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bnf 2021 > 2. Hypertension > Flashcards

2. Hypertension Flashcards

1
Q

HYPERTENSION

What is it and what are the symptoms

A

High blood pressure, is when the pressure in your blood vessels is unusually high. It can be serious if not treated

High blood pressure does not usually have any symptoms. The only way to find out if you have it is to get your blood pressure checked

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2
Q

When to take the first ever dose of hypertension

A

At night

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3
Q

Hypertension

Step 1 (age dependent)

A

Pt <55

⭕️ACE

(if cough or Afro pt)
Give:

ARB

If both CI give BB

⭕️If pts >55 or (African)

CCB

If CI or HF

Give TLD

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4
Q

Hypertension

Step 2 (age dependent)

A

Add to step 1

STEP 2
<55

CCB (if CI or HF)
Give TLD

ADD
>55
ACE /ARB

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5
Q

Hypertension

Step 3

Not age or origin dependent

A

ACE/ ARB

+

CCB

+

TLD

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6
Q

Hypertension

Step 4

(Specialist)

A

Resistant hypertension

ADD to step 3

low-dose spironolactone

if blood potassium level is ≤4.5 mmol/l

blood potassium >4.5 mmol/l
Give high dose TLD
If CI
Give

AB or Bb

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7
Q

Spironolactone

Class

Side effect

A

aldosterone receptor antagonist

It causes the kidneys to eliminate unneeded water and sodium from the body into the urine but reduces the loss of potassium from the body.

Hyperkalamia 
Drowsiness
dizziness
lightheadedness
stomach upset
diarrhea
nausea
vomiting
headache
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8
Q

CCB in hypertension

Calcium channel blockers

List (3)

A

Amlodipine
Felodipine
Nifedipine

———

Verapamil
Dilitiazem
(Avoid in HF)

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9
Q

CCB

Side effects

A 
Constipation.
Dizziness.
Fast heartbeat (palpitations)
Fatigue.
Flushing.
Headache.
Nausea.
Rash
Swollen legs
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10
Q

CCB

CI

A

HF, grapefruit juice

Cardiac outflow obstruction; 
significant cardiac valvular obstruction (e.g. aortic stenosis); 
uncontrolled heart failure
unstable angina; 
within 1 month of myocardial infarction
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11
Q

Verapamil
Diltiazem

CI

A

HF
Acute porphyrias;
atrial flutter or fibrillation associated with accessory conducting pathways (e.g. Wolff-Parkinson-White-syndrome);
bradycardia;
cardiogenic shock;
heart failure (with reduced ejection fraction);
history of significantly impaired left ventricular function (even if controlled by therapy);
hypotension;
second- and third-degree AV block;
sick sinus syndrome;
sino-atrial block

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12
Q

Hypertension

If CCB contra indicated
What to give —->

If ACE/ARB contra indicated
Wgat to give?——>

A

TLD

BB

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13
Q

THIAZIDE LIKE DIURETIC

In hypertension

TLD

List

A

Indapramide
Cortalidone
Metolazone

Avoid in afro and diabetes

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14
Q

TLD

SE

A 
Alkalosis hypochloraemic; 
constipation; diarrhoea; 
dizziness; 
dry mouth; 
electrolyte imbalance; 
erectile dysfunction; 
fatigue; headache; 
hyperglycaemia; 
hyperuricaemia; 
nausea; 
postural hypotension; 
skin reactions
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15
Q

TLD

CI

A 
Addison’s disease; 
hypercalcaemia; 
hyponatraemia; 
refractory hypokalaemia; 
symptomatic hyperuricaemia
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16
Q

ARB

Angiotensin II receptor blocker

List

A

Valsartan
Losartan
Candesartan
Irbesartan

(Preferred in Afro pts)

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17
Q

ARB

SE

A

Abdominal pain;
asthenia; abnormal physical weakness or lack of energy.

back pain; 
cough; 
diarrhoea; 
dizziness; 
headache; 
hyperkalaemia; 
hypotension; 
nausea; 
postural hypotension (more common in patients with intravascular volume depletion, e.g. those taking high-dose diuretics); 
renal impairment; 
vertigo; 
vomiting
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18
Q

Postural hypotension

What is it

Common in pts taking TLD

A

Postural hypotension

(also called orthostatic hypotension) is a condition in which a person’s blood pressure drops abnormally when they stand up after sitting or lying down

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19
Q

ACEi

ACE inhibitors

List

A 
Benazepril 
Captopril.
Enalapril 
Fosinopril.
Lisinopril 
Moexipril.
Perindopril.
Quinapril
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20
Q

ACE

when to take

How often?

A

To be taken 30-60mints BEFORE A MEAL

Usually it’s OD
Unless captopril BD

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21
Q

ACEi

SE

A

Dry cough.
Increased potassium levels in the blood (hyperkalemia)
Fatigue.
Dizziness from blood pressure going too low.
Headaches.
Loss of taste.

Avoid in RENAL IMPAIRMENT

22
Q

ACEi

Contra indication

A

idiopathic angioedema
Renal impairment

the combination of an ACE inhibitor with aliskiren is contra-indicated in patients with diabetes mellitus

eGFR less than 60 mL/minute/1.73 m2;

People with diabetes and kidney disease are at increased risk of hyperkalemia so ACE inhibitors must be used with caution in these patients. Symptoms of hyperkalemia include: general weakness, confusion, and muscle cramps. In severe cases, hyperkalemia can lead to dangerous cardiac arrhythmias (an abnormal heartbeat).

23
Q

Hypertension

Stage 1

Always -5 if done at home/ambulatory

A

140/90

  1. Life style advice
  2. If age over 80 + 1 or more of the list: GIVE MEDS

CVD
Diabetes
Renal disease
10 yr CVD risk greater than 20%

24
Q

Hypertension

Stage 2

A

160/100 +

Treat regardless of age

25
Q

Stage 3

Severe hypertension
(Crisis)

Hospital referral!!! Stat

A

180/110 +

Hypertensive emergency:
Risk of acute target organ damage
Give: IV HYDRALAZINE

Hypertensive urgency:
No acute target organ damage: give oral
Anti hypertensive
(Increase slowly over 24-48hrs)

26
Q

Why does hypertensive lowering have to be slow?

A

To Avoid organ damage due to reduced perfusion.

If done fast can cause:

MI
BLINDNESS
RENAL DETERMINATION
CEREBRAL INFRACTION

27
Q

What’s is the normal range for
BP

Where is the systolic number?

A

120/80

Above number is systolic

28
Q

When is an ALPHA-blocker + BETA-blocker given at the same time?

The only indication

A

A pheochromocytoma

is a tumor in the adrenal gland. It causes the gland to make too much of the hormones epinephrine and norepinephrine. This tumor often occurs when you are in your 30s, 40s, or 50s. It happens to both men and women.

29
Q

CCB
Contra indicated which ♥️ conditions
(4)

A

Angina
Arrhythmia
HF
within 1 month of MI

30
Q

What do

Alpha blockers do

A

Reduce BP

And prostate problems

31
Q

Beta blockers

what do they do

A

Reduce HF

Beta blockers, also known as beta-adrenergic blocking agents, are medications that reduce your blood pressure. Beta blockers work by blocking the effects of the hormone epinephrine, also known as adrenaline. Beta blockers cause your heart to beat more slowly and with less force, which lowers blood pressure

32
Q

Verapamil & diltiazem

SE

A

Constipation

+ all other SE of all CCB

33
Q

Clinic BP target

1) Under 80

2) + 
Arthosclerotic CVD
Diabetes
Kidney
Eye
Cerebrovascular disease
A

1) 140/90 or less

2) 130/80 or less

34
Q

Clinic BP target

Over 80

A

150/90 or less

35
Q

Clinic BP target

1) renal disease

2) +
CKD
Diabetes
Proteinuria more than 1g/24hrs

A

1) 140/90 or less

2) 130/90 or less

36
Q

Clinic BP target

1) diabetes

2) +
Eye
Kidney
Cerebrovascular disease

A

1) 140/90 or less

2) 130/80 or less⚠️

37
Q

Clinic BP target

1) Pregnancy chronic hypertension

2) +
or just given birth
Target organ damage

Treat with:

A

1) 150/100 or less
2) 140/90 or less

Labetalol (hepatoxic) 1st choice in ⬆️BP in pregnancy

OR

Methldopa (stop 2 days after birth)

OR

MR nifedipine (= unlicensed)

38
Q 
Which drugs to give In Pregnancy 
For hypertension (3)
A

Labetalol (hepatoxic) 1st choice in ⬆️BP in pregnancy

OR

Methldopa (stop 2 days after birth)

OR

MR nifedipine (= unlicensed)

39
Q

Which drugs to TEMPORARILY stop in renal impairment

DAMN

A

DIURETIC
ACE/ARB
METFORMIN
NSAIDs

40
Q

When to stop ACE in liver problems

A

transaminases X3 normal

Jaundice occurs , oral ulcers, taste disturbance, hypoglycaemia

41
Q

ACE in pregnancy?

A

Avoid! Unless absolutely essential

42
Q

ACE

and hypoglycaemia and hyperkalaemia

A

Hyperkalaemia is linked to hypoglycaemia and vice versa

43
Q

Keep Same brand

A

MR Nitidipine

Diltiazem doses 60mg and over

44
Q

Drugs causing hyperkalaemia

A 
ARB
ACE
Potassium sparing diuretics 
Spironolactone 
Aliskeren
NSAIDs
45
Q

Vasodilators
used in hypertension

SE

A

Hydralazine
SE Fluid-retention

Minoxidil
SE tachycardia, fluid retention, increase cardiac output

46
Q

Alpha-blockers

in hypertension

A

Alfuzosin
Doxazosin
Prazosin
Tamsulosin

Silodosin
Terazosin

47
Q

Alpha-blockers

SE

A

Asthenia; constipation; depression; diarrhoea; dizziness; drowsiness; dry mouth; dyspnoea; headache; nasal congestion; nausea; nervousness; oedema; palpitations; postural hypotension; sexual dysfunction; skin reactions; syncope; urinary disorders; vertigo; vision blurred; vomiting

48
Q

Centrally acting hypersensitives

3

A

Methyldopa- driving caution
Clonidine - flushing
Moxomidine

Not used much due to SE
dry mouth, dizzy, impotence

49
Q

Beta blockers

List

A 
atenolol 
bisoprolol 
carvedilol.
esmolol.
metoprolol 
nebivolol (70+ in hypertension) 
propranolol
50
Q

Increase blood pressure and DIABETES TYPE1

indicates what?

A

Diabetic nephropathy

51
Q

Treating hypertension in diabetes type 2

Prevents what ?

A

Micro albuminuria

Which can progress to diabetic nephropathy

bnf 2021 (20 decks)

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