Anti-hypertensives
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ACE Inhibitors Indications?
Hypertension Post MI (Clinically stable)
Contra-indications for ACE inhibitors?
ACE + Aliskerin if eGFR<60ml/min/1.73m2 ACE + Aliskerin (Diabetes)
What is aliskerin and why is it contraindicated for use in certain cases with ACE inhibitors?
It is a renin inhibitor
What are the common side effects of ACE?
Alopecia Dry mouth Dyspnoea Sleep Disorder Asthenia Blurred Vision Depression Bronchitis Confusion Ileus impotence Tinnitus Glossitis Chest pain Muscle cramps Stomatitis
Can you abruptly stop ACE inhibitors?
Yes however there are some cases of rebound hypertension
Beta blocker indications?
Hypertension Anxiety
Asthma is contraindicated for BB use however if it is well controlled and a BB is deemed necessary which is the appropriate type to use?
Selective Beta Blocker - with caution!
What conditions contra-indicate use of both selective and non-selective BBs?
Cardiogenic shock Hypotension Marked Bradycardia Metabolic acidosis Phaechromocytoma (apart from specific use with alpha blockers) Prinzmetal's angina 2nd/3rd degree heart block Severe peripheral arterial disease Sick sinus syndrome Uncontrolled heart failure
What type of medication is Propanolol?
Non-selective BB
What are the side effects of Propanolol?
Tiredness Cold extremities Insomnia Slow/irregular heartbeat, Severely restricted blood flow to fingers and toes (Raynaud's syndrome) Nightmares or disturbed sleep, Shortness of breath
Can selective/non-selective beta blockers be stopped abruptly?
Ideally not - definitely not in the case of ischaemic heart disease where sudden cessation can lead to rebound worsening of myocardial ischaemia
What type of medication is atenolol?
Selective BB
What are the common side effects of Atenolol?
Slower pulse Cold hands/feet Diarrhoea Nausea TIred or aching and tired muscles
What are the indications for Thiazide diuretics?
Oedema Hypertension Congestive heart failure
What are the contra-indications for Thiazide diuretics?
Addison's disease Hypercalcaemia Hyponatraemia Refractory Hypokalaemia Symptomatic Hyperuricaemia
What are the side effects of Thiazide Diuretics?
Altered plasma lipid concentrations Gout Hypercalcaemia Hyperglycaemia Hyperuricaemia Hypochoraemic alkalosis Hypokalaemia Hypomagnesaemia Hyponatraemia Metabolic and electrolyte disturbances Mild GI disturbances Postural Hypotension
Can Thiazide diuretics be stopped abruptly?
If stopped abruptly switch to a low sodium diet due to potential risk of rebound salt and water retention in those with a normal sodium level in their system