hypertension

all treatments that can be used

ABAA CD VR

ACE inhibitors

ARBs

CCBs

Diuretics

Alpha Blockers

BB

Vasodilators

Renin inhibitors

ace inhibitor examples

ramipril 1.25 - 2.5 mg every day

ace inhibitors general info

- preferred under 55s

- first dose given before bed

when are ace inhibitors also used

diabetes

primary and secondary CVD prevention

HF

ace inhibitors MOA

ACE enzyme has a zinc dependent hydrolase - responsible for converting Ang I to Ang II

inhibit conversion of ang I to ang II

inhibit bradykinin metabolism

ace inhibitors side effects

first dose hypotension

dry cough

hyperkalaemia

renal impairment

Why do ACE inhibitors cause cough?

ACE increases bradykinins causing lung irritation

ace inhibitors contraindications

bilateral kidney stenosis

history of oedema associated with ACE inhibitors

pregnancy

hereditary or recurrent angioedema

diabetes or eGFR < 60 on aliskiren

breast feeding women

ARBS examples

Losartan

Valsartan

ARBs general info

preferred in over 55s and black population

not superior to ace inhibitors

arbs moa

block action of angiotensin II after it's formed, blocks receptors

arbs side effects

same as ACE

dry cough - minimal

arbs contraindications

Same as ACE Inhibitors:

-Pregnancy

-Angioedema

-Acute Renal insufficiency

-Hyperkalemia

-Bilateral renal artery stenosis

-Severe stenosis of abdominal aorta

CCBs examples

diltiazem

amlodipine

nicardipine

nifedipine

verapamil

ccbs general info

preferred in over 55s and black population

when are ccbs used

angina

not in acute cardiac conditions

2 types of CCBs

1. Dihydropyridines

2. Non-dihydropyridines / Phenylalkylamines

Examples of dihydropyridines

Nifedipine

Amlodipine

dihydropyridines moa

target L-type calcium channels on smooth muscle of blood vessels - causing dilation - decreasing peripheral resistance

dihydropyridines side effects

flushing/headaches

peripheral oedema

Non-dihydropyridines examples

Diltiazem

Verapamil

when are non-dihydropyridines used?

angina and arrhythmia

alternative to BB post-cardiac event

not used in HF

what is not used in HF

non-dihydropyridines

Non-dihydropyridines moa

target L-type channel blockers in heart

decreasing frequency and force of heartbeat

Non-dihydropyridines side effects

verapamil - constipation, bradycardia, heart block, cardiac failure

diltiazem - any of the above due to mixed vascular and cardiac actions

CCB contraindications

combining CCBs

grapefruit juice - inhibits CYP3A4 enzyme - responsible for metabolism of drug in liver - toxic

diuretics: different types

thiazide

loop

K+ sparing

Thiazide diuretics examples

bendroflumethiazide

chlortalidone

cyclopenthiazide

thiazide diuretics moa

inhibit Na+/Cl- co transporter in DT

inhibiting reabsorption of Na+ (thus water)

preload volume decreases, reducing BP

acts as a vasodilator

duration of thiazides

long

thiazide side effects

hypokalaemia

metabolic alkalosis

thirst

headache/dizziness

impotence (reversible)