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308: Clinical Pharmacology and Therapeutics > Cardiovascular drugs 2 > Flashcards

Cardiovascular drugs 2 Flashcards

1
Q

Hypertension clinical diagnosis

A

> 140/90

Two consecutive seated measurements, at least 1 minute apart

Blood pressure is recorded twice a day for at least 4 days

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2
Q

Secondary causes

A

Renal disease:

  • renovascular disease
  • renal parenchymal disease

Endocrine disease

  • Conn’s
  • Cushing’s
  • phaeo

Drugs

  • COC pill
  • steroids
  • NSAIDs
  • cocaine

Vascular

Others

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3
Q

Contributory factors for hypertensions

A

Increased BMI

> 14 units alcohol

Salt intake

Lack of exercise

Stress

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4
Q

Hypertension risk factors

A

Male

Age

Family history and ethnicity

Smoker

Cholesterol

Diabetes

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5
Q

Hypertension symptoms

A

Headache

Blurred vision

Dizziness

Shortness of breath

Palpitations

Epitaxis

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6
Q

Hypertension investigations

A

Urinalysis- proteinuria

ECG- LVH, AF

Blood tests- U&E, LFT, lipids, glucose/HbA1C

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7
Q

Non- drug treatment of hypertension

A

Weight reduction

DASH eating plan

Dietary sodium restriction

Physical activity

Alcohol moderation

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8
Q

Stage 1 hypertension

A

CMP >140/90mmHg, ABPM/HBPM >135/85

and

  • target organ damage
  • established CV risk
  • renal disease
  • diabetes
  • 10 year CV risk >20%
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9
Q

Stage 2 hypertension

A

CBP >160/100, ABPM/HBPM >150/95

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10
Q

Severe hypertension

A

CBP >180/110

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11
Q

Step 1 treatment

A

Aged under 55: ACEi or ARB

Aged over 55 or African/ Caribbean: CCB

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12
Q

Step 2 treatment

A

ACEi and CCB

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13
Q

Step 3 treatment

A

ACEi/ARB and CCB and thiazide like diuretic

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14
Q

Step 4 treatment

A

Resistant hypertension

ACEi/ARB and CCB and thiazide like diuretic and further diuretic and alpha/beta blocker

Consider seeking expert advice

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15
Q

ACEi/ARBs

A

Check creatinine and potassium

  • before starting therapy
  • after 1-2 weeks
  • after subsequent dose increases

If creatinine rises >30% or GFR falls ?25% of K >6

  • stop drug
  • repeat tests
  • consider other causes
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16
Q

ACEi/ARBs in pregnancy

A

Contraindicated in pregnancy

Contraindicated in breast feeding

Alternatives- labetalol, methyldopa, nifedipine/ amlodipine

17
Q

Targets for low proteinuria

A

ACR<70 or PCR <100

Target blood pressure <140/90

18
Q

Targets for high proteinuria

A

ACR>70 or PCR>100

Target blood pressure <130/80

19
Q

Causes of treatment failure

A

Psuedo resistant hypertension (non-adherance, white coat effect)

Secondary hypertension

Resistant hypertension

20
Q

Hypertensive emergency

A

Severe hypertension with acute damage to the target organs

BP>180/110

Lower BP in minutes to hours

21
Q

Hypertensive urgency

A

Severe hypertension without acute damage to the target organs

Lower BP in 1-2 days

22
Q

Hypertensive crises- pathophysiology

A

Dysfunction of the renin-angiotensin- aldosterone system

Acute baroreflex failure

Autodysregulation

23
Q

Hypertensive crises- clinical features

A

Asymptomatic

Headache

Epitaxis

Presyncope

Palpitations

Chest pain

Dyspnoea

Neurological deficit

24
Q

Hypertensive crises- acute target organ damage

A

Eyes (papilloedema)

Brain (encephalopathy, stroke)

Heart (pulmonary oedema, MI)

Kidneys (AKI)

Aortic dissection

25
Q

Hypertensive crises- secondary causes

A

Intracranial haemorrhage/ SOL

Phaeochromocytoma

Drugs

Pre-eclampsia/ eclampsia

Renal artery stenosis

Carotid baroreceptor dysfunction

26
Q

Hypertensive emergency treatment

A

IV therapy- labetalol, GTN, sodium nitroprusside, esmolol

Reduce BP/MAP (20-255 in the 1-2 hours)

Target of 160/100 in 6 hours

27
Q

Hypertensive urgency treatment

A

Oral treatment

GP review in 48 hours

28
Q

Statins for primary prevention of CVD

A

40-85 year olds should have CVD risk estimated

Lifestule modification

Offer atorvastatin for a 10% or greater 10 year risk of developing CVD

Offer statins in diabetes, CKD, familial hypercholesterolaemia

For people 85 or older consider atorvastatin

29
Q

Statins for secondary prevention of CVD

A

Start statin treatment in people with CVD

Do not delay statin treatment to manage modifiable risk factors

30
Q

Blood tests before statins

A

Lipid measurement

Liver function tests- 3 x upper limit of normal

Renal function

HbA1C

Thyroid stimulating hormone

Creatine kinase- 5 x upper limit of normal

31
Q

Follow up after statins

A

Lipid measurement (3 months after)- 40% reduction in non-HDL cholesterol

LFT (3 months after)

Creatine kinase- if symptoms

Annual medication review

32
Q

Statins not tolerated?

A

Stop, reduce dose or switch statin

Specialist input

Ezetimibe

Not fibrates

33
Q

Ezetimibe

A

Option for treating primary hypercholesterolaemia in adults in whom initial statin therapy is contraindicated or not tolerated

Co-adminstered with statin might be appropriate

34
Q

Framingham heart study- risk

A

AGE

Gender

LDL cholesterol

HDL cholesterol

BP

Diabetes

Smoking

Obesity

35
Q

CV risk calculators

A

QRISK2- 10 year CV risk

JBS3- lifetime CV risk

QRISK3- 10 year CV risk

308: Clinical Pharmacology and Therapeutics (14 decks)

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