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*3. Thorax > Pharmacology: hypertension and antihypertensives (major drugs) > Flashcards

Pharmacology: hypertension and antihypertensives (major drugs) Flashcards

1
Q

What are some risk factors for CVD?

A

Sex (male)
Age (older)
Smoking
Diabetes
Cholesterol
Systolic BP

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2
Q

Define normotensive and hypertensive in terms of systolic/diastolic BP

A

Normotensive: 90-140/60-90
Hypertensive: >140/>90

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3
Q

Hypertension may be primary (essential) or secondary. What does this mean?

A

Primary (essential): we don’t know the cause
Secondary: occurs secondarily to a disease (known cause)

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4
Q

Can hypertension be either symptomatic or asymptomatic?
Hypertension is a risk factor for _______ ___________ and _________.

A

Yes
Heart disease and stroke

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5
Q

5 non pharmacological means for managing hypertension?

A

Increase exercise
Decrease weight
Improve diet
Cease smoking
Limit alcohol intake

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6
Q

What are the 4 main types of antihypertensives?

A

ACE inhibitors
Angiotensin receptor blockers
Calcium channel blockers
Diuretics

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7
Q

ACE INHIBITORS
Mechanism of action?

A

Angiotensin converting enzyme (ACE) usually converts angiotensin I to angiotensin II; and bradykinin to junk products.
Angiotensin II usually leads to vasoconstriction and salt retention.

ACE inhibitors block the above processes –> inhibiting vasoconstriction and salt retention –> lowers BP, reduces hypertension.

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8
Q

ACE INHIBITORS
Indications (other than hypertension)

A

Heart failure, renoprotection in diabetes

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9
Q

ACE INHIBITORS
ADRs: cardiovascular

A

Hypotension
Oedema
Hyperkalemia (esp with preexisting renal impairment)
Compensatory tachycardia, palpitations, anginal pain
Headache

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10
Q

ACE INHIBITORS
ADRs: renal

A

Impairment
Bradykinin isn’t broken down as much –> dry cough

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11
Q

ACE INHIBITORS
ADRs: GI

A

Nausea
Vomiting
Abdominal pain
Taste disturbances

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12
Q

ACE INHIBITORS
ADRs: what are the elderly predisposed to? How to manage?

A

First dose hypotension (BP drops significantly on first dose, before returning) and hyperkalemia –> it’s important to start LOW doses at a SLOW pace in the elderly

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13
Q

ACE INHIBITORS
What two cases should ACE inhibitors be avoided in?

A

Bilateral artery stenosis (increased risk of renal failure)
Pregnancy (can harm developing fetus’ kidneys)

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14
Q

ACE INHIBITORS
Suffix?
Example?
What drug ends in this suffix but is NOT an ACE inhibitor?

A

-pril
Perindopril
Verapamil - a calcium channel blocker

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15
Q

ANGIOTENSIN RECEPTOR BLOCKERS
- MOA?
- Are its indications/contraindications/ADRs basically the same as ACE inhibitors? What is the one difference?
- Suffix and example?

A

Yes, however doesn’t affect bradykinin breakdown - less cough.
-sartan, eg. irbesartan

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16
Q

CALCIUM CHANNEL BLOCKERS
MOA:
- What channels do they block?
- What are their two classifications (location)?

A

L type (voltage gated) calcium channels
Central and peripheral

17
Q

CALCIUM CHANNEL BLOCKERS
Peripheral: MOA?

A

Blocks these calcium channels.
Reduces calcium entry into vascular arteriolar SMCs
Causes arteriolar vasodilation –> relieves hypertension

18
Q

CALCIUM CHANNEL BLOCKERS:
Peripheral: ADRs

A

GENERAL TO CENTRAL AND PERIPHERAL
Hypotension
Dizziness/syncope
Headache
Nausea
Diarrhoea

SPECIFIC TO PERIPHERAL
Oedema
Facial/neck flushing

19
Q

CALCIUM CHANNEL BLOCKERS
Peripheral: examples

A

Dihydropyridines eg. amlodipine

20
Q

CALCIUM CHANNEL BLOCKERS
Central: MOA?

A

Block L type (voltage gated) calcium channels in the heart. Reduces conduction, HR, and contractility

21
Q

CALCIUM CHANNEL BLOCKERS
Central: contraindications?

A

Heart failure - further depresses heart function
Beta blockers - additive effect

22
Q

CALCIUM CHANNEL BLOCKERS
Central: ADRs?

A

GENERAL TO CENTRAL AND PERIPHERAL
Hypotension
Dizziness/syncope
Headache
Nausea
Diarrhoea

SPECIFIC TO CENTRAL
Reduced myocardial workload
Bradycardia
Dysrhythmias

23
Q

CALCIUM CHANNEL BLOCKERS
Central: examples?

A

Verapamil, diltiazem

24
Q

CALCIUM CHANNEL BLOCKERS
Indications, in addition to hypertension?

A

Angina and tachydysrhythmias (especially central calcium channel blockers)

25
Q

DIURETICS
MOA?

A

Increase sodium and water excretion from the kidney –> treat hypertension
Vasodilators at small doses

26
Q

DIURETICS
ADRs: metabolic?

A

Electrolyte imbalances - hyponatremia, hypomagnesemia, hypokalemia, hypercalcemia, hyperuricemia
Hypercholesterolaemia
Glucose intolerance
Itchy skin (pruritis)

27
Q

DIURETICS
ADRs: CVS + renal?

A

Dehyrdation
Hypotension, dizziness
Increased urinary frequency

28
Q

DIURETICS
ADRs: other?

A

Erectile dysfunction
Loss of appetite

29
Q

DIURETICS
Suffix?
Examples?

A

-ide
Eg. hydrochlorothiazide, indapamide

30
Q

Drug escalation protocol?

31
Q

Can drug resistant hypertension exist?
What % of patients does it occur in?

*3. Thorax (33 decks)

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