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103 theme 3 > treatment of cardiovascular disease 2 > Flashcards

treatment of cardiovascular disease 2 Flashcards

1
Q

what are classes of hypertensives

A 
ACE inhibitors and Angiotensin receptor blockers
Calcium channel antagonists 
Diuretics 
Beta blockers
Vasodilators
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2
Q

what are the NICE guidelines for treatments of hypertension

A 
1st line
Under 55 - ACE inhibitor or ARB 
Over 55/Black (African or Caribbean) - CCB
2nd ine A+C
3rd A+C+D (thiazide like diuretics)
4th resistant hypertension
A,C,D + further diuretics/a or B blocker
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3
Q

how do ACE inhibitors work

A

blocks ANG I to ANG II to decrease BP

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4
Q

what are side effects of ACE inhibitors

A

dry cough
1st dose hypotension until body adapts to dose
Hyperkalaemia (can affect heart and NS)
No adverse effects on serum glucose or lipids (front line for diabetes hypertension)

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5
Q

what are the contraindications of ACE inhibitors

A

Renal impairment– impaired kidneys reliant on ANG II (blocked by ACE inhibitors)
Contraindicated in bilateral renal artery stenosis (dilate the arterioles leading to severe impairment)
Monitor regularly and before any dose increase

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6
Q

how are ACE inhibitors named

A

End in PRIL

eg Ramipril

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7
Q

what are angiotensin receptor antagonists (blockers) aka ARBs

A

Block actions of Ang II or AT1-R

side effects minimal

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8
Q

how are ARBs named

A

End in ARTAN

Eg Losartan

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9
Q

what are aldosterone antagonists

A

eg Spironolactone
Can be used as an add on for resistant hypertension but frontline for hypertension in patients with primary aldosteronism

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10
Q

what are Ca2+ channel antagonists

A 
Main class dihydropyridines (amlodipine) - Target L-type Ca2+ channels on smooth muscle of arterioles
Phenylalkylamines (eg verapamil) and benzothiazepines (eg diltiazem) target L-type channels in the heart and decrease frequency and force of contraction, used less regularly to treat hypertension unless caused by tachycardia
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11
Q

how is smooth muscle contraction regulated in arterioles

A

Target L-type Ca2+ channels on smooth muscle of arterioles to stop it entering the cells
relaxes as can’t contract as frequently
less calmodulin to MLCK used to form ATP

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12
Q

what are side effects of Ca2+ blockers

A

Peripheral oedema
Preferential dilation of precapillary arteriole and impairment of the function of the pre-capillary sphincter increases hydrostatic pressure across the capillary and reducing fluid reabsorption
Flushing and headaches

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13
Q

what are contraindications of Ca2+ blockers

A

Combos of Ca2+ channel antagonists not recommended

Grapefruit enhances the action of (CYP3A4)

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14
Q

what are thiazide and thiazide like diuretics

A

block reabsorption of Na and Cl to increase diuresis and natriuresis
Some diuretic action also acts via activation of K+ channel in smooth muscle of blood vessel to dilate arterioles and decrease BP

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15
Q

what is an example of a diuretic that acts on a K+ channel

A

Indapamide hyperpolarises smooth muscle cells causing dilation of arteriole and a dec in total PR
(more negative so less voltage gated ca2+ channels open so harder to depolarise and contract)
less K+ out so less ca2+ in

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16
Q

what are side effects of thiazide and thiazide like diuretics

A 
Hypokalaemia 
Increase in urate
Increase in glucose
Increase in blood lipids 
Eg Bendroflumethiazide (-thiazide)
Newer recommended thiazide like diuretics include indapamide
17
Q

what are contraindications of thiazide and thiazide like diuretics

A

patents with diabetes

Stimulate K channel to inhibit ca2+ channels so less insulin released

18
Q

what are beta blockers

A

block B1 receptors tov decrease frequency and force of contraction of the heart
also dec BP and AL

19
Q

what are side effects of beta blockers

A

fatigue
Beta blockers cause vaso/bronco constriction
Smooth muscle cell in the airways of peripheral arterioles perfusing skeletal muscle
Works mostly on b1 but can also work on b2 (less camp, less stoping MLCK phos myosin)

Hypoglycaemia (enhance this in insulin dependant diabetics)
Low blood glucose activates the release of adrenaline, mobilises glucose release from liver via sympathetic activation
Leads to tremor, palpitations and sweats

20
Q

what are contraindications of Betablockers

A

Combinations of betablockers and thiazides contraindicated in diabetics

21
Q

what are types offbeat blockers

A 
Non selective (B1 and B2)
EG Propranolol (-olol)
Selective B1 antagonist eg bisoprolol
22
Q

what are vasodilators

A

A1 antagonists
NA>a1>IP3>Ca2+>constriction
Used to treat hypertension in patient with benign prostatic hypertrophy (eg Doxazosin -azosin) allows prostate to move away from urethra and causes vasodilation
Other vasodilators such as minoxidil open K+ channels

103 theme 3 (20 decks)

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