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YEAR 2 > Cardiovascular - Hypertension > Flashcards

Cardiovascular - Hypertension Flashcards

1
Q

What is blood pressure?

A

Pressure exerted on the walls of the blood vessels

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2
Q

2 types readings of blood pressure

A
  • Systolic BP is the maximum blood pressure exerted by the blood against the artery walls (corresponds to a contraction of the ventricles i.e. systole)
  • Diastolic BP is the minimum pressure in the main arteries (corresponds to the relaxation of the ventricles i.e. diastole)
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3
Q

Formula for blood pressure

A

BP = Cardiac output x Systemic vascular resistance

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4
Q

What is cardiac output?

A

Amount of blood that is ejected from the left ventricle and is measured in L/min

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5
Q

What is systemic vascular resistance?

A

The resistance blood flow is determined by the diameter of the blood vessels and the vascular musculature.

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6
Q

What factors affects circulating volume?

A
  • Salt

- Aldosterone (hormone)

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7
Q

Factors affecting cardiac

A
  • Heart rate

- Contractibility

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8
Q

What drugs can be used to help with cardiac issues?

A
  1. Beta-blockers
  2. Calcium channel blockers
  3. Centrally acting adrenergic
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9
Q

What drugs can be used to help circulatory issues?

A
  1. ACE inhibitors

2. Diuretics

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10
Q

What drugs can be used for vasodilators and vasoconstrictors?

A
  1. Vasodilators
  2. Prostaglandins
  3. ACE inhibitors
  4. Calcium channel blockers
  5. Angiotensin II blockers
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11
Q

What types of receptors are involved with peripheral sympathetic receptors?

A
  1. Alpha-1 blockers

2. Beta blockers

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12
Q

What is hypertension (HTN)?

A

Condition in which the blood pressure is elevated to a level that is likely to have adverse consequences.

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13
Q

2 categories of hypertension?

A
  1. Primary hypertension

2. Secondary hypertension

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14
Q

What causes primary hypertension?

A

No identifiable cause

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15
Q

What causes secondary hypertension?

A
  • Renal disease
  • Endocrine disease such as: 1. steroid excess: hyperaldosteronism (Conn’s syndrome); hyperglucocorticoidism (Cushing’s syndrome)
    2. Growth hormone excess: acromegaly
    3. Catecholamine excess: pheochromocytoma
    4. Others: pre-eclampsia
  • Vascular causes
  • Renal artery stenosis: fibromuscular
  • Drugs such as
    1. Sympathomimetic amines
    2. Oestrogen (e.g. combined oral contraceptive pills)
    3. Erythropoietin
    4. Ciclospoin
    5. Steroids
    6. Non-steroidal anti-inflammatory drugs
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16
Q

Hypertension is not a disease but a risk factor (TRUE OR FALE)

A

TRUE.

Greater the blood pressure, the more risk people are from complications of hypertension

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17
Q

MODIFIABLE risk factors for hypertension

A
  • Excess dietary salt
  • Poor diet and obesity
  • Excess alcohol consumption
  • Lack of physical activity
  • Deprivation and socio-economic status
  • Mental health and stress-
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18
Q

NON-MODIFIABLE risk factors for hypertension

A
  • Age
  • Ethnicity
  • Genetics
  • Gender
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19
Q

What are the advantages of home BP monitoring?

A
  • Strong association with cardiovascular outcomes

- Detects white coat and masked hypertension

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20
Q

What are the advantages of ambulatory BP monitoring?

A
  • Strong association with cardiovascular outcomes
  • Detects white coat and masked hypertension
  • BP measured at work and at night (i.e., during sleep)
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21
Q

What are the advantages of clinic measurements?

A
  • Associated with cardiovascular outcomes

- Only method that has been used to guide treatment in large outcome trials

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22
Q

What are the disadvantages of home BP monitoring?

A
  • Patients may not correctly measure and report their BP
  • Requires patient training and re-training
  • Many home devices are not validated
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23
Q

What are the disadvantages of clinic measurements?

A
  • Less precise as only 1 or 2 BP measurements are typically obtained
  • Many factors affect the accuracy of readings
  • Requires training and frequent re-training of staff
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24
Q

What are the disadvantages of ambulatory BP monitoring?

A
  • Not tolerated by some patients
  • Equipment is not widely available
  • Requires two clinic visits to set up and return the device
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25
Q

Non-pharmacological advice for hypertension

A
  • Weight loss
  • Diet rich in fruits, vegetables, low-fat dairy products, reduced saturated fats
  • Reduced salt intake
  • Regular aerobic physical activity
  • Moderation of alcohol & caffeine intake
  • Address other CV risk factors e.g. smoking, dyslipidaemia
  • Stress management
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26
Q

Benefits of antihypertensives

A

Up to 5 years longer life expectancy compared individuals with uncontrolled HTN

27
Q

Benefit of antihypertensives

A

Up to 5 years longer life expectancy compared to individuals with uncontrolled HTN

28
Q

4 types of antihypertensive drug classes

A
  1. Angiotensin-converting enzyme (ACE) inhibitors
  2. Diuretics
  3. Angiotensin receptor blockers (ARBs)
  4. Calcium channel blockers (CCBs)
29
Q

Example of ACE inhibitors

A

Ramipril
Enalapril
Lisinopril

(‘pril’)

30
Q

How does ACE inhibitors work?

A

Blocks the conversion of angiotensin I to angiotensin II.

31
Q

What are angiotensin II?

A

Angiotensin II is a potent vasoconstrictor and stimulates aldosterone release -> inhibition inhibits downstream effects of RAAS so lowers BP

32
Q

Cautions & Contraindications of ACE inhibitors

A

Caution: In aortic or mitral stenosis

Contraindication: significant bilateral renal artery stenosis or renal artery stenosis in a single functioning kidney

33
Q

What group of patients may respond less well to ACE inhibitors?

A

Afro-Caribbean patients

34
Q

Adverse drug reactions of ACE inhibitors

A

Risk of hyperkalaemia and hyponatraemia

Dry cough due to accumulation of bradykinin

Angioedema (especially in lack patients)

35
Q

What is hyperkalaemia?

A

Potassium level in your blood that’s higher than normal.

36
Q

What is hyponatraemia?

A

The concentration of sodium in your blood is abnormally low.

37
Q

What is bradykinin?

A

Bradykinin is a peptide that regulates vascular tone, and water and electrolyte balance, and has a role in the control of arterial pressure.

38
Q

What is angiodema?

A

Swelling underneath the skin. It’s usually a reaction to a trigger, such as a medicine or something you’re allergic to.

39
Q

Examples of Drug interactions of ACE inhibitors

A
  • Potassium-sparing diuretics (e.g. spironolactone) - increased risk of hyperkalaemia
  • NSAIDs - increased risk of renal impairment
  • Interaction with OTC meds
40
Q

Examples of ARBs

A
  • Losartan
  • Candesartan

(‘artan’)

41
Q

How does ARBs work?

A

Blocks the action of angiotensin II at the angiotensin II type 2 receptor

42
Q

ARBs drugs are less/more likely to cause dry cough or angioedema.

43
Q

How do CCBs work?

A

Slow calcium channels in the peripheral vessels and/or in the heart.

44
Q

Common side effects of CCBs

A

Constipation
Flushing, headache, ankle swelling, palpitations
Gingival hyperplasia

44
Q

Common side effects of CCBs

A

Constipation
Flushing, headache, ankle swelling, palpitations
Gingival hyperplasia

45
Q

What is Gingival hyperplasia?

A

excessive growth of the gums

46
Q

Examples of CCBs

A

Dihydropyridines:

  • Amlodipine
  • Nifedipine
  • Felodipine
47
Q

What are dihydropyridines?

A

Dihydropyridine calcium channel blockers are drugs used to treat high blood pressure and severe angina (chest pain caused by lack of oxygen to the heart muscle). Dihydropyridines are one of the different types of calcium channel blockers; they predominately act on blood vessels with less effect on the heart.

48
Q

If prescribed diltiazem (Adizem-SR) 120 mg prolonged release capsuples, should a patient take the medicine one or twice daily?

A

TWICE DAILY

49
Q

If prescribed diltiazem (Adizem-XL) 180 mg prolonged release capsuples, should a patient take the medicine one or twice daily?

A

ONCE DAILY

50
Q

If Creatinine clearance is less than 30 mL /min for diuretics is this effective or ineffective?

A

Ineffective

51
Q

Cautions and contraindications of diuretics

A

Caution: diabetics and those with gout - risk of exacerbation

Contraindication: severe liver/renal impairment and refractory hypokalaemia

52
Q

Adverse drug reactions of diuretics

A
  • Vertigo/light-headedness
  • Hypokalaemia
  • Hyponatraemia
  • Hypercalcaemia
  • Hyperglycaemia
  • Hyperuricaemia/gout
53
Q

Diuretics Drug interactions

A
  • NSAIDs - increased risk of renal impairment

- Lithium

54
Q

When starting drug treatment for hypertension, when should a recheck of BP be scheduled?

A

Every 4 weeks

55
Q

First-line treatment for antihypertensives in pregnancy and breast feeding

56
Q

Second-line treatment for antihypertensives in pregnancy and breast feeding

A

Nifedipine (Unlicensed)

57
Q

What drugs to avoid during pregnancy for hypertension?

A

ACEi/ARBs and thiazide-like diuretics

58
Q

For hypertensive emergency, what is the blood pressure for severe HTN?

A

≥ 180/120 mmHg

59
Q

For a hypertensive emergency, what medicines can be given to the patient?

A
  • IV sodium nitroprusside (unlicensed)
  • Nicardipine
  • Labetalol
  • GTN
  • Phentolamine
  • Hydralazine
  • Esmolol
60
Q

For a hypertensive urgency, what medicines can be given to the patient?

A
  • Oral labetalol
  • Amlodipine
  • Felodipine
61
Q

For hypertensive urgency, what is the blood pressure for severe HTN?

A

≥ 180/120 mmHg

62
Q

What questions would you consider when counselling patients on to encourage them to comply with antihypertensives?

A
  • How much to take?
  • Interactions?
  • When to take? (Morning/night ; with or without food)
  • How often to take? (Frequency ; intervals between doses)
  • What to watch out for? (How do they know its an ADR and not an organic disease?)
  • How to minimise risk of ADR?

YEAR 2 (4 decks)

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