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
How does digoxin work?
Inhibits Na/K pump
What are the main effects on the heart with digoxin?
Bradycardia
Slowing of AV conduction
Increased ectopic activity
Increased force of contraction
When is digoxin used?
In atrial fibrillation to reduce ventricular rate response
In severe heart failure as it is positively inotropic
