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Theraputics > Cardiovascular Therapeutics- Hypertension > Flashcards

Cardiovascular Therapeutics- Hypertension Flashcards

1
Q

What are the stages of HTN?

A

Stage 1- Clinic >140/90, ABPM 135/85
Stage 2- Clinic >160/100, ABPM 150/95
Stage 3- Clinic >180/110 (systolic or diastolic above this)

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2
Q

What is the first line management of hypertension in someone under 55? (Not black person)

A

ACE Inhibitor

ARB if the cough is troublesome

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3
Q

What is the first line management of hypertension in someone over 55 or black?

A

Calcium channel blocker

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4
Q

What is second line management for HTN

A

Combine either ACEi or ARB and Calcium Channel Blocker

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5
Q

What is third line management for HTN?

A

Add in a thiazide like diuretic to second line therapy

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6
Q

What is the fourth step? What is this hypertension now called?

A

This is now called resistant hypertension.
Adding in another diuretic, alpha or beta blocker should be considered
Refer on to a specialist

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7
Q

What is it important to do at each stage?

A

Check patient is complying to the regime

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8
Q

What is a common side effect of ACEi?

A

Dry cough- due to bradykinin metabolism in the lung

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9
Q

Give an example of an ACEi

A

Ramipril

Lisinopril

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10
Q

What is a rare side effect to ACEi?

A

Angioedema

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11
Q

What are some contraindications to ACEi?

A

Pregnancy
Breast feeding
Bilateral renal artery stenosis- ACEi further reduces renal artery perfusion and can cause kidney damage

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12
Q

Give an example of an ARB

A

Losartan, Candesartan

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13
Q

What are contraindications to ARBs?

A

Pregnancy
Breast feeding
Renal artery stenosis
(As with ACEi)

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14
Q

What are the two types of calcium channel blocker? How do they work?

A

Calcium channel blockers block L-type calcium channels and so prevent smooth muscle contraction leading to vasodilation
Two types are dihydropyridines and non-dihydropyridines

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15
Q

Give an example of a dihydropyridine

A

Amlodipine
Felodipine
Nifedipine
(These are first line for HTN in black people or over 55)

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16
Q

What is a side effect of dihydropyridines?

A

Ankle oedema
Gum enlargement- gingival hyperplasia
Acid reflux
Flushing

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17
Q

Give an example of a non-dihydropyridine

A

Verapamil (cardiospecific)

Diltiazem (heart and blood vessels)

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18
Q

Which form of calcium channel blocker is rate limiting?

A

Non dihydropyridines

19
Q

What are some side effects of verapamil?

A

Worsening heart failure
Bradycardia
Heart block
Constipation

20
Q

Give another use for diltiazem

A

Cluster headaches and migraine

21
Q

How do thiazide diuretics work?

A

Block Na/Cl co-transporter in distal convoluted tubule and so reduce sodium re-absorption from the filtrate leading to diuresis

22
Q

Give an example of a thiazide diuretic

A

Bendroflumethiazide

23
Q

Give an example of a thiazide like diuretic

A

Indapamide

Chlortalidone

24
Q

What are some side effects of thiazides?

A

Hyponatraemia
Gout
Erectile dysfunction
Hypercalcaemia

25
Q

What is a loop diuretic? How does it work?

A

Furosemide
Inhibits NKCC2 in thick ascending limb
Causes potent diuresis

26
Q

What are some side effects of furosemide?

A

Hyopnatraemia
Hypokalaemia
Hypocalcaemia
Digoxin toxicity

27
Q

When is furosemide commonly used?

A

Heart failure
Ascites
Pulmonary oedema

28
Q

What is a potassium sparing diuretic?

A

Diuretic that does not cause potassium losses at the kidney

29
Q

Give an example of a potassium sparing diuretic

A

Aldosterone Receptor Antagonist- Spironolactone

Amiloride, Triamtrene

30
Q

What triggers aldosterone release and what is it’s normal effect?

A

Aldosterone is released due to low sodium delivery to the macula densa. This results in activation of the RAAS.
Aldosterone causes increases sodium re-abosption from the filtrate and increased potassium excretion.

31
Q

What are some side effects of spironolactone?

A

Gynaecomastia
Hyperkalaemia
Hyponatraemia

32
Q

When else might spironolactone be used?

A

Conn’s Syndrome (tumour producing aldosterone)

Hyperaldosteronism

33
Q

Why are beta blockers used for the treatment of HTN?

A

B1 receptors cause increased cardiac contraction and force
B2- causes vasodilation and bronchodilation
Blocking them reduces heart rate, force of contraction, reduces TPR and reduces beta mediated release of renin

34
Q

Give an example of a cardio-selective beta blocker

A

Metoprolol

Bisoprolol

35
Q

What is the first line for treatment of HTN in pregnancy?

A

Labetalol- beta blocker with weat alpha blocking activity

36
Q

What are some side effects of beta blockers?

A

Tiredness
Cold periphery
Bronchoconstriction
Erectile dysfunction

37
Q

What is a contra-indication to beta-blocker use?

A

Asthma is an absolute contra-indication

Relative contraindications include peripheral vascular disease and acute heart failure

38
Q

How do alpha blockers work?

A

Prevent alpha mediated vasoconstriction

39
Q

Give an example of an alpha blocker

A

Doxazosin

Terazosin

40
Q

What is another use of alpha blockers?

A

BPH

41
Q

What is the definition of postural hypotension?

A

Drop of 20mmHg in SP or more when standing

Drop of 10mmHg in DP or more when standing

42
Q

What are some causes of postural hypotension?

A

Antihypertensive drugs
Diuretic use
Adrenal insufficiency- Addisons
Autonomic failure- diabetes, parkinon’s

43
Q

What non- pharmacological ways could postural hypotension be treated?

A

Increasing fluid intake
Remove causative medications
Standing slowly
Compression socks

44
Q

What pharmacological ways could postural hypotension be treated?

A

Fludrocortisone- if aldosterone insufficient this is a mineralocorticoid
Desmopressin- ADH analogue
Doxydropa
Midorine- Alpha agonist

Theraputics (12 decks)

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