Antihypertensives And Heart Failure Flashcards

1
Q

Give three effects of hyperglycaemia and insulinaemia.

A

Increased ROS
Decreased NO
Endothelial dysfunction

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2
Q

Give four lifestyle changes for pre-hypertension

A
Less sodium 
More exercise
Less caffiene
Less stress
Less smoking
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3
Q

Give four function of ANGII acting at AT1 receptor.

A

Vasoconstriction
ADH release
Aldosterone secretion
Cardiac and vascular cell growth

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4
Q

Give 4 side effects of ACEi.

A

Dry cough
Angioedema
Renal failure
Hyperkalemia

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5
Q

Name two ARBs.

A

Losartan
Candesartan
(Eprosartan)
(Irbesartan)

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6
Q

Why may ARBS be less effective in low renin hypertensives compared to ACEi?

Why are they more effective at inhibiting AngII mediated vasoconstriction?

Give two side effects.

A

They do not potentiate BK therefore you do not get BK induced NO formation leading to vasodilation.

ACEinhibitors still allow some AngII formation via chymase reaction.

Renal failure and hyperkalemia.

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7
Q

Name 2 DHP CCBs.

Name some ADRs.

What is their interaction with simvastatin?

High or low degree of protein binding?

A

Amlodipine
Nicardipine

Flushing 
Peripheral oedema 
Sweating 
Headache
Gingival enlargement 

Increased plasma concentration of simvastatin.

90% protein bound and metabolised by the liver.

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8
Q

Name a PA CCB.

Name 3 ADRs.

A

Verapamil.

Bradycardia
Constipation
Worsen heart failure (negative inotropy)

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9
Q

Name a BTP CCB.

A

Diltiazem

Bradycardia
Worsen heart failure (negative inotropy)

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10
Q

Give two thiazide diuretics.

Side effects?

A

Bendroflumethiazide
Indapamide

Hypokalemia 
Hyperuricaemia 
Increased urea levels
Impaired glucose tolerance
Increased TAGs and cholesterol 
RAAS activation
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11
Q

What should be firstlie in heart failure and diabetics?

A

ACEi

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12
Q

Hypertensive energy?

A

Nitrates (SNP)

Labetalol

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13
Q

Labetalol use?

A

Gestational hypertension

Can not use ACEi or ARBs.

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14
Q

Name an alpha 1 blocker.

A

Doxazosin

Postural hypotension (baroreceptor reflex blunted)
Headache
Fatigue
Oedema with DHP

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15
Q

Name some ADRs of bisoprolol.

Why may you give caution in diabetics?

Why cautious in asthmatics?

Another condition you dont give it in?

A

Bradycardia
Raynauds
Bronchoconstriction.

Mask tachycardia associated with hypoglycaemia.

Bronchoconstriction

2nd/3rd degree heart block

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16
Q

Give two causes of inherited cardiomyopathy.

A

Congenital hypertrophic CM

Arrhythmogenic RV CM

17
Q

Give to initial lifestyle changes for heart failure.

What should you watch out for when giving spironolactone?

A

Decreased fluids
Decreased salt

Refractory hyperaldosteronism

18
Q

Why do you want to give a low initial dose of ACEi or ARB in heart failure patients?

A

Reduce risk of sudden BP fall
Already reduced perfusion to tissues and decreased CO
Especially if taking diuretics.

19
Q

In CHF what should be added in along with ACEi and ARBs.

Why are they used?

A

B blockers

Reduce heart rate and therefore increase filling time - increase EDV= greater output due to starlings law