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Pharmacology and Therapeutics > Treating Hypertension > Flashcards

Treating Hypertension Flashcards

1
Q

What are the common therapeutic drug classes used to treat hypertension.

A 
Diuretics
Calcium channel blockers
ACE inhibitors
Angiotensin II receptor blocker
Beta blockers
Direct renin inhibitors
α Adrenergic receptor antagonists
Centrally acting agents
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2
Q

What diuretics are commonly used to treat hypertension?

A
  • Furosemide
  • Bendroflumethiazide
  • Indapamide
  • Amiloride
  • Spironolactone
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3
Q

How do diuretics work?

A

Act on kidneys to increase excretion of water and Na+

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4
Q

What is the mechanism of how Furosemide works?

A

Act on thick ascending limb of loop of Henle
• Inhibit reabsorption of Na+, K+ and H2O
• Inhibit Na+/K+/2Cl- pump = INCREASED salt, water and potassium loss.

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5
Q

What are common adverse effects of diuretics?

A
  • Urinary frequency
  • Postural hypotension
  • Hypokalaemia
  • Hyponatraemia
  • Hyperuricaemia and Gout (inhibition of urate excretion)
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6
Q

What are potassium sparing diuretics?

A

Spironolactone

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7
Q

How does Spironolactone work?

A
  • Aldosterone receptor antagonist
  • Used in combination ‘weak when used alone’
  • Prevent hypokalaemia when used with other diuretics.
  • Control Na+ and K+ exchange in the distal tubule.
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8
Q

What are the three classes of calcium channel blockers?

A
  • Phenylalkylamines (verapamil)
  • Dihydropyridines (amlodipine, nifedipine)
  • Benzothiazepines (diltiazem)
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9
Q

How do calcium channel blockers generally work?

A
  • Block cellular movement of Calcium through L-type Ca2+ channels.
  • All bind α1 subunit of the L-type calcium channel but at distinct sites
  • Mainly affect heart and vascular smooth muscle.
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10
Q

What effect do calcium channel blockers have on peripheral vessels?

A

• Vasodilator effect on peripheral vessels reduces AFTERLOAD.

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11
Q

What are other clinical uses of calcium channel blockers such as diltiazem?

A

Angina: dilate coronary vessels – diltiazem

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12
Q

What are other clinical uses of calcium channel blockers such as verapamil?

A

Antidysrhythmic: impaired AV conduction and reduced contractility. Reduce heart rate and force of contraction.

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13
Q

What are the adverse effects of calcium channel blockers?

A
  • Headache
  • Flushing
  • Ankle swelling
  • Dizziness
  • Hypotension
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14
Q

What are the main ACE inhibitors used?

A

Ramipril
lisinopril
Perindopril

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15
Q

Through what mechanism do ACE inhibitors work?

A

• Inhibits ACE → Reduced synthesis of angiotensin II which leads to:

  • Vasodilation (Angiotensin2 is a vasoconstrictor)
  • ↓ Aldosterone - ↓ Na and H2O retention
  • Accumulation of bradykinin (a vasodilator)
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16
Q

What Angiotensin II receptor blockers are used clinically?

A

Candesartan
Losartan
Valsartan

17
Q

How do Angiotensin II receptor blockers work?

A
  • Angiotensin II receptor antagonists

* Blocks vasoconstrictor effects thus has a anti-hypertensive effect.

18
Q

ACe inhibitors prevent conversion of what?

A

Angiotensin I into Angiotensin II by inhibiting ACE.

19
Q

What are the adverse effects of ACE inhibitors?

A
  • Postural hypotension / dizziness
  • Dry cough
  • Angioedema
  • NEPHROTOXIC and ⬆K+
  • Teratogenic
20
Q

Teratogenic

A

Teratogenic drugs: A teratogen is an agent that can disturb the development of the embryo or fetus. Teratogens halt the pregnancy or produce a congenital malformation

21
Q

What beta blockers are used clinically?

A

Atenolol
Bisoprolol
Note: Not first line.

22
Q

Through what mechanism do beta blockers work to treat hypertension?

A
  • Both β1 selective
  • Reduces heart rate and force of contraction, thus decreased workload.
  • Reduces renal production of renin
  • Reduces sympathetic activity
23
Q

What are the adverse efects of beta blockers?

A
  • Lethargy
  • Bradycardia
  • Hypotension
  • Cold peripheries
  • Bronchospasm in asthma
  • Impotence
24
Q

What direct renin inhibitor is used clinically?

A

Aliskirenin

25
Q

Through what mechanism does aliskrenin work?

A
  • Binds to the S3bp binding site of renin, essential for its activity.
  • Prevents the conversion of angiotensinogen to angiotensin I.
26
Q

What are the adverse effects of direct renin inhibitors?

A
  • Hypotension
  • GI symptoms – diarrhoea (common)
  • Angioedema
  • NEPHROTOXIC and ⬆K+
27
Q

What α Adrenergic receptor antagonists are used clinically?

A

Doxazosin used in hypertension

Alpha 1 receptor blocker

28
Q

Through what mechanism do α Adrenergic receptor antagonists work?

A
  • Inhibits the binding of norepinephrine to α1 receptors on vascular smooth muscle cells.
  • Vasodilation.
  • Decreases peripheral vascular resistance – antihypertensive effects.
29
Q

What centrally acting agents are used clinically to treat hypertension?

A

Methyldopa

30
Q

How does methyldopa work?

A
  • Acts centrally on alpha 2 adrenoceptors.
  • Reduces sympathetic nerve flow from medulla in brainstem.
  • Vasodilation.
  • Reduction in peripheral vascular resistance and fall in blood pressure.
31
Q

How is a hypertensive emergency treated?

A

Hypertensive Crisis Treatment:
• Aim at a <25 % BP reduction during the first 1-4 hours, and proceed cautiously thereafter.
• Target 100mmHg diastolic BP over 24hrs.
• Preferred first line i.v. agent- sodium nitroprusside or labetolol.
• If MI treat with nitroglycerine.

32
Q

What is the first line treatment for hypertension in patients under 55yrs old?

A

ACE inhibitors.

33
Q

What is the first line treatment for hypertension in patients over 55yrs old or any BLACK patients?

A

Calcium channel blockers or thiazide type diuretic.

34
Q

In pregnancy what treatment for hypertension is contraindicated?

A

ACE inhibitors.

35
Q

What medication should be used to treat hypertensive pregnant women?

A
  • Methyldopa
  • Labetolol
  • Nifedipine
36
Q

What lifestyle changes should be made to manage hypertension?

A
  • Patient education
  • Low salt intake <6g/day
  • BMI 20-25 kg/m2
  • Reduce alcohol intake
  • Reduce excessive consumption of coffee >5cups/day.
  • Stop smoking
  • Aerobic physical exercise >30min/day
  • Reduce saturated fat diet
  • Consume at least five portions/day fresh fruit and vegetable (DASH Trial).
37
Q

What are the key lifestyle risk factors of hypertension?

A

Excess weight/salt/alcohol, smoking, physical inactivity.

38
Q

Hypertension increases the risk of a number of conditions including:

A
  • Heart failure.
  • Coronary artery disease.
  • Stroke.
  • Chronic kidney disease.
  • Peripheral arterial disease.
  • Vascular dementia.
  • Hypertensive retinopathy

Pharmacology and Therapeutics (7 decks)

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