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(LUSUMA) Clinical Pharmacology & Therapeutics > S4) Hypertension and Heart Failure > Flashcards

S4) Hypertension and Heart Failure Flashcards

1
Q

What is the 1st line pharmacological therapy for treating hypertension in the UK?

A
  • ACE inhibitors / ARBs
  • Calcium channel blockers
  • Diuretics
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2
Q

Which drug would one prescribe for the following patients presenting with hypertension:

  • <55 y/o and not Afro-Caribbean
  • > 55 y/o or any age Afro-Carribean
A
  • < 55 y/o and not Afro-Caribbean – ACE inhibitor
  • > 55 y/o or any age Afro-Carribean – Ca2+ channel blocker
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3
Q

Describe the action of ACE inhibitors

A

Competitive inhibitors of Angiotensin Converting Enzyme:

  • Reduce formation of angiotensin II
  • Arteriole vasodilation
  • Reduce circulating aldosterone
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4
Q

Provide two examples of ACE inhibitors

A
  • Lisinopril
  • Ramipril
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5
Q

Identify some important side effects of ACE inhibitors

A
  • Dry cough (main)
  • Angio-oedema (rare, common in black patients)
  • Renal failure (incl. renal artery stenosis)
  • Hyperkalaemia
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6
Q

Describe the action of ARBs

A

Bind to angiotensin AT1 receptor:

  • Inhibit vasoconstriction
  • Inhibit aldosterone stimulation
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7
Q

Provide two examples of ARBs

A
  • Losartan
  • Candesartan
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8
Q

Identify two important side effects of ARBs

A
  • Renal failure
  • Hyperkalaemia
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9
Q

Describe the action of CCBs

A

Bind to alpha subunit of L-type calcium channel, reducing cellular calcium entry:

- Vasodilates peripheral, coronary and pulmonary arteries

  • No significant effect on veins
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10
Q

Identify the three main groups of CCBs and provide an example for each

A
  • Dihydropyridines e.g. nifedipine, amlodipine
  • Benzothiazepines e.g. diltiazem
  • Phenylalkylamines e.g. verapamil
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11
Q

Describe the properties and adverse effects of Dihydropyridines (calcium channel blockers) e.g. amlodipine

A
  • Properties: good oral absorption, protein bound > 90%, metabolised by the liver
  • Adverse effects: oedema, SNS activation – tachycardia and palpitations, flushing, sweating
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12
Q

Describe the properties and adverse effects of Phenylalkylamines (calcium channel blockers) e.g. verapamil

A
  • Properties: impedes calcium transport across the myocardial and vascular smooth muscle cell membrane, peripheral vasodilation, ↓ myocardial contractility
  • Adverse effects: constipation, bradycardia, can worsen heart failure
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13
Q

Describe the properties and adverse effects of Benzothiazepines (calcium channel blockers) e.g. diltiazem

A
  • Properties: impedes calcium transport across the myocardial and vascular smooth muscle cell membrane, peripheral vasodilation, ↓ myocardial contractility
  • Adverse effects: bradycardia, can worsen heart failure
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14
Q

Describe the action of thiazide diuretics

A

Reduce distal tubular sodium reabsorption:

  • Initial blood volume decrease
  • Later, total peripheral resistance falls
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15
Q

Identify four adverse effects of thiazide diuretics

A
  • Hypokalaemia
  • Increased urea and uric acid levels
  • Impaired glucose tolerance
  • Increased cholesterol and triglyceride levels
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16
Q

Describe the actions of alpha blockers

A

Selective antagonism at post-synaptic α-1 adrenoceptors:

  • Antagonise contractile effects of NA on vascular smooth muscle
  • Reduce peripheral vascular resistance
  • Benign effect on plasma lipids / glucose
17
Q

Provide an example of an alpha blocker

A

Doxazosin

18
Q

Identify 3 adverse effects of alpha blockers

A
  • Postural hypotension
  • Headache and fatigue
  • Oedema
19
Q

Describe the action of beta blockers

A
  • Reduce HR and CO
  • Inhibit renin release
  • Initially TPR increases later falls to normal
20
Q

Provide three examples of beta blockers

A
  • Bisoprolol
  • Atenolol
  • Nebivolol
21
Q

Identify five adverse effects of beta blockers

A
  • Lethargy
  • Reduced exercise tolerance
  • Bradycardia
  • Impaired glucose tolerance
  • Contraindication – asthma
22
Q

Provide three examples of centrally acting agents

A
  • Methydopa
  • Clonidine
  • Moxonidine
23
Q

Describe the action of the following centrally acting agents:

  • Methydopa
  • Clonidine
  • Moxonidine
A
  • Methydopa: converted to α-methyl-noradrenaline – a potent α2 adrenoceptor agonist
  • Clonidine: direct pre-synaptic α2 adrenoceptor agonist
  • Moxonidine: imidazoline I1 receptor agonist and some α2 agonist effect
24
Q

Identify 2 adverse effects of centrally acting agents

A
  • Tiredness/lethargy
  • Depression
25
Q

In four steps, describe the clinical management of heart failure

A

⇒ Correct underlying cause

⇒ Non-pharmacological measures

⇒ Pharmacological therapy – symptomatic improvement, delay progression of HF, reduce mortality

⇒ Treat complications / associated conditions / CV risk factors e.g. arrhythmias

26
Q

What are the five main drugs used in the pharmacological management of heart failure?

A
  • Diuretics
  • ACE inhibitor
  • ARB
  • β-blocker
  • Spironolactone
27
Q

Describe the effects of beta blockers on heart failure

A
  • Reduce HR (cardiac beta receptor + myocardial oxygen demand)
  • Reduce BP (reduced CO + myocardial oxygen demand)
  • Reduce mobilisation of glycogen
  • Negate unwanted effects of catecholamines

(LUSUMA) Clinical Pharmacology & Therapeutics (29 decks)

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