors (ACEi)
  • Angiotensin Receptor Blockers (ARBs)
  • Diuretics
  • Calcium Channel Blockers (CCBs)
  • Other agents used to treat ‘resistant hypertension’
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2
Q

Where is the enzyme ACE found?

A

Luminal surface of capillary endothelial cells, predominantly in the lung

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3
Q

Angiotensin II acts through AT1 and AT2 receptors.

List 3 actions via AT1

A
  • Stimulation of Aldosterone production
  • Vasoconstriction
  • ADH release

(Sometimes, AT2 receptor effects oppose AT1 effects)

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4
Q

How can Angiotensin II be produced from Angiotensin I independently of ACE?

Give 2 examples of ACE Inhibitors

A

Via Chymases

  • Lisinopril
  • Ramipril
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5
Q

List 5 ADRs of using ACE Inhibitors

A
  • Dry cough
  • Hyperkalaemia
  • Hypotension
  • Renal failure (including Renal Artery Stenosis)
  • Angio-oedema (More common in Afro-Caribbeans)
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6
Q

List 4 contra-indications for using ACE Inhibitors

A
  • Renal artery stenosis
  • Pregnancy
  • AKI (CKD) too
  • Angio-oedema
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7
Q

Give examples of 2 ARBs

Where do ARBs work?

A
  • Losartan
  • Candesartan

At AT1 receptors

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8
Q

Give 3 ADRs of ARBs

A
  • Hypotension
  • Hyperkalaemia
  • Renal failure
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9
Q

Why are ARBs more effective than ACE Inhibitors at inhibiting Ang-II mediated vasoconstriction?

A

Ang-II can still be made from Ang-I by Chymases

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10
Q

List 3 contra-indications for using ARBs

A
  • Renal artery stenosis
  • AKI (CKD too)
  • Pregnancy
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11
Q

Why don’t ARBs cause angio-oedema?

A

No buildup of Bradykinin (a substrate of ACE), which causes a dry cough and angio-oedema

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12
Q

How do CCBs work?

A
  • Bind to Alpha-subunit of L-Type Calcium Channel (LTCC), reducing cellular Ca entry
  • The different types of CCB have higher selectivity for either vascular smooth muscle or myocardium

(LTCCs are a type of VOCC)

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13
Q

What are the 3 types of CCBs?

A
  • Dihydropyridines

Non-dihydropyridines;

  • Phenylalkylamines
  • Benzothiazapines
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14
Q

List some features of Dihydropyridine CCBs

Give 3 examples

A
  • Selective for peripheral vasculature
  • Little Chronotropic or Inotropic effect
  • Amlodipine (Most common)
  • Nifedipine
  • Nimodipine
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15
Q

List features of Phenylalkylamine CCBs

Give an example

A
  • Less peripheral selectivity
  • Depresses SA node and slows AV conduction-> Negative Inotropy
  • Verapamil
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16
Q

How do Benzothiazapine CCBs compare to Phenylalkylamines and Dihydropyridines

Give an example of a Benzothiazapine

A

Sit in the middle;

  • Some action on peripheral vasculature
  • Some action on SA and AV nodes
  • Diltiazem
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17
Q

What drugs are the Primary anti-hypertensive agent in patients with low renin?

A

CCBs, as ARBs and ACEi are not likely to be very useful

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18
Q

Which Dihydropyridine CCB has selectivity for cerebral vasculature?

When can this be useful clinically?

A
  • Nimodipine

- Useful for ischaemic effects of subarachnoid haemorrhage

19
Q

List 4 ADRs of Dihydropyridine CCBs

A
  • Ankle swelling
  • Flushing
  • Headaches (All due to vasodilation)
  • Palpitations (compensatory tachycardia)
20
Q

List 2 contra-indications of Dihydropyridine CCBs

A
  • Aortic stenosis

- Unstable angina

21
Q

How does Amlodipine interact with Simvastatin?

A

Can maintain plasma levels of Simvastatin-> Increased statin effect

22
Q

Phenylalkylamine CCBs can be used for Arrythmia, Angina and Hypertension.

What are 3 side effects?

A
  • Constipation
  • Heart block and cardiac failure
  • Bradycardia, if given by IV
23
Q

List 2 contra-indications of Phenylalkylamine CCBs

A
  • Poor LV function

- AV node delay

24
Q

List 6 ADRs of Thiazide thiazide-like diuretics

A
  • Hypokalaemia
  • Hyperuricaema, can-> Gout
  • Arrhythmia
  • Hyperglycaemia
  • Small increases in TAG and Cholesterol levels
  • Hyponatraemia (not really a long term issue)
25
Q

List 3 contra-indications of thiazide diuretics

A
  • Gout
  • Hypokalaemia
  • Hyponatraemia
26
Q

Step 1 in treating primary hypertension in what 2 groups involves use of CCBs

A
  • Age >55

- Blacks (less likely to have high renin)

27
Q

Why are ARBs and ACEi good for treating Type 2 diabetic nephropathy or Proteinuria?

A

“Two pronged approach”:

  • Reduced peripheral resistance= Reduced BP
  • Dilation of efferent arteriole= Reduced intraglomerular pressure
28
Q

Suggest 3 drugs used to treat Resistant hypertension

A
  • Spironolactone
  • Alpha blockers
  • Beta blockers

(Consider the blockers if K+ is already high)

29
Q

What are 2 ADRs and contra-indications for Spironolactone

A

Side effects;

  • Hyperkalaemia
  • Gynaecomastia, Impotence, Menstrual irregularities (Androgenic properties)

Contra-indications;

  • Hyperkalaemia
  • Addision’s
30
Q

How do Beta blockers work?

A

Decrease sympathetic tone by;

  • Blocking NA
  • Reducing myocardial contraction-> Reduced CO
  • Also decreases renin secretion
31
Q

List 3 Beta blockers

A
  • Labetalol (Pregnant hypertensive emergency)
  • Bisoprolol
  • Metoprolol
32
Q

List 5 ADRs of beta blockers

A
  • Bronchospasm
  • Heart block
  • Raynaud’s (cold hands)
  • Lethargy
  • Impotence
33
Q

List 2 contraindications of beta blockers

A
  • Asthma (COPD too)

- Hepatic failure

34
Q

Describe the interactions between beta blockers and Verapamil (Phenylalkylamine) and Diltiazem (Benzothiazapine)

A

Can cause asystole

35
Q

Name an Alpha blocker

How do these work?

(Safe relatively in renal disease)

A
  • Doxazosin

- Selectivity to Alpha 1 receptors, so reduce peripheral resistance

36
Q

Alpha blockers also act on the urinary tract at the bladder neck and prostate.

Which one is used to treat BPH?

A

Tamsulosin

37
Q

List 5 ADRs of Alpha blockers

A
  • Postural hypotension (Contraindications)
  • Dizziness
  • Syncope
  • Headaches
  • Fatigue
38
Q

Describe the interaction between Alpha blockers and Dihydropyridine CCBs (Amlodipine)

A

Can cause Oedema

39
Q

List 4 factors that affect CO

A
  • Heart rate
  • Contractility
  • Preload
  • Afterload
40
Q

Suggest 2 non-pharmacological managements of heart failure

A
  • reduced salt intake

- liquid reduction

41
Q

What 5 drug types are used in treating Heart Failure?

A
  • ARBs
  • ACEi
  • Diuretics
  • Beta blockers
  • Spironolactone
42
Q

What drugs are usually used to treat HF with reduced EF?

A
  • Diuretics
  • ACEi/ ARB + Beta Blocker
  • can give Spironolactone as well
43
Q

Are NSAIDs and ACEi contra-indicated?

A

Yes, can lead to nephrotoxicity

CPT (19 decks)

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