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BRS YEAR 2 > Pharm - Hypertension > Flashcards

Pharm - Hypertension Flashcards

1
Q

What are the main drug classes used for HTN treatment

A

ACE inhibitors
Calcium channel blockers
Thiazide or thiazide like diuretics
Angiotensin receptor blockers

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2
Q

What are ACEi examples

A

Ramipril
Lisinopril
Perindopril

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3
Q

What are CCB examples

A

Amlodipine

Felodipine

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4
Q

What are thiazide diuretic example

A

Bendro-flumethiazide

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5
Q

What is a thiazide like diuretic example

A

Indapamide

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6
Q

What are ARB examples

A

Losartan
Irbesartan
Candesartan

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7
Q

What is the drug target for ACEi

A

Angiotensin converting enzyme

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8
Q

What is the drug target for CCB

A

L-type calcium channel

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9
Q

What is the drug target for thiazide like diuretics

A

Sodium/chloride co transporter

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10
Q

What is the drug target for ARBs

A

Angiotensin receptor

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11
Q

What is the main effect of ACEi

A

Prevents conversion of angiotensin 1 to 2 by blocking ACE.
Angiotensin 2 is a vasoconstrictor and stimulates aldosterone secretion which in turn increases blood volume thus pressure

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12
Q

What is the main effect of CCB

A

Block L-type calcium channels – predominantly on vascular smooth muscle. This results in a decrease in calcium influx, with downstream inhibition of myosin light chain kinase and prevention of cross-bridge formation. The resultant vasodilation reduces peripheral resistance.

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13
Q

What is the main effect of thiazide like diuretics

A

They block the Na+, Cl- co-transporter in the early DCT.
Therefore Na+ and Cl- reabsorption is inhibited.
As a result the osmolarity of the tubular fluid increases, decreasing the osmotic gradient for water reabsorption in the collecting duct.



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14
Q

What is the main effect of ARBs

A

These agents act as insurmountable (i.e. non-competitive) antagonists at AT1 receptor (found on kidneys and on the vasculature)

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15
Q

What are the main side effects of ACEi

A

Cough (due to bradykinin build up)

Hypotension

HyperK (take care with K sparing diuretics or K supplements)

Foetal injury

Renal failure (in patients with renal artery stenosis)

Urticaria/ angioedema

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16
Q

What are the main side effects of CCB

A

Ankle oedema
Constipation
Palpitations
Flushing/headaches

17
Q

What are the main side effects of thiazide diuretics

A

HypoK
HypoNa
Metabolic alkalosis (increased H excretion)
HyperCa
hyperglycaemia (due to hyper polarised pancreatic beta cells)
Hyperuricemia

18
Q

What are the main side effects of ARBs

A

Hypotension

HyperK (take care with K sparing diuretics or K supplements)

Foetal injury

Renal failure (in patients with renal artery stenosis)

19
Q

Who is contraindicated for ARB or ACEi use

A

Pregnant women

20
Q

What do ACEis require to work

A

Hepatic activation to generate active metabolites as they are pro drugs - therefore avoid in people with liver problems

21
Q

What must we check regularly with ACEi

A

eGFR and serum K

22
Q

Which is more effective: ACEI or ARB?

A

ACEi

23
Q

What else should we know about CCB

A

Dihydropiridine type calcium channel blockers demonstrate a higher degree of vascular selectivity

24
Q

How long do the diuretic effects of thiazide diuretics last

A

1-2 weeks of treatment

25
Q

What explains the anti-hypertensive effect of thiazide drugs after a few weeks? In which drugs are these effects more pronounced

A

Due to the vasodilation properties - more pronounced in thiazide like diuretics

26
Q

What ARBs are pro-drugs

A

losartan

Candesartan

27
Q

What is clearance

A

The measure of the ability of the body to eliminate a drug - may occur as a result of processes in the liver, kidney and other organs

28
Q

What is elimination half life

A

The length of time for the conc of a particular drug to decrease to half of its starting dose in the body

29
Q

What are time to peak plasma levels

A

Time required for a drug to reach peak conc in the plasma - faster absorption leads to a lower time.

30
Q

Why is it important that Indapamide and there thiazide like diuretics are excreted unchanged in the urine

A

This means that they are not metabolised therefore have an increased effect on the DCT.

BRS YEAR 2 (37 decks)

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