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Pre reg > Cardiovascular- hypertension > Flashcards

Cardiovascular- hypertension Flashcards

1
Q

Lowering blood pressure reduces risk of what?

A

stroke, coronary events, HF and renal impairment

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2
Q

What is stage 1 hypertension?

A

BP>140/90 (home 135>85)

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3
Q

Who do we treat with stage 1 hypertension?

A

patients under 80 with target organ damage, diabetes, 10 year CV risk >20%

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4
Q

What is stage 2 hypertension?

A

BP>160/100 (home 150/95)

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5
Q

What is severe hypertension?

A

Systolic BP>180 or diastolic BP>110. HYPERTENSIVE CRISIS

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6
Q

What is the target blood pressure for under 80s?

A

<140/90

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7
Q

What is the target blood pressure in diabetes?

A

<140/80 (<130/80 with kidney, eye, cerebrovascular damage)

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8
Q

How long should you trial each stage of anti-hypertensive treatment?

A

4 weeks to determine response

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9
Q

Step 1 treatment for under 55s

A

ACE inhibitor. If not tolerated ARB. If both not toelrated consider a beta blocker

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10
Q

Step 2 treatment for under 55s

A

Step 1 + CCB. If not tolerated or HF give thiazide related diuretic i.e. chlortalidone or indapamide.

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11
Q

Step 3 treatment

A

ACE inhibitor (ARB) + CCB + thiazide

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12
Q

Step 4 treatment

A

Add low dose spironolactone (unlicensed) or high dose thiazide if potassium >4.5mmol/L
Monitor RF and electrolytes
If diuretic therapy contraindicated, use beta blocker or alpha blocker

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13
Q

Step 1 treatment for over 55 or Afro-Caribbean

A

CCB. If not tolerated or HF give thiazide related diuretic

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14
Q

Step 2 treatment for over 55 or Afro-Caribbean

A

Step 1 + ACE inhibitor (ARB preferred in Afro-Caribbean patients)

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15
Q

What is the target blood pressure for over 80s

A

150/90

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16
Q

What is isolated systolic hypertension and what does it increase the risk of?

A

Systolic >160 but diastolic <90. Increased CV risk

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17
Q

What is the role of ACE inhibitors in diabetes?

A

Management of diabetic nephropathy.

T2DM can delay progression of microalbuminuria to nephropathy

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18
Q

When should you consider ACE inhibitors in renal disease?

A

patients with proteinuria

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19
Q

What is the problem with diuretics in renal impairment?

A

thiazides may be ineffective. High dose loop diuretics may be required

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20
Q

What drugs can be used for hypertension in pregnancy?

A

methyldopa, labetalol, nifedipine MR (unlicensed)

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21
Q

What is the target BP in pregnancy?

A

<150/100

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22
Q

How do ACE inhibitors work?

A

inhibit conversion of angiotensin 1 to angiotension 2

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23
Q

What is the role of ACE inhibitors in HF?

A

all grades, usually combined with beta blockers.
stop potassium sparing diuretics- risk of hyperkalaemia. Low dose spironolactone beneficial in sever HF. monitor potassium.
If already taking high dose loop diuretics, may get profound first dose hypotension.

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24
Q

What are the renal effects of ACE inhibitors?

A

RF and electrolytes should be monitored before treatment, when doses are increased and during treatment.
Treatment with NSAIDs increases risk to kidneys

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25
Q

How do ARBs differ to ACE inhibitors?

A

They don’t inhibit breakdown of bradykinin- less likely to cause cough

26
Q

Name 3 centrally acting antihypertensives

A

clonidine, methyldopa. moxonidine

27
Q

What happens if you suddenly withdraw clonidine?

A

rebound hypertension

28
Q

What are the side effects of clonidine and methyldopa?

A

dry mouth, constipation, bradycardia, drowsiness

29
Q

What patient info do you need to give for clonidine and methyldopa?

A

may affect skilled tasks and enhance alcohol

30
Q

When is methyldopa contraindicated?

A

depression

31
Q

What monitoring is needed for methyldopa?

A

blood counts and LFTs before treatment and during intervals of first 6-12 weeks, or unexplained fever

32
Q

Where do beta blockers work?

A

heart, peripheral vasculature, bronchi, pancreas, liver

33
Q

What beta blockers have intrinsic sympathomimetic activity and what does this mean?

A

Oxoprenolol, acebutolol, pindolol, celiprolol- less bradycardia and cold extremities

34
Q

What are the most waters soluble beta blockers and what does this mean?

A

Celiprolol, atenolol, nadolol, sotalo- less likely to cross BBB, cause less sleep disturbances and nightmares. Excreted by the kidneys

35
Q

Which beta blockers have a longer duration of action and once daily dosing?

A

atenolol, bisoprolol, celiprolol and nadilol

36
Q

When are beta blockers contraindicated?

A

2nd/3rd degree heart block

37
Q

Which beta blockers are cardioselective

A

atenolol, bisoprolol, metoprolol, nebivolol

38
Q

How do beta blockers were in hypertension?

A

reduce cardiac output, alter baroceptor reflex sensitivity, block peripheral adrenoreceptors

39
Q

How do beta blockers work in angina?

A

Reduce cardiac work, improve exercise tolerance, relieve symptoms.
Risk of precipitating HF is verapamil and beta blocker used together in IHD.

40
Q

What do beta blockers reduce after MI?

A

Reduce recurrence risk

41
Q

How do beta blockers work in arrhythmias?

A

Reduce effects of sympathetic system on automaticity and conductivity

42
Q

How do beta blockers work in HF?

A

Block sympathetic activity. Bisoprolol and carvedilol reduce mortality in any grade stable HF

43
Q

Why should you avoid abrupt withdrawal of beta blockers?

A

Rebound worsening myocardial ischaemia

44
Q

Name some dihydropyridine CCBs

A

amlodipine, felodipine

45
Q

When should you avoid verapamil and diltiazem?

A

HF. May further depress cardiac function causing deterioration

46
Q

What can verapamil be used for?

A

Angina, HTN, arryhthmias

47
Q

Verapamil is a highly …. ionotrope

A

negative

48
Q

How does verapamil work?

A

reduces cardiac output., slows HR

49
Q

How does nifedipine work?

A

relaxes vascular smooth muscle, dilates coronary and peripheral arteries

50
Q

What is nifedipine used for?

A

HTN and angina

51
Q

How do CCBs affect calcium ions?

A

Interfere with inwards displacement of calcium ions through slow channels of active cell membranes.

52
Q

What effect do CCBs have?

A

Reduce myocardial contractility, depress the formation and propagation of electrical impulses within the heart, diminish coronary or systemic vascular tone

53
Q

Name some peripheral vasodilators

A

Hydralazine, minoxidil, sildenafil

54
Q

What should you monitor with Hydralazine?

A

Proteinurea every 6 months and antinuclear factor.

Acetylator status for doses >100mg

55
Q

Name a renin inhibitor

A

Aliskiren

56
Q

How does renin work?

A

converts angiotensin to angiotensin 1

57
Q

When are thiazides contraindicated?

A

Addisons, hypercalcaemia, hyponatraemia, hypokalaemia

58
Q

What condition might thiazides cause?

A

gout

59
Q

What should you avoid giving thiazides with?

A

Lithium- sodium depletion increases risk of toxicity

60
Q

What electrolyte disturbances can thiazides cause?

A

Low potassium, sodium, and high calcium and glucose.

Pre reg (11 decks)

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