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CPTP

Offer ANTI-HYPERTENSIVEdrug treatment to people:

who have stage 1 hypertension, are aged under 80 and meet identified criteria

who have stage 2 hypertension at any age

If aged 80 yo, 150/90

decrease in extracellular volume, resulting

in a cardiac o/put and renal blood flow.

Act mainly in the cortical region of the

ascending loop of Henle and the distal

tubule.

uricaemia => GOUTK+, Mg+ (blood), Ca2+

(urine)

Should be monitored when

using with digoxin

HF

Possible: elderly with

isolated systolic HPT

Gout, renal failure

[use loop d.]

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CPTP

Loop

FUROSEMIDE,

Inhibit the co-transport of Na+/K+/2CL- in

the luminal membrane in the ascending

limb on loH. It could cause decreased renal

vascular resistanceand increased renal

blood flow.

Ca2+ content of the urine

Ototoxicity

uricaemia => GOUT

K+, Mg+ (blood), Ca2+

(urine)

Acute P Oedema

K+ sparing

Aldosterone antagonist:

SPIRONOLACTONE

Amiloride

Acts on C tubules to inhibit Na+

reabsorption and K+ excretion.

Gastric upset, peptic

ulcers.

Gynaecomastia,

amenorrhea

HPT (usually in

combination with

thiazide)

Renal dysfunction

bcause increased risk

of hyperkalaemia.

B-BLOCKER

Prototype: Propranolol

Non-selective: Atenolol

Selective: BISOPROLOL

(asthma with HPT)

LEBATOLOL -

PREGNANT

1.

activationof b1 adrenoceptors on

the heart

2. renin=> angiotensin ->

aldosterone -> Na, H2O retention

3.

Na, H2O retention

Hypotension

Bradycardia

Fatigue, Insomnia,

hallucinations

Sexual dysf(x) + libido

Disturb serum lipid

patterns;

HDL, plasmaTGA

Angina, post-MI,

tachycardias

Asthma, COPD, heart

block

ACEi LISINOPRIL

RAMIPRIL

Decrease both preload and after load.

Block the ACE that cleaves angiotensin I

to form potent vasoconstrictor

angiotensin II.

ACEi inhibits breaks down of bradykinin

which also increases the prod. Of NO

and prostacyclin by the BV.

angiotensin II and bradykinin

Dry cough

Altered taste

K+ (potassium level

should be monitored)

Skin rash

Hypotension

Fever

HPT, post MI

LV dysfunction

Diabetic nephropathy

(with ARB, ACEi slows

the progression of

diabetic nephropathy)

CRF, and for pt with

increased risk of CAD

Pregnancy foetal

malformations

Hyperkalaemia

Bilateral renal artery

stenosis

ARB

Losartan Competitive antagonists of the

angiotensin type 1 receptor.

Altered taste

K+ (potassium levelshould be monitored)

Skin rash

Hypotension

Fever

Pts cant tolerate ACEiPregnancy foetal

malformations

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CPTP

CCB

AMLODIPINE

Diltiazem

Verapamil

Block the inward of the ca2+ by binding

to the L-type Ca channels in the heart

and in smooth muscle of the coronary

and peripheral arteriolar vasculature.

This causes the smooth muscles to

relax, dilating mainly arterioles.

Constipation

Fatigue, flushing

Hypotension

Headache, dizziness

Useful for HPT pts with

asthma, DM, angina

and/or peripheral

vascular disease

Little interaction with

other CVS drugs

A-BLOCKER

Doxazosin

Competitive block of alpha1

adrenoceptors. Synthetic steroids

They decrease peripheral vascular

resistance and lower arterial BP by

causing relaxation of both arterial and

venous smooth muscle.

Reflex tachy and first-dose

syncopeProstatism Urinary incontinence

P.VASO

Hydralazine, Minoxidil,

Diazoxide, Fenaldopam

Activation of potassium channels

Increase in K+ conductance-

hyperpolarisation- relaxation of

vascular smooth muscle

Reflex stimulation to heart

May prompt angina

pectoris, MI

CENTRAL

CYMPAT

Methyldopa, Clonidine,

Moxonidine, Rilmendine

Decrease sympathetic outflow from

vasopressor center in brainstem Pregnant pt with HPT

PREGNANT

SAFE UNSAFE

Labetalol - beta blockers

Methyldopa - alpha-adrenergic agonist

Nifedipine - calcium channel blockers

Beta blocker - growth retardation

Thiazides - oligohydramnios

ACE Inhibitors - cleft palate

Alpha blockers - cleft palate

CHD risk reduction

Reduces relative risk (given) x probability of developing CHD (get from the calculator in the net)

Stroke risk reduction

Reduces relative risk (given) X prob got from the calculator ->

Number needed to treat (NNT)

Numbers needed to treat = 100 / Absolute risk reduction

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CPTP

Acute HF First line

Sit patient up, give high flow oxygen, iv access

Diamorphine 2.5-5mgi.v. (in-dwelling i.v. cannula)

Furosemide 40-120mg i.v. (lower dose with diuretic nave patient)

Buccal GTN 5mgif BP >100 systolic

Second line (not better within 2 hrs)

GTN 1-2mg/mini.v. infusion, increasing as tolerated by BP

Dobutamine 2.5-7.5microg/kg/min infusion, higher dose if hypotensive

Nebulised salbutamol 2.5-5mg 4hrly, as tolerated by heart rate

Third line (consider occasionally)

Mechanical ventilation (tired patient, inability to maintain oxygenation)

Intra-aortic balloon pump (generally only if there i s a reversible cause for the heart failure)

Dialysis/CVVH