treating hypertension Flashcards
what would you use to first treat an over 55 or of afro caribbean origin for hypertension
CCB
what would you use to first treat an under 55 patient for hypertension
ACE
what would you do if a patient on ACE develops a cough
take off ACE put on ARBs
if a patient also has angina and hypertension what medication would you put them on?
BB
Examples of rate limiting CCB
verapamil and diltiazem
what’s xanthelasma
the deposit of cholesterol under the skin
what is a sign of hyperlipidaemia
xanthelasma
what medication blocks HCN channels?
ivabradine
what are the two types of ccb
dihydropyridine and non dihydropyridine (non selective )
example of dihydropyridine ccb
amlodipine and nifedipine
example of non dihydropyridine (non selective ) ccb
verapamil and diltiazem
how do calcium channel blockers work?
usually the alpha 1 adrenoceptors stimulate the L-type ca2+ channels in the vascular smooth tissue, increasing Ca2+ influx, causing muscle contraction. CCB block the L-type ca2+ channels, decreasing the influx of calcium , decreasing TPR and MABP. Also causing coronary vasodilation
why one of the calcium channel blockers is best for angina and hypertension and why?
amlodipine because it’s a dyhydropyridine and so unlike the non- dyhidropyridines targets the L-type channels in the vascular smooth muscle instead of both the vascular smooth muscle and the cardiac muscle, meaning there’s less chance of having unwanted effects on cardiac muscle
side effects of CCB
ankle oedema, hypotension, dizziness, flushing
what are the warnings for dihydropyridines and non dihydropyridines?
non dihydropyridines should not be used with beta antagonists whereas dihydropyridines are usually given with beta antagonists
example of an ACE inhibitor
lisinopril
how do ACE inhibitors work?
they block the conversion of angiotensin I to angiotensin II, causing venous dilatation (decreasing preload) and arterial dilatation (decreasing after load and TPR) decreasing arterial blood pressure in cardiac load
side effects of ACE inhibitors
dry cough, hypotension (especially in patients on diuretics) , hyperkalemia and angiodema
when should ACE inhibitors not be used?
during pregnancy or in bilateral renal artery stenosis
example of ARBs
losartan
how to ARBs work
AT1 receptor antagonists - competitively block the action of angiotensin II at the AT1 receptors causing venous dilatation (decreasing preload) and arterial dilatation (decreasing after load and TPR) decreasing MABP
when should ARBs not be used
during pregnancy and bilateral renal artery stenosis
examples of alpha blockers
prazosin and doxazosin
how do alpha blockers work
alpha blockers block vascular adreno1-receptors causing vasodilation , decreasing MABP and TPR
side effects of alpha blockers ?
postural hypotension
examples of casio selective beta blockers
atenolol, bisoprolol
examples of non selective beta blockers
propanolol and carvidilol
how do cardio selective beta blockers work
only block the Beta1 receptors- beta 1 adrenoceptors stimulate Gs to increase conversion of ATP to cAMP, increasing PKa
what are the side effects of beta blockers
tiredness , cold peripheries, can cause heart failure in the long term, bradycardia
when should beta blockers not be used
in asthma as can cause bronchospasms
what are the 2 types of diuretics
thiazide and loop diuretics
examples of thiazide diuretics
bendrofluazide
examples of loop diuretics
furosemide
how do diuretics work?
they promote sodium water excretion from the kidneys by inhibiting réabsorption in the loop of Henle or distal tube
what are thiazide and loop diuretics used for
loop (stronger) - heart failure thiazide (weaker) - hypertension
side effects of diuretics
hypokalaemia, arrhythmias, hyperglycaemia, diabetes, increase uris acid (gout), impotence
what is given to type 2 diabetic?
ACEI (regardless of age)
