Prescribing Antihypertensives Flashcards
What class of drug is ramipril?
ACE inhibitor
What class of drug is amlodipine?
Calcium channel blocker
What class of drug is indapamide?
Thiazide-like diuretic
What class of drug is losartan?
ARB
What 3 factors about the patient is important to consider when prescribing antihypertensives?
1) What is the patient’s age?
2) What is the patient’s ethnicity?
3) Does the patient have type 2 diabetes?
Why may an ACEi not be tolerated?
Due to cough
If an ACEi is not tolerated, what should be offered instead?
ARB
Of the 4 main antihypertensive drugs, which 2 CANNOT be used in combination?
ACEi + ARB
In patients of Black African or African-Caribbean origin, are ARBs or ACEi preferred?
ARBs
If a patient has oedema, which class of antihypertensives is NOT tolerated?
Calcium channel blockers
If a patient has heart failure, which class of antihypertensives is NOT tolerated?
Calcium channel blockers
Does the treatment for isolated systolic hypertension (>160 mmHg) differ from the treatment for patients with both raised systolic and diastolic blood pressure?
No, treatment is the same
If a CCB is not tolerated, what should be offered instead?
Thiazide-like diuretic
A white patient aged 50 presents to the clinic with hypertension. They are not on any antihypertensives and do not have a history of type 2 diabetes.
What is the first line antihypertensive?
ACEi
A white patient aged 60 presents to the clinic with hypertension. They are not on any antihypertensives and do not have a history of type 2 diabetes.
What is the first line antihypertensive?
Calcium channel blocker
Patients of any age and any origin presenting with hypertension with type 2 diabetes are prescribed which 1st line antihypertensive?
ACEi (or ARB - consider if Black African/African-Caribbean or cough)
Black African/African-Caribbean patients of any age are prescribed which 1ary antihypertensive if they do not have type 2 diabetes?
Calcium channel blocker
Antihypertensives prescribing chart:
Describe the step-wise approach to prescribing antihypertensives in patients aged <55 y/o and not of Black African
- ACEi (or ARB)
- ACEi + CCB or thiazide-like diuretic
- ACEi + CCB + thiazide-like diuretic
Describe the step-wise approach to prescribing antihypertensives in all patients with type 2 diabetes (all ages and origins)
- ACEi (or ARB)
- ACEi + CCB or thiazide-like diuretic
- ACEi + CCB + thiazide-like diuretic
Describe the step-wise approach to prescribing antihypertensives in all patients of Black African or African-Caribbean origin without type 2 diabetes
- Calcium channel blocker (e.g. amlodipine)
- Calcium channel blocker + ACEi (or ARB) or thiazide-like diuretic (e.g. indapamide) → N.B. ARBs are preferred in patients from Black African or African-Caribbean descent
- Calcium channel blocker + ACEi (or ARB) and thiazide-like diuretic
Describe the step-wise approach to prescribing antihypertensives in patients aged 55 years or older (without type 2 diabetes)
- Calcium channel blocker (e.g. amlodipine)
- Calcium channel blocker + ACEi (or ARB) or thiazide-like diuretic (e.g. indapamide)
- N.B. ARBs are preferred in patients from Black African or African-Caribbean descent
- Calcium channel blocker + ACEi (or ARB) and thiazide-like diuretic
What is resistant hypertension?
Patients whose blood pressure is not adequately controlled after a combination of 3 antihypertensives.
In resistant hypertension, what does management then depend on?
Serum potassium
In resistant hypertension, if a patient has a serum potassium or 4.5 mmol/l or less, what drug is offered?
Low dose spironolactone
In resistant hypertension, if a patient has a serum potassium of more than 4.5 mmol/l, what drug is offered?
Alpha blocker or beta blocker
What class of drug is doxazosin?
Alpha blocker
