p.10
Renin Inhibitors and Their Contraindications
What does Aliskiren do?
Aliskiren directly inhibits renin, which converts Angiotensinogen to Angiotensin I.
p.5
Side Effects of Antihypertensive Medications
What are the side effects of beta blockers?
Fatigue, coldness of extremities, sleep disturbances, bradycardia, hypotension, hypoglycemia.
p.6
Calcium Channel Blockers: Types and Indications
What are the types of calcium channel blockers?
1. Dihydropyridines (e.g., Amlodipine, Nifedipine), 2. Phenylalkylamines (e.g., Verapamil), 3. Benzothiazepines (e.g., Diltiazem).
p.7
Diuretics: Types and Mechanisms
What is a caution associated with thiazide diuretics?
Thiazide diuretics carry a greater risk of hypokalaemia, especially dangerous in patients with severe cardiovascular disease or those on cardiac glycosides.
p.4
Beta Blockers: Classification and Uses
What is the primary receptor for the heart affected by beta blockers?
The primary receptor for the heart is B1.
p.4
Beta Blockers: Classification and Uses
Name an example of an ISA beta blocker.
Examples include pindolol, acebutolol, celiprolol, and oxprenolol.
p.7
Diuretics: Types and Mechanisms
What is the mechanism of action of thiazide-like diuretics?
They inhibit sodium reabsorption at the start of the distal convoluted tubule.
p.2
Antihypertensive Drug Classes
Who should avoid ACE inhibitors?
Afro-Caribbean individuals, those with severe renal disease, and pregnant women.
p.6
Beta Blockers: Classification and Uses
What is the memory trick for remembering beta blocker cautions?
The memory trick is ABCDE: A for Asthma, B for Block (heart block), C for COPD, D for Diabetes, and E for Electrolytes (hypERkalaemia).
p.4
Beta Blockers: Classification and Uses
What do beta blockers block in the cardiovascular system?
Beta blockers block adrenoreceptors in the heart, bronchi, pancreas, liver, and peripheral vasculature.
p.9
ACE Inhibitors and Angiotensin II Receptor Blockers
How are ACE inhibitors used in heart failure?
ACE inhibitors are used in all grades of heart failure, usually combined with a beta blocker.
p.10
ACE Inhibitors and Angiotensin II Receptor Blockers
What combination increases the risk of renal damage?
The combination of ACE inhibitors and NSAIDs increases the risk of renal damage.
p.10
Hypertension in Pregnancy
What should be avoided during pregnancy regarding antihypertensives?
Both ACE inhibitors and Aliskiren should be avoided during pregnancy.
p.5
Beta Blockers: Classification and Uses
Which beta blockers are used for angina?
Atenolol, Bisoprolol, Metoprolol, Propranolol.
p.7
Diuretics: Types and Mechanisms
What are the indications for thiazide-like diuretics?
Lower doses are indicated for hypertension, while high doses are indicated for edema due to congestive heart failure (CHF).
p.7
Other Anti - Anginal Drugs
What is Nicorandil used for?
Nicorandil is licensed for long-term treatment of angina and has both arterial and venous vasodilatory effects.
p.8
Diuretics: Types and Mechanisms
What are some side effects of Thiazide-like diuretics?
Constipation, electrolyte imbalance, headache, postural hypotension, skin reactions.
p.9
ACE Inhibitors and Angiotensin II Receptor Blockers
What should be discontinued before starting an ACE inhibitor?
Potassium-sparing diuretics and potassium supplements due to the risk of hyperkalaemia.
p.8
Diuretics: Types and Mechanisms
What are contraindications for loop diuretics?
Renal failure, severe hypokalaemia/hyponatraemia, liver cirrhosis.
p.10
ACE Inhibitors and Angiotensin II Receptor Blockers
Why are ARBs less likely to cause a dry cough compared to ACE inhibitors?
ARBs are less likely to cause a dry cough because they do not inhibit the breakdown of bradykinin.
p.4
Beta Blockers: Classification and Uses
Which beta blockers are considered long-acting?
Long-acting beta blockers include bisoprolol, atenolol, and celiprolol.
p.5
Beta Blockers: Classification and Uses
What are the uses of beta blockers in hypertension?
Beta blockers reduce cardiac output.
p.5
Side Effects of Antihypertensive Medications
Why should beta blockers be avoided in asthma patients?
They can precipitate bronchospasm.
p.2
Antihypertensive Drug Classes
What are the side effects of ACE inhibitors?
Angioedema, dry cough, hyperkalaemia.
p.9
ACE Inhibitors and Angiotensin II Receptor Blockers
What cautions should be taken when prescribing ACE inhibitors?
Caution in Afro-Caribbean patients, concomitant diuretics, and risk of first dose hypotension.
p.4
Beta Blockers: Classification and Uses
How do ISA beta blockers affect bradycardia?
ISAs cause less bradycardia and less coldness of extremities.
p.10
ACE Inhibitors and Angiotensin II Receptor Blockers
What should be avoided in patients with renovascular disease?
ACE inhibitors should be avoided in patients with renovascular disease.
p.8
Diuretics: Types and Mechanisms
What are examples of potassium-sparing diuretics?
Amiloride and Triamterene.
p.3
Diuretics: Types and Mechanisms
What is recommended for patients who cannot tolerate CCBs due to edema or heart failure?
Thiazide Diuretic [Indapamide > Bendroflumethiazide] unless stable on Bendroflumethiazide
p.5
Beta Blockers: Classification and Uses
Which beta blockers are preferred for patients with diabetes and asthma?
Cardioselective beta blockers.
p.7
Diuretics: Types and Mechanisms
What should be considered when prescribing thiazide-like diuretics?
They should be taken in the morning to avoid diuresis at night, which can interfere with sleep.
p.8
Hypertension in Pregnancy
What should be avoided during pregnancy when using Thiazide-like diuretics?
Gestational hypertension; they can cause neonatal thrombocytopenia, bone marrow suppression, jaundice, and electrolyte imbalances.
p.9
ACE Inhibitors and Angiotensin II Receptor Blockers
What conditions require initiating an ACE inhibitor under specialist supervision?
Unstable/severe heart failure, high dose loop diuretics, hypovolaemia, hyponatraemia, hypotension, and renovascular disease.
p.10
ACE Inhibitors and Angiotensin II Receptor Blockers
Name some examples of Angiotensin II Receptor Blockers (ARBs).
Examples of ARBs include Candesartan, Eprosartan, Irbesartan, Losartan, and Valsartan.
p.7
Calcium Channel Blockers: Types and Indications
What is the effect of sudden withdrawal of Calcium Channel Blockers (CCBs) on angina?
Sudden withdrawal of CCBs may worsen angina.
p.9
ACE Inhibitors and Angiotensin II Receptor Blockers
What is the mechanism of action of ACE inhibitors?
Inhibit conversion of Angiotensin I to Angiotensin II.
p.6
Antihypertensive Drug Classes
What are the potential interactions of beta blockers with IV Verapamil?
The combination can lead to hypotension and bradycardia.
p.10
ACE Inhibitors and Angiotensin II Receptor Blockers
What should be checked before starting ACE inhibitors?
Renal function and electrolytes should be checked before starting ACE inhibitors to avoid hyperkalaemia.
p.8
Diuretics: Types and Mechanisms
What is a key characteristic of loop diuretics?
They inhibit reabsorption from the ascending loop of Henle and are more powerful than thiazides.
p.2
Antihypertensive Drug Classes
What is a contraindication for Alpha Blockers?
Elderly individuals due to postural hypotension.
p.3
Hypertension in Pregnancy
What is the third-line treatment for hypertension in pregnancy?
Methyldopa [Unlicensed] – Stop 2 days after birth & start normal treatment
p.2
Antihypertensive Drug Classes
Who should avoid ARBs?
Those with severe renal disease and pregnant women.
p.10
ACE Inhibitors and Angiotensin II Receptor Blockers
What is a potential risk of using ACE inhibitors in the elderly?
ACE inhibitors may cause renal impairment in the elderly, requiring specialist supervision.
p.4
Beta Blockers: Classification and Uses
Can cardioselective beta blockers affect airway resistance?
Yes, they are selective but not specific, meaning they can still affect airways.
p.8
Diuretics: Types and Mechanisms
What is Mannitol used for?
As an osmotic diuretic for cerebral oedema and raised intraocular pressure.
p.5
Beta Blockers: Classification and Uses
What is the role of beta blockers in myocardial infarction?
They reduce the recurrence rate.
p.5
Side Effects of Antihypertensive Medications
How do beta blockers affect diabetes management?
They can interfere with carbohydrate metabolism and mask symptoms of hypoglycemia.
p.6
Calcium Channel Blockers: Types and Indications
What are the effects of dihydropyridines?
They relax vascular smooth muscle and primarily have vasodilatory effects without anti-arrhythmic activity.
p.6
Calcium Channel Blockers: Types and Indications
What are the effects of phenylalkylamines like Verapamil?
They are used in hypertension, angina, and arrhythmias, have minimal vasodilatory effects, and can cause constipation and profound cardiac depressant effects.
p.8
Diuretics: Types and Mechanisms
What are examples of loop diuretics?
Furosemide and Bumetanide.
p.2
Diuretics: Types and Mechanisms
Who should avoid Spironolactone?
Individuals with Addison’s disease.
p.2
Beta Blockers: Classification and Uses
Who should avoid Beta Blockers?
Asthmatics and individuals with COPD.
p.10
Renin Inhibitors and Their Contraindications
Can Aliskiren be used alone for hypertension?
Yes, Aliskiren can treat hypertension alone or in combination with other antihypertensives.
p.6
Beta Blockers: Classification and Uses
What are the cautions and contraindications for using beta blockers?
Cautions include asthma, heart block, COPD, diabetes, and electrolyte imbalances like hyperkalemia. Contraindications include unstable heart failure, frequent hypoglycemia, severe hypotension, and bradycardia.
p.9
ACE Inhibitors and Angiotensin II Receptor Blockers
What are the contraindications for ACE inhibitors?
ACE inhibitors combined with Aliskiren in diabetic patients and eGFR < 60ml/min/1.73m³.
p.4
Beta Blockers: Classification and Uses
What does ISA stand for in the context of beta blockers?
ISA stands for Intrinsic Symptomatic Activity, which refers to the ability of beta blockers to stimulate and block adrenergic receptors.
p.2
Diuretics: Types and Mechanisms
What are the contraindications for Thiazide diuretics?
Diabetes, gout, eGFR <30.
p.4
Beta Blockers: Classification and Uses
What are some examples of water soluble beta blockers?
Examples include celiprolol, atenolol, nadolol, and sotalol.
p.3
Hypertension in Pregnancy
What is the second-line treatment for hypertension in pregnancy?
MR Nifedipine [Unlicensed]
p.7
Calcium Channel Blockers: Types and Indications
Which patients should Verapamil and Diltiazem be reserved for?
Verapamil and Diltiazem should be reserved for patients resistant to beta-blocker treatment.
p.9
ACE Inhibitors and Angiotensin II Receptor Blockers
What are the indications for using ACE inhibitors?
Heart failure, hypertension, diabetic neuropathy, prophylaxis of cardiovascular events.
p.4
Beta Blockers: Classification and Uses
What is the effect of beta blockers on heart rate?
They slow the heart and can depress the myocardium.
p.9
Side Effects of Antihypertensive Medications
What are some side effects of ACE inhibitors?
Alopecia, angioedema, angina, dry cough, electrolyte imbalance, skin reactions, constipation, and gastrointestinal issues.
p.7
Side Effects of Antihypertensive Medications
What are the side effects of Calcium Channel Blockers?
Side effects include dizziness, flushing, headaches, postural hypotension, GI disorders, ankle swelling, and skin reactions.
p.2
Antihypertensive Drug Classes
What are the side effects of ARBs?
Angioedema, hyperkalaemia.
p.2
Calcium Channel Blockers: Types and Indications
What are the side effects of Calcium Channel Blockers (CCBs)?
Oedema, heart failure (except Amlodipine).
p.2
Diuretics: Types and Mechanisms
What are the side effects of Thiazide diuretics?
Hypokalaemia, hyperuricaemia, hypercalcaemia.
p.2
Diuretics: Types and Mechanisms
What are the side effects of Spironolactone?
Hyperkalaemia, gynaecomastia.
p.4
Beta Blockers: Classification and Uses
List some examples of cardioselective beta blockers.
Examples include bisoprolol, atenolol, metoprolol, acebutolol, and nebivolol.
p.6
Calcium Channel Blockers: Types and Indications
What are the cautions when using benzothiazepines like Diltiazem?
Caution is advised when used with beta blockers due to the risk of bradycardia.
p.4
Beta Blockers: Classification and Uses
What is the difference between lipid soluble and water soluble beta blockers?
Water soluble beta blockers are less likely to enter the brain, leading to less sleep disturbance and nightmares, and are renally excreted requiring dose reduction in renal impairment.
p.9
ACE Inhibitors and Angiotensin II Receptor Blockers
What is a significant contraindication for ACE inhibitors during pregnancy?
ACE inhibitors should be avoided during pregnancy.
p.10
ACE Inhibitors and Angiotensin II Receptor Blockers
What are the side effects of Angiotensin II Receptor Blockers?
The side effects of ARBs include hypotension, dizziness, and hyperkalaemia.
p.10
Renin Inhibitors and Their Contraindications
What combination should be avoided with Aliskiren?
The combination of ACE inhibitors and Aliskiren should be avoided due to the risk of hyperkalaemia, hypotension, or renal impairment.
