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BRS Year 2 > Pharmacology of Hypertension > Flashcards

Pharmacology of Hypertension Flashcards

1
Q

what is the MOA for angiotensin converting enzyme inhibitors? (ACEi)
ramipril lisinopril

A

inhibits angiotensin converting enzyme

prevents conversion of angiotensin I to angiotensin II by ACE

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2
Q

what is the drug target for ACEi? (ramipril lisinopril)

A

angiotensin converting enzyme

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3
Q

what are the main side effects for ACE inhibitors? (ramipril. lisinopril)

A 
cough
hypotension
hyperkalaemia
foetal injury
renal failure
urticaria/angioedema
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4
Q

what do most ACE inhibitors (excl lisinopril) require?

A

require hepatic activation as they are pro-drugs

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5
Q

what must be monitored in patients prescribed ACE inhibitors? #(lisinopril ramipril etc)

A

eGFR and serum K+

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6
Q

what is the MOA for calcium channel blockers? (amlodipine)

A

block L type Ca2+ channels (mostly on vascular smooth muscle)
decrease calcium influx
so - downstream inhibition of myosin light chain kinase, prevention of crossbridge formation
therefore vasodilation - reduced peripheral resistance

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7
Q

what is the drug target for calcium channel blockers? (amlodipine)

A

L type calcium channels

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8
Q

what are the main side effects of calcium channel blockers? (amlodipine)

A

ankle oedema
constipation
palpitations
flushing/headaches

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9
Q

give examples of calcium channel blocker drugs

A

amlodipine

felodipine

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10
Q

what is the MOA of thiazide/thiazide like diuretics? (indapamide or bendroflumethiazide)

A

blocks Na+, Cl- co transporter in early distal convoluted tubule
reabsorption of Na+ inhibited
osmolarity of tubular fluid increases, decreased osmotic gradient for water reabsorption in collecting duct

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11
Q

what is the drug target for thiazide like diuretics? (indapamide or bendroflumethiazide)

A

sodium/chloride transporter in early distal convoluted tubule

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12
Q

what are the main side effects of thiazide like diuretics? (indapamide or bendroflumethiazide)

A 
hypokalaemia & hyponatraemia
metabolic alkalosis
hypercalcaemia 
hyperglycaemia
hyperuricaemia
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13
Q

how long does the diuretic effect of thiazide like diuretics last with treatment?

A

1-2 weeks

vasodilating properties continue

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14
Q

give an example of a thiazide like diuretic

A

indapamide

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15
Q

what is the MOA of angiotensin receptor blockers? (ARBs) (losartan)

A

non competitive antagonists at AT1 receptor on kidneys and vasculature

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16
Q

what is the drug target for ARBs? (candesartan, losartan)

A

angiotensin 1 receptor on kidneys and vasculature

17
Q

what are the main side effects of ARBs? (losartan, candesartan)

A

hypotension
hyperkalaemia
foetal injury
renal failure

18
Q

what is more effective - ARBs or ACEi? (ramipril lisinopril VS losartan, candesartan)

A

ACE inhibitors

19
Q

what is stage 1 hypertension?

A

135/85 to 149/94mmHg

20
Q

when is treatment to be started in stage 1 hypertension?

A 
if target organ damage
CVD
renal disease
diabetes
10yr CVD risk >10%
21
Q

what is stage 2 hypertension?

A

150/95mmHg or over

immediate start drug treatment

22
Q

why are ACEi associated with cough?

A

prevents bradykinin breakdown
bradykinin builds up, causes muscle spasms
results in dry cough

23
Q

what is the MOA for ARBs?

A

competitive inhibitor for AT-1 therefore prevents angiotensin II binding

therefore reduce downstream aldosterone synthesis, vasodilate, downregulates sympathetic activity (by reduced effects of angiotensin II)

24
Q

what population should ACEi be avoided in

A

pregnant women

those with renal artery stenosis

25
Q

what population should ARBs be avoided in?

A

pregnant women - risk of foetal injury

26
Q

when to take ambulatory or home blood pressure monitoring

A

if clinic BP reading is over 140/09mmHg

27
Q

first line treatment for hypertension in diabetes

A

ACEi or ARB
(acei better)
then CCB or thiazidelike diuretic if needed

28
Q

first line treatment for 55+ hypertension/ afro carribean

A

calcium channel blocker

then ACEi if required

29
Q

first line treatment for hypertension in under 55s/ non-afro carribean

A

ACEi or ARB

then CCB or thiazidelike diuretic if needed

BRS Year 2 (67 decks)

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