Cardio 4

Aliskiren directly inhibits renin, which converts Angiotensinogen to Angiotensin I.

Fatigue, coldness of extremities, sleep disturbances, bradycardia, hypotension, hypoglycemia.

1. Dihydropyridines (e.g., Amlodipine, Nifedipine), 2. Phenylalkylamines (e.g., Verapamil), 3. Benzothiazepines (e.g., Diltiazem).

Thiazide diuretics carry a greater risk of hypokalaemia, especially dangerous in patients with severe cardiovascular disease or those on cardiac glycosides.

The primary receptor for the heart is B1.

Examples include pindolol, acebutolol, celiprolol, and oxprenolol.

They inhibit sodium reabsorption at the start of the distal convoluted tubule.

Afro-Caribbean individuals, those with severe renal disease, and pregnant women.

The memory trick is ABCDE: A for Asthma, B for Block (heart block), C for COPD, D for Diabetes, and E for Electrolytes (hypERkalaemia).

Beta blockers block adrenoreceptors in the heart, bronchi, pancreas, liver, and peripheral vasculature.

ACE inhibitors are used in all grades of heart failure, usually combined with a beta blocker.

The combination of ACE inhibitors and NSAIDs increases the risk of renal damage.

≥ 140/90 mmHg

Both ACE inhibitors and Aliskiren should be avoided during pregnancy.

Atenolol, Bisoprolol, Metoprolol, Propranolol.

Lower doses are indicated for hypertension, while high doses are indicated for edema due to congestive heart failure (CHF).

Nicorandil is licensed for long-term treatment of angina and has both arterial and venous vasodilatory effects.

Constipation, electrolyte imbalance, headache, postural hypotension, skin reactions.

Potassium-sparing diuretics and potassium supplements due to the risk of hyperkalaemia.

Renal failure, severe hypokalaemia/hyponatraemia, liver cirrhosis.

ARBs are less likely to cause a dry cough because they do not inhibit the breakdown of bradykinin.

Long-acting beta blockers include bisoprolol, atenolol, and celiprolol.

Beta blockers reduce cardiac output.

They can precipitate bronchospasm.

Angioedema, dry cough, hyperkalaemia.

Caution in Afro-Caribbean patients, concomitant diuretics, and risk of first dose hypotension.

ISAs cause less bradycardia and less coldness of extremities.

ACE inhibitors should be avoided in patients with renovascular disease.

Amiloride and Triamterene.

Oral Labetalol

Thiazide Diuretic [Indapamide > Bendroflumethiazide] unless stable on Bendroflumethiazide

Cardioselective beta blockers.

They should be taken in the morning to avoid diuresis at night, which can interfere with sleep.

Gestational hypertension; they can cause neonatal thrombocytopenia, bone marrow suppression, jaundice, and electrolyte imbalances.

Unstable/severe heart failure, high dose loop diuretics, hypovolaemia, hyponatraemia, hypotension, and renovascular disease.

Examples of ARBs include Candesartan, Eprosartan, Irbesartan, Losartan, and Valsartan.

Potassium supplements.

Caution or avoid use.

Sudden withdrawal of CCBs may worsen angina.

Inhibit conversion of Angiotensin I to Angiotensin II.

The combination can lead to hypotension and bradycardia.

Renal function and electrolytes should be checked before starting ACE inhibitors to avoid hyperkalaemia.

They inhibit reabsorption from the ascending loop of Henle and are more powerful than thiazides.

Tinnitus and deafness.

Elderly individuals due to postural hypotension.

Methyldopa [Unlicensed] – Stop 2 days after birth & start normal treatment

Those with severe renal disease and pregnant women.

ACE inhibitors may cause renal impairment in the elderly, requiring specialist supervision.

Yes, they are selective but not specific, meaning they can still affect airways.

≥ 130/80 mmHg

As an osmotic diuretic for cerebral oedema and raised intraocular pressure.

They reduce the recurrence rate.

They can interfere with carbohydrate metabolism and mask symptoms of hypoglycemia.

They relax vascular smooth muscle and primarily have vasodilatory effects without anti-arrhythmic activity.

They are used in hypertension, angina, and arrhythmias, have minimal vasodilatory effects, and can cause constipation and profound cardiac depressant effects.

Furosemide and Bumetanide.

Individuals with Addison’s disease.

Asthmatics and individuals with COPD.

Yes, Aliskiren can treat hypertension alone or in combination with other antihypertensives.

Esmolol and Sotalol.

Cautions include asthma, heart block, COPD, diabetes, and electrolyte imbalances like hyperkalemia. Contraindications include unstable heart failure, frequent hypoglycemia, severe hypotension, and bradycardia.

ACE inhibitors combined with Aliskiren in diabetic patients and eGFR < 60ml/min/1.73m³.

ISA stands for Intrinsic Symptomatic Activity, which refers to the ability of beta blockers to stimulate and block adrenergic receptors.

Diabetes, gout, eGFR <30.

135 / 85 mmHg

Examples include celiprolol, atenolol, nadolol, and sotalol.

MR Nifedipine [Unlicensed]

Verapamil and Diltiazem should be reserved for patients resistant to beta-blocker treatment.

Heart failure, hypertension, diabetic neuropathy, prophylaxis of cardiovascular events.

They slow the heart and can depress the myocardium.

Alopecia, angioedema, angina, dry cough, electrolyte imbalance, skin reactions, constipation, and gastrointestinal issues.

≥ 140/90 mmHg

Severe hyperkalaemia.

Use ACE-I/ARB

Side effects include dizziness, flushing, headaches, postural hypotension, GI disorders, ankle swelling, and skin reactions.

Angioedema, hyperkalaemia.

Oedema, heart failure (except Amlodipine).

Hypokalaemia, hyperuricaemia, hypercalcaemia.

Hyperkalaemia, gynaecomastia.

Examples include bisoprolol, atenolol, metoprolol, acebutolol, and nebivolol.

It can cause blue urine.

Caution is advised when used with beta blockers due to the risk of bradycardia.

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.

ACE inhibitors should be avoided during pregnancy.

The side effects of ARBs include hypotension, dizziness, and hyperkalaemia.

The combination of ACE inhibitors and Aliskiren should be avoided due to the risk of hyperkalaemia, hypotension, or renal impairment.

≥ 150/90 mmHg