Pharmacology Flashcards
Hypertension should be considered if BP is measured at what value?
140/90mmHg or higher
Which lifestyle modifications should be considered for hypertensive patients?
Weight, smoking, alcohol, exercise, diet
Anti-hypertensive drugs should be given to people
Target organ damage
Established CV disease
Renal disease
Diabetes
What classes of drugs can be used to treat hypertension?
ACE-I (ramipril, perinodipril, enalapril)
Angiotensin receptor blockers (valsartan, candesartan, losartan)
Calcium channel blocker (amlodipine, nifedipine, verapamil, diltiazem)
Beta-adrenoceptor-blockers (bisoprolol, carvedilol, propanolol, metoprolol, atenolol)
Aldosterone antagonist (doxazosin)
Renin inhibitors (aliskiren)
Centrally acting drugs (methyldopa, moxonidine)
Diuretics
How do ACE-I work?
Block production of angiotensin two by inhibiting ACE
What are the main adverse effects of ACE-I?
Reduced angiotensin II - hypotension, acute renal failure, hyperkalaemia
Increased kinin production - cough, rash, anaphylactoid reactions
What are the main adverse effects of angiotensin II receptor blockers?
Symptomatic hypotension Hyperkalaemia Potential for renal dysfunction Rash Angio-oedema Contraindicated in pregnancy - congenital abnormalities in children
What are the 3 types of L-type calcium channel blockers?
Dihydropyridine (nifedipine, amlodipine, felodipine) - peripheral arterial vasodilators
Phenylalkylamines (verapimil) - reduces HR and force of contraction
Benzothiazipines (diltiazem) - intermediate
What are the main adverse effects of calcium channel blockers?
Peripheral vasodilation - flush, headache, oedema, palpitations
Negatively chronotropic effects - bradycardia, atrioventricular block
Inotropic effects - worsening cardiac failure
Verapimil causes constipation
How do calcium channel blockers work?
Smooth muscle contraction > peripheral vessels control peripheral resistance > calcium causes contraction > blocking calcium channels stops constriction
How do beta-adrenoceptor-blockers work?
Block receptor > reduce activation from SNS > force of contraction reduced
Name the beta-1 selective and non-selective drugs
Beta-1 selective - metoprolol, bisoprolol
Non-selective - propranolol, nadolol, carvedilol
What are the main adverse effects of beta-adrenoceptor-blockers?
Fatigue, headache, sleep disturbances/nightmares
Bradycardia, hypotension, cold peripheries, erectile dysfunction
Worsening of - asthma or COPD, PVD (claudication/Raynaud’s), heart failure
Name the 4 classes of diuretics and where they act
Thiazides - distal tubule (bendroflumethiazide)
Loop diuretics - loop of henle (furosemide, blumetanide)
Potassium-sparing diuretics (spironolactone, eplerenone, amiloride)
Aldosterone antagonists
What are the main adverse effects of diuretics?
Hypovolaemia Hypotension Hypokalaemia Hyponatraemia Low serum magnesium/calcium Raised uric acid (gout) Erectile dysfunction Impaired glucose tolerance
What are the four treatment steps for hypertension in
1 - ACE-I or ARB
2 - ACE-I/ARB +CCB
3 - ACE-I/ARB + CCB + thiazide-like diuretic
4 - referral to specialist > spironolactone, high dose thiazide-like diuretic
What is the change in treatment steps for hypertension in >55 or Afro-Caribbean of any age?
Step 1 - CCB instead of ACE-I/ARB
Which therapy for heart failure provide the best benefit?
Vasodilator therapy via neurohumoral blockade (RAAS - SNS)
How do nitrates work?
Arterial and venous dilators; reduction of preload and after load; lower BP
What are the main adverse effects of nitrates?
Headache, GTN syncope causes collapse as BP is lowered too quickly
What treatments are used for chronic stable angina?
Anti-platelet therapy - aspirin of clopidrogrel
Lipid-lowering therapy - statins (simvastatin, atorvastatin, pravastatin)
Short acting nitrate - GTN spray for acute attack
What is the first line of treatment for chronic stable angina?
Beta-blocker of calcium channel blocker
What therapies are used for acute coronary syndromes?
Pain relief - GTN spray or opiates (diamorphine)
Dual anti-platelet therapy - aspirin + ticagrelor or praugrel or clopidogrel
Antithrombin therapy - fondaparinux
Lipid-lowering therapy - statins
Which drugs make up the 4 classes in the Vaughan Williams classification for anti arrhythmic drugs?
1 - sodium channel blockers
2 - beta adrenoceptor antagonists
3 - prolong action potential
4 - calcium channel blockers
