Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

BNF > CHAPTER 2: CVS: Hypertension > Flashcards

CHAPTER 2: CVS: Hypertension Flashcards

1
Q

What does lowering blood pressure reduce the risk of? (4)

A
  1. Stroke
  2. Coronary heart events
  3. Renal impairment
  4. Heart failure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What lifestyle advice should patients with hypertension be given? (7)

A
  1. Smoking cessation
  2. Weight reduction
  3. Alcohol and coffee intake reduction
  4. Salt reduction
  5. Total and saturated fat reduction
  6. Increasing exercise
  7. Increasing fruit and veg
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What should patients presenting with a BP of 140/90mmHg be offered to confirm diagnosis? (2)

A
  1. Ambulatory BP monitoring

2. Home BP monitoring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the BP of someone with stage 1 hypertension?

A

140/90mmHg and ambulatory average of 135/85mmHg or higher

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Patients UNDER 80 with STAGE 1 hypertension are only treated if they have which other co-morbidities? (5)

A
  1. Target organ damage
  2. Cardiovascular disease
  3. Renal disease
  4. Diabetes
  5. 10 year cardiovascular risk >20%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

If a patient under 40 presents with stage 1 hypertension and has no other co-morbidities, what further investigations should be done?

A

Causes of secondary hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How are patients UNDER 80 with STAGE 1 hypertension with no other co-morbidities treated?

A

Lifestyle advice only

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

All patients with STAGE 2 hypertension should be treated. What is the BP of someone with STAGE 2 hypertension?

A

> 160/100 (ambulatory >150/95)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What should you do if someone has a clinic blood pressure over 180 systolic or over 110 diastolic?

A

TREAT PROMPTLY

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the target clinic BP of someone with STAGE 1 hypertension?

A

140/90

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the target home BP of someone with STAGE 1 hypertension?

A

135/85

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the target clinic BP of someone with STAGE 1 hypertension and cardiovascular disease, diabetes in the presence of kidney, eye or cerebrovascular disease?

A

130/80

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

When treating hypertension, how long should treatment be tried for to see if it is effective?

A

4 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the first line treatment for hypertension in a white person under 55?

A

ACE Inhibitor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

First line HPT: What is an option if the ACE inhibitor is not tolerated?

A

Angiotensin Receptor Blocker

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

First line HPT: What is an option if neither the ACE inhibitor nor the ARB are tolerated?

A

Beta blocker

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the first line treatment for hypertension in a person over 55 or a black person?

A

Calcium channel blocker

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

First line HPT >55: What is an option if the calcium channel blocker is not tolerated?

A

Thiazide-like diuretic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the second line treatment for hypertension in a white person under 55?

A

ACE inhibitor + Calcium Channel Blocker (or thiazide-like diuretic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the second line treatment for hypertension in a person over 55 or a black person?

A

Calcium Channel Blocker (or thiazide-like diuretic) + ACE inhibitor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Is it advisable to give a Beta-blocker together with a thiazide-like diuretic to treat hypertension in those under 55 or white?

A

NO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the third line treatment for hypertension in all patients?

A

ACE Inhibitor + Calcium Channel Blocker + Thiazide-like diuretics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What must you seek if the patient does not respond to third-line antihypertension treatment?

A

Specialist advice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the options when third-line antihypertension treatment fails?

A

1) Add low dose spironolactone

2) Increase the dose of the thiazide-like diuretic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

If a patient does not tolerate an increased in their thiazide-like diuretic, what 2 other options can be considered?

A
  1. Alpha blocker

2. Beta blocker

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Unless contra-indicated, what should all patients with established cardiovascular disease receive?

A

Aspirin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

As well as aspirin, which other drug is used in patients with established or to prevent cardiovascular disease?

A

Statin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Is there evidence for the use of aspirin as primary prevention?

A

No

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is the blood pressure target for patients over 80?

A

Clinic: 150/90
Home: 145/85

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is the target blood pressure for patients with diabetes?

A

140/80

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is the target blood pressure for patients with diabetes in the presence of kidney, eye or cererbovascular disease?

A

130/80

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Which antihypertensive is recommended in patients with diabetes?

A

ACE inhibitor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

When can pregnancy women develop hypertension?

A

In the latter half

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What are the 3 treatment options for hypertension in pregnancy?

A
  1. Labetalol
  2. Methyldopa
  3. MR Nifedipine (unlicensed)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is the target BP of pregnant women with chronic hypertension?

A

<150/100

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What is the target BP of pregnant women with chronic hypertension and target organ damage / women with chronic hypertension who have given birth?

A

<140/90

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Which medication are pregnancy women at risk of pre-eclampsia recommended to take?

A

Aspirin from week 12 until the baby is born

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

How long after birth should antihypertensives be stopped in women with gestational hypertension?

A

2 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

If blood pressure is reduced too quickly in a hypertensive crisis, what is there a risk of?

A

Reduced organ perfusion leading to cerebral infarction, blindness, deterioration in renal function, myocardial ischaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What is a hypertensive emergency defined as?

A

Severe hypertension with acute damage to target organs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

During a hypertensive crisis, prompt IV treatment is needed. What are the options? (7)

A
  1. Sodium nitroprusside
  2. Nicardipine
  3. Labetalol
  4. GTN
  5. Phentolamine
  6. Hydralazine
  7. Esmolol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

If BP is >180/110 and no acute organ damage, this is defined as hypertensive urgency. What is the treatment?

A

Oral antihypertensives

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

For the treatment of resistance hypertension, can the vasodilator hydralazine be used alone?

A

No, must be as an adjunct otherwise causes tachycardia and fluid retention

44
Q

Which drug which can be used as an adjunct in resistant hypertension is not suitable for females?

45
Q

Which class of drug used as options in stage 4 hypertension must be used with caution because they drop blood pressure very quickly?

A

Alpha blockers

46
Q

What are the indications of ACE Inhibitors? (4)

A
  1. Heart Failure
  2. Hypertension
  3. Diabetic nephropathy
  4. Prophylaxis of cardiovascular events
47
Q

Which drug are ACE inhibitors usually combined with in heart failure?

A

Beta blockers

48
Q

Which drugs should be discontinued before starting treatment with ACE inhibitors for heart failure?

A
  1. Potassium supplements

2. Potassium sparing diuretics

49
Q

Providing serum potassium is monitored, which drug can be used with an ACE inhibitor at a low dose for the treatment of heart failure?

A

Spironolactone

50
Q

If a patient with heart failure is already taking a loop diuretic and they are started on an ACE inhibitor, what can be a profound effect?

A

First dose hypotension - may need to initiate under specialist supervision as temporary withdrawal of the diuretic can cause pulmonary oedema

51
Q

What must be monitored before starting treatment with an ACE inhibitor? (2)

A
  1. Renal function

2. Electrolytes

52
Q

What effect do ACE inhibitors have on serum electrolytes?

A

Hyperkalaemia

53
Q

A specialist must be involved in initiating ACE inhibitors in patients with which impairment?

54
Q

Concomitant treatment with ACE inhibitors and which other drug increases the risk of renal impairment?

55
Q

Concomitant treatment with ACE inhibitors and which other drug increases the risk of hyperkaleamia?

A

Potassium sparing diuretics

56
Q

Is it safe for patients with renal artery stenosis to take ACE inhibitors?

A

No, they should not take them

57
Q

Is it safe for patients with renovascular disease to take ACE inhibitors?

A

No, but they can be used if there is no other option

58
Q

If a patient is taking a loop diuretic at which dose, the ACE inhibitor should be introduced under specialist supervision?

A

Furosemide 80mg or equivalent

59
Q

ACE inhibitors can cause a persistent dry cough, why can’t ARBs also cause it?

A

They do not inhibit the breakdown of bradykinin

60
Q

Which renin inhibitor is an option in hypertension?

61
Q

Why is a combination of 2 drugs affecting the RAAS not advised? (3)

A
  1. Hypotension
  2. Hyperkalaemia
  3. Renal impairment
62
Q

In which organs do bete-blockers block the beta-adrenoceptors? (5)

A
  1. Heart
  2. Peripheral vasculature
  3. Liver
  4. Lungs
  5. Pancreas
63
Q

Give an example of a really water soluble beta blocker

64
Q

Which beta blocker is less likely to cause the side effect of nightmares? Why?

A

Atenolol. It is less likely to cross the BBB due to low lipid-solubility

65
Q

How are water soluble beta-blockers excreted?

A

By the kidneys, Dose adjustment in renal failure sometimes necessary

66
Q

Give 2 examples of beta blockers with an intrinsically long duration of action, allowing for once daily dosage

A
  1. Atenolol

2. Bisoprolol

67
Q

Why are beta blockers contra-indicated in patients with second or third degree heart block?

A

They slow heart rate and depress the myocardium

68
Q

As well as in patients with heart block, who else are beta-blockers contraindicated in?

A

Worsening unstable heart failure

69
Q

Why should beta-blockers be avoided in patients with a history asthma?

A

Can precipitate bronchospasm

70
Q

Where necessary, can patients with controlled asthma or COPD receive beta blockers?

71
Q

Give 4 examples of caridoselective beta blockers with less of an effect on airway resistance

A
  1. Atenolol
  2. Bisoprolol
  3. Nebivolol
  4. Metoprolol
72
Q

Give 3 side effects of beta-blockers

A
  1. Coldness of the extremities
  2. Sleep disturbance including nightmares
  3. Fatigue
73
Q

Affecting carbohydrate metabolism, what can beta-blockers cause in patients with or without diabetes?

A

Hypoglycaemia or hyperglycaemia

74
Q

In diabetics, what can beta blockers mask?

A

Symptoms of hypoglycaemia such as tachycardia and tremor

75
Q

Why are beta blockers effective in angina?

A

Reduce cardiac work and improve exercise tolerance

76
Q

Is it advised to stop taking beta blockers suddenly in angina?

A

No, gradual dose reduction

77
Q

If a beta blocker is used with which drug, can heart failure be precipitated in established ischaemic heart disease?

78
Q

Which drug can beta blockers be used with in AF, especially in patients with thyrotoxicosis?

79
Q

Which beta blocker is licensed for mild to moderate heart failure in patients over 70?

80
Q

Before which operation are beta blockers used?

A

Thyroidectomy

81
Q

What are some other uses of beta blockers?

A
  1. Migraine prophylaxis
  2. Anxiety
  3. Glaucoma
82
Q

What are the symptoms of overdose with beta blockers? (3)

A
  1. Lightheadedness
  2. Syncope
  3. Dizziness`
83
Q

Which 2 calcium channel blockers must be avoided in heart failure?

A
  1. Verapamil

2. Diltiazem

84
Q

What is verapamil used to treat? (3)

A
  1. Angina
  2. Hypertension
  3. Arrythmias
85
Q

Verapamil is a highly negatively inotropic calcium channel blocker. What does it reduce?

A
  1. Cardiac output

2. Heart rate

86
Q

Can Verapamil be used with beta blockers?

87
Q

What is a common side effect of Verapamil?

A

Constipation

88
Q

Does nifedipine have much influence on the myocardium?

A

No, more on the vessels - smooth muscle relaxation and dilation of coronary vessels

89
Q

Can nifedipine precipitate heart failure?

90
Q

Which other calcium channel blockers resemble nifedipine in the way they act? Peripherally, used to treat angina and hypertension

A
  1. Amlodipine
  2. Felodipine
  3. Nicardipine
91
Q

Give 3 side effects of calcium channel blockers. All become less obtrusive after a few days

A
  1. Flushing
  2. Headache
  3. Ankle swelling
92
Q

Which calcium channel blocker must be used with caution with beta blockers?

93
Q

Give 8 signs of calcium channel blocker overdose

A
  1. Nausea
  2. Vomiting
  3. Dizziness
  4. Agitation
  5. Confusion
  6. Coma
  7. Metabolic acidosis
  8. Hyperglycaemia
94
Q

Do standard release preparations of diltiazem need to be prescribed by brand?

95
Q

Do modified release preparations of diltiazem need to be prescribed by brand?

96
Q

What effect can diuretics have on electrolytes?

A

Hypokaleamia

97
Q

Which type of diuretics have a greater impact on potassium loss?

98
Q

If a patient is taking diuretics and there is a concern over potassium loss, what else can be prescribed? This is seldom necessary in the routine treatment of hypertension

A
  1. Potassium sparing diuretics

2. Potassium supplements

99
Q

In hepatic failure, what can hypokalaemia precipitate?

A

Encephalopathy

100
Q

In which group of people should lower initial doses of diuretics be used?

101
Q

Diuretics should not be routinely prescribed for simple oedema. Which measure can be taken instead? (3)

A
  1. Raising legs
  2. Increased movement
  3. Stockings
102
Q

Which 3 conditions can thiazides exacerbate?

A
  1. Gout
  2. Diabetes
  3. Systemic lupus
103
Q

What should be monitored with use of thiazide diuretics?

A

Electrolytes

104
Q

What should be monitored both at baseline and during treatment with ARBs? (2)

A
  1. Renal function

2. Electrolytes

105
Q

What should be monitored both at baseline and during treatment with ACE inhibitors? (2)

A
  1. Renal function

2. Electrolytes

106
Q

When treating hypertension, when should the first dose of an ACE inhibitor be given?

A

At bedtime

BNF (28 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions