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MD3001 Cardiology > Pharmacological Treatment of Hypertension > Flashcards

Pharmacological Treatment of Hypertension Flashcards

1
Q

Criteria for treatment of stage 1 hypertension

A
  • end organ damage and under 80?
  • CVS disease?
  • renal disease?
  • diabetes?
  • 10 year CV risk >10%?
  • if yes: lifestyle changes and therapeutic interventions
  • if no: lifestyle changes/monitor BP
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2
Q

List the anti-hypertensive therapeutics

A
  • ACE inhibitors
  • ARBs
  • diuretics
  • CCBs
  • a-adrenergic receptor blockers
  • b-adrenergic receptor blockers
  • spironolactone/potassium-sparing diuretics
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3
Q

What drugs target the kidneys?

A
  • ACE inhibitors
  • ARBs
  • thiazide diuretics
  • spironolactone and K+ sparing diuretics
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4
Q

Explain the mechanism of action of ACE inhibitors

A

prevents the conversion of Angiotensin I to Angiotensin II in the RAAS

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5
Q

What effect do ACE inhibitors have on the RAAS pathway?

A
  • decrease vasoconstriction decreasing TPR
  • decrease water and salt retention decreasing ECV
  • overall decreasing BP
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6
Q

What are some examples of ACE inhibitors?

A
  • captopril
  • enalapril
  • perindopril
  • lisinopril
  • ramipril
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7
Q

What effect do ACE inhibitors on the kinin-kallikrein system?

A
  • increases bradykinin
  • prevents conversion of bradykinin to its inactive metabolite
  • increases vasodilation
  • decreases TPR
  • overall decreases BP
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8
Q

Side effect of ACE inhibitors?

A
  • dry cough
  • due to increased bradykinin which can cause bronchoconstriction
  • patient can be prescribed ARB instead
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9
Q

Explain the mechanism of action of ARBs

A

Blocks the AT1 receptors that angiotensin II bind to, blocking their action

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10
Q

What effect does ARBs have?

A
  • decreases vasoconstriction decreasing TPR
  • decreases water and salt retention decreasing ECV
  • overall decreasing BP
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11
Q

Why do patients not experience a dry cough with ARBs?

A

the drug has specific effects on AT1 and so has no effect on bradykinin

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12
Q

What are the 3 types of diuretics?

A
  • loop diuretics
  • thiazide diuretics
  • K+ sparing diuretics
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13
Q

What are some examples of ARBs?

A
  • losartan
  • irbesartan
  • valsartan
  • olmesartan
  • candesartan
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14
Q

Explain the mechanism of action of loop diuretics

A
  • inhibit NKCC in thick ascending limb of Loop of Henle

- reduces reabsorption of Na, K and Cl

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15
Q

What diseases are loop diuretics used to treat?

A
  • acute pulmonary oedema
  • chronic heart failure
  • cirrhosis of liver
  • nephrotic syndrome
  • renal failure
  • hypertension (only with impaired renal function)
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16
Q

What are some examples of loop diuretics?

A
  • furosemide

- bumetanide

17
Q

Explain the mechanism of action of thiazide diuretics

A
  • inhibit NCC
  • reduces reabsorption of Na and Cl
  • can also cause vasodilation
18
Q

What is a side effect of thiazide diuretics?

A

erectile-dysfunction

19
Q

What are some examples of thiazide diurectics?

A
  • bendroflumethiazide

- hydrochlorothiazide

20
Q

Why must K+ sparing diuretics be used in combination with loop/thiazide diuretics?

A
  • would cause hyperkalaemia alone

- combinations balance plasma concentration of K+

21
Q

Explain the mechanism of action of K+ sparing diuretics

A

Aldosterone antagonists:
- competitively inhibit mineralcorticoid receptor

ENaC inhibitors:
- block epithelial Na+ channel

22
Q

What are some examples of aldosterone inhibitors?

A
  • spironolactone

- eplerenone

23
Q

What are some examples of ENaC inhibitors?

A
  • amiloride

- triamterene

24
Q

Locations of adrenoreceptors

A
  • a1: vascular smooth muscle
  • a2: brain
  • B1: heart
  • B2: vascular smooth muscle
25
Explain the mechanism of action of a-adrenoreceptor antagonists
- decreases vasoconstriction - decreases TPR - decreases BP - non-selective a-antagonists cause rapid decrease in BP which can trigger tachycardia and decreased negative feedback of NA release - selective a1 antagonists cause less tachycardia as they do not bind a2 receptors - only used in severe hypertension
26
Explain the mechanism of action of b-adrenoreceptor antagonists
- decrease HR/force of contraction - decreases cardiac output - decreases BO also - inhibits renin release from granular cells - decreases angiotensin II - decreases vasoconstriction - decreases salt retention
27
When are b-adrenoreceptors used?
for antihypertensive patients with additional need for B-blockade such as angina/heart failure
28
What are some additional examples of DHP CCBs?
- clevidipine - nicardipine - nimodipine
29
Describe the effect CCBs have
Cardiac: - decrease contractility - decrease HR - decrease conduction velocity - decrease CO - decrease BP Smooth muscle: - decrease coronary artery constriction - decrease peripheral vessel constriction - decrease TPR - decrease BP
30
What are the advantages of multi-drug treatment?
- reduced mortality/morbidity - each drug class works at different sites, can achieve BP treatment quicker - reduces dose burden of individual drugs minimising side effects
31
What are the disadvantages of multi-drug treatment?
- concordance a problem - forgetting to take drugs - side effects more frequent - drug costs to NHS
32
Describe the stepped process of treatment of hypertension
If under 55 and no afro-carribean descent If type 2 diabetes: - step 1: ACE inhibitor or ARBs - step 2: add CCBs or thiazide diuretic - step 3: ACEi, ARB, CCB and thiazide diuretic - step 4: confirm resistant hypertension. Confirm elevated BP with HBPM/ABPM - add low dose spironolactone if blood K+ level is less than 4.5mmol - or add a-blocker or b-blocker if blood K+ level is more than 4.5mmol If over 55/afro-carribean descent: - same protocol but CCB is first given

MD3001 Cardiology (56 decks)

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