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Chapter 2 - Cardiovascular system > 4. Blood pressure conditions > Flashcards

4. Blood pressure conditions Flashcards

1
Q

What is a healthy blood pressure

A

120/80

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2
Q

Stage 1 hypertension

A

Stage 1 hypertension: Blood pressure greater than 140/90.
Offer anti-hypertensive if they are
* 80years+ AND have bP of 150/90
* Have organ damage: left ventricular hypertrophy, CKD, retinopathy
* CVD
* if CVD risk is ≥ 10%
* Diabetes mellitus
* Kidney disease

ABPM: 135/85

Do not reduce blood pressure too quickly as this can reduce blood flow to vital organs: heart and brain

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3
Q

Stage 2 hypertension

A

Stage 2: 160/100

ABPM: 150/95

Treat all patients

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4
Q

Stage 3 hypertension

A

SEVERE:

≥ 180 (Systolic)
≥ 110 (Diastolic)

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5
Q

NICE guidlines hypertension

A

ARBs are preferred over ACEinhibitors in black people

ACE/ARBs are preferred in diabetes due to their renal protective properties

If blood pressure remains uncontrolled in stage 1 hypertension, try to increase the dose before adding another drug .

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6
Q

Hypertension in pregnancy

A

Target: <135/85

1st line: Labetalol (beta-blocker)

However can cause liver toxicity, STOP if jaundice occurs

ALternatively: Nifedipine MR
ALternative to this: methyldopa (stop 2 days after birth)

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7
Q

Blood pressure targets

A
  • Under 80 years old: <140/90
  • Over 80: <150/90 (more relaxed target to reduce likelihood of hyPOtension)
  • Kidney disease: <140/90

If ACR > 70 then <130/80

  • Type 1 diabetes: <140/90
    If ACR >70 then <130/80
    If over 80 then <150/90

ACR - urine albumin to creatnine ratio AKA microalbumin

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8
Q

ACE inhibitor and ARB mechanism of action

A

Angiotensin II stimulates the release of aldosterone, increasing plasma volume and also constricts blood vessels. ARBS directly block this effect

ACE inhibitors inhibit conversion of angiotensin I to angiotensin II.

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9
Q

ACE inhibitors and ARB’s

A

Usually taken once daily except captopril which is taken BD

ACE inhibitors
* Captopril
* Enalapril
* Lisinopril
* Perindopril (30-60min before food)
* Ramipril

ARB’s
* Candesartan
* Losartan
* Valsartan

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10
Q

ACE inhibitors/ARBS uses

A

For heart attack
For CVD prevention
For diabetic nephropathy (due to renal protective properties)
For CKD

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11
Q

ACE inhibitor/ARB’s side effect

A
  • Dry cough (due to build up of bradykinin in lungs) - ARBS can be given instead
  • HypERkalaemia (risk is higher in renal impairement and diabetes)
  • First-dose hypotension
    Can cause dizziness, fainting, especially in the elderly.
    Patients must take their first dose at bedtime
  • Nephrotoxic
    Can cause acute kidney injury in short term, characterised by a low GFR.
    Renal function must be monitored
    They are renal protective in the long term
  • Kidney sick day rules:
    ACEi/ARBs must temporarily be stopped during fever, diarrhoea, vomiting as there is a higher risk of AKI = increased risk of dehydration = therefore increased risk of AKI.
    rule also applies to NSAIDS and diuretics
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12
Q

ACEinhibitors/ARB’s caution

A

ACEi/ARBs can worsen renal vascular disease, where renal arteries are narrowed, as GFR is reduced.

ACEi/ARBs should also be used in caution in atherosclerosis as this can also narrow renal arteries = low GFR

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13
Q

ACEinhibitors/ARBs side effect

summed up

A

CAPTOPRIL

C - cough dry
A -angioedema (common in afro-carribean origin)
P - postural hypotension, hypotension
T - taste disturbance
O - oral ulcers
P - potassium high (hyperkalaemia)
R - renal impairment
I - indigestion
L - Low BP

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14
Q

ACE inhibitors/ARBs and pregnancy

A

Teratogenic

Can cause birth defects
Can affect baby’s renal function

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15
Q

ACE inhibitors/ARBs interactions

A
  • Interacts with drugs which are also hypotensive, which further increases hypotension
  • Alpha-blockers, beta blockers, calcium-channel blockers (anti-hypertensive), levodopa, dopamine-receptor antagonist, MAO-B inhibitor, antipsychotic, nitrate, Phosphodiesterase type 5 inhibitor e.g sildenafil, SGLT2 inhibitor canaglifozin, TCA antidepressant
  • Interacts with diuretics, they can cause a rapid fall in BP in volume depleted patients.
  • Intreracts with drugs that also cause hyperkalaemia
    Aldosterone antagonist: spiranolactone, alikskiren, ciclosporin, tacrolimus, heparin, potassium-sparing diuretic, potassium supplements, trimethoprim
  • Interacts with NSAIDs, as there is an increased risk of AKI
    NSAIDs may lower GFR as they cause vasoconstriction of afferent arteriole
  • Interacts with drugs that also affect the renal system as there is an increased risk of renal impairement, hyPERkalaemia and hypotension
    ACE inhibitors, ARB’s aliskiren
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16
Q

Calcium channel blockers mechanism of action

A

CCB’s interfere with the calcium influx into vascular smooth muscle and the heart

Lowers blood pressure by acting on blood vessels, causing reduced heart rate, blood pressure and force of contraction

17
Q

Types of calcium channel blockers

A

Dihydropyridines
Mainly act on blood vessels (coronary arteries and systemic circulation)
so can treat hypertension and angina

  • amlodipine OD
  • felodipine OF
  • Nifedipine (maintain same brand for MR)

Rate-limiting
Mainly depress the heart by reducing the heart rate and force of contraction, reduce cardiac output
* Diltiazem (same brand for MR, when dose is >60mg)
* Verapamil (arrhythmias)

18
Q

Calcium channel blockers uses

A

Angina, Arrhythmias, Hypertension (1st line)

Not used in heart failure as CCB reduce cardiac output and there is alre

19
Q

Calcium channel blockers side effects

A
  • Ankle swelling, flushing, headache (associated with vasodilation)
  • Tachycardia and palpitations (reflux response, as body increases blood pressure to compensate)
  • Angioedema, gingival hyperplasia
  • Constipation (with verapamil)
20
Q

Calcium channel blockers side effect
*summary

A

D - dizziness
E - erectile dysfunction
A - ankle swelling, angioemdema
T - tachycardia, palpitations
H - headache
F - flushing
O - oedema
G - gingival hyerplasia

21
Q

Calcium channel blockers interactions

A

CCB’s are metabolised by cytochrome P450 enzymes

  • Interacts with drugs which are enzyme inhibitors = higher levels of CCB in body
    Clarithromycin, Erythromycin, Azole antigungals: fluconazole
  • Interacts with drugs which are enzyme inducers = lower levels of CCB in body
    Carbamazepine, Pheenytoin, Rifampicin, St John’s Wort
  • Interacts with drugs which are also hypotensive, which further increases hypotension
  • ACE inhibitors, ARB’s, beta blockers (anti-hypertensive), levodopa, dopamine-receptor antagonist, MAO-B inhibitor, antipsychotic, nitrate, Phosphodiesterase type 5 inhibitor e.g sildenafil, SGLT2 inhibitor canaglifozin, TCA antidepressant
  • Interacts with drugs which also cause bradycardia (verapamil and diltiazem cause bradycardia as a side effect)
    Amiodarone, beta-blockers (cardiodepression), digoxin (toxicity)

Verapamil AND beta-blockers = SEVERE hypotension and bradycardIa AND heart failure in ischaemic heart disease e.g angina

22
Q

Beta blockers mechanism of action

A

Blocks adrenoreceptors in peripheral vessels and heart. This results is lower blood pressure, heart rate and force of contraction.

23
Q

Beta-blockers list

A
  • Atenolol
  • Nebivolol
  • Propanolol (for migraine, anxiety, thyrotoxicosis)
  • Bisoprolol
  • Labetaolol
24
Q

Beta blockers counselling

A

Label: warning. Do not stop taking this medicine unless your doctor tells you to stop.

25
Q

Beta blockers uses

A

1st line in heart failure and angina, also treat arrhythmias, hypertension and for long term management following a heart attack

26
Q

Types of beta -blockers

A

PACO CANS BANMe ABC-N

PACO:
* Pindolol
* Acebutolol
* Celiprolol
* Oxprenolol

CANS
* Celiprolol
* Atenolol
* Nadolol
* Sotalol

BAN Me
* Bisoprolol
* Atenolol
* Nebivolol
* Metoprolol

ABC-N
* Atenolol
* Bisoprolol
* Celiprolol
* Nadolol

27
Q

PACO Beta-blockers

A

PACO - stimulate and block B-adrenoreceptors partial agonists so less likely to cause side effects like bradycardia and cold extremities

P- Pindolol
A - Acebutolol
C - celiprolol
O -oxprenolol

28
Q

CANS beta-blockers

A

CANS
Are water soluble, less likely to cause lipophilic blood brain barrier, therefore less likely to cause sleep disturbances and nightmares as side effects

Are excreted in the kidneys, so dose may need to be reduced in renal impairement

C - celiprolol
A - atenolol
N - nadolol
S - sotalol

29
Q

BANme beta-blockers

A

Are cardioselective and preferably act on the heart. Less likely to act on the bronchi and cause bronchospasms as a side effect

  • B- bisoprolol
  • A - atenolol
  • N - nebivolol
  • Me -metoprolol

Cardioselective beta blockers can be given under supervision in controlled asthma (if no other choice)

Cardioselective beta blockers can be given under supervision in contro

30
Q

ABC-N beta blocker

A

Are long-acting and given once daily (different to other beta-blockers which are typically given twice daily)

A - atenolol
B - bisoprolol
C - celiprolol
N - nadolol

31
Q

Beta-blockers side effects
summed up

A

B - Bradycardia, bronchospasms
A - Atrioventricular block
D - Disturb glucose metabolism
F - Fainting and dizziness
I - Impotence
S - Sleep disturbances
H - Hypotension, Heart Failure, Hands and feet cold

Can also worsen heart failure, as they reduce cardiac output BUT equally they reduce the heart workload = beneficial in heart failure

Also affects glucose metabolism, can cause hypo or hyperglycaemia in patients with or without diabetes

Can mask signs of hypoglycaemia e.g tachycardia but beta blockers lower heart rate, so tachycardia does not occur

32
Q

Beta-blockers interactions

A
  • Interacts with drugs which are also hypotensive, which further increases hypotension
  • ACE inhibitors, ARB’s, beta blockers (anti-hypertensive), calcium-channel blockers, levodopa, dopamine-receptor antagonist, MAO-B inhibitor, antipsychotic, nitrate, Phosphodiesterase type 5 inhibitor e.g sildenafil, SGLT2 inhibitor canaglifozin, TCA antidepressant
  • Interacts with drugs which also cause bradycardia (verapamil and diltiazem cause bradycardia as a side effect)
    Amiodarone, beta-blockers (cardiodepression), digoxin (toxicity)

Verapamil AND beta-blockers = SEVERE hypotension and bradycardIa AND heart failure in ischaemic heart disease e.g angina

33
Q

Shock

A

When the body does not get enough blood flow, causing hypotension. Organs and cells are starved of oxygen = multiple organ failure

34
Q

Treatment for shock

A

Inotrope sympathomimetics:
adrenaline, dopamine

Increases heart’s force of contraction, so more blood is pumped out to the rest of the body and raises blood pressure

Vasoconstrictor sympathomimetics:
ephedrine, noradrenaline, phenylephrine

Constricts blood vessels, increasing blood pressure.
Avoid in cardiogenic shock as blood pressure will already be high, and worsen the problem

35
Q

Causes for shock

A

Sepsis

Major bleeding

Haemorrhage -> hypovolemic

Anaphylaxis

Neurogenic

36
Q

Vasoconstrictor sympathomimetics mechanism of action

A

Acts on alpha-adrenergic receptors on peripheral blood vessels, causing vasoconstriction and increases blood pressure

37
Q

Vasoconstrictor sympathomimetics use

A

Used to raise blood pressure if other methods have failed

38
Q

Vasoconstrictor sympathomimetics side effects

A
  • May cause high blood pressure, which can reduce blood pressure to vital organs e.g kidneys, this leading to organ failure
39
Q

A 38-year old woman with HTN becomes pregnant. She is currently taking Ramipril 2.5mg. She has no other medical conditions. Which of the following is the next appropriate step?
a) Stop ramipril and switch to losartan
b) Stop ramipril and switch to labetalol
c) Continue ramipril at current dose
d) Reduce ramipril to 1.25mg
e) Pregnancy is contra-indicated in patients with HTN

A

b) Stop ramipril and switch to labetalol

ACEi/ARBs are contraindicated in pregnancy

Chapter 2 - Cardiovascular system (10 decks)

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