CV Drugs 1 Flashcards
DIAGNOSIS OF HYPERTENSION
i) what is the clinical level of high BP? what important question must be asked when this is seen
ii) what can the clinic blood pressure be recorded as?
iii) name four things that can affect a BP reading? what is the ideal situation to take a reading from?
iv) what should be offered if the clinic BP is between 140/90 and 180/120? what else can be offered if this is unsuitable?
i) more than or equal to 140/90
- need to work out whether its sustained
ii) if high then take a second measure during the consultation
- if second i different then do a third
- record lower of last 2 measurements as the clinic BP
iii) aff by - cuff too small, cuff over clothing, back/arm/feet unsupported, legs crossed, patient talking, distended bladder
- ideal to take it from a bare arm
iv) offer ambulatory blood pressure monitoring (ABPM)
- if unsuitable - offer home BP monitoring
TYPES OF BLOOD PRESSURE MONITORING - HBPM
i) when are measurements taken in home BP monitor? how many times a day is it recorded?
ii) which readings of HBPM are discarded?
iii) when should readings not be taken
i) two consecutive measurements at least 1 min apart
- record twice a day for at least 4 days (ideally a week)
ii) discard first day readings
iii) dont take readings in morning first thing as morning surge in hormones that increase BP
CONFIRMING HTN DIAGNOSIS
i) which BP can be confirmed as HTN? what must also be done to make sure it is sustained?
ii) what is true normotension, true hypertension, white coat hypertension and masked hypertension in relation to office BP, ABP, HBPM?
iii) name four symptoms of HTN
i) clinic BP of 140/90 or higher
and ABPM daytime average or HBPM avergae of 135/85 or higher to check that it is sustained
ii) true normotension - normotensive by both clinc + ABPM/HBPM
- true HTN - hypertensive by both
white coat - hypertensive on office BP but normo on ABP/HBP
masked - normotensive by clinic but hypertensive by ABP/HBO
iii) none, headache, blurred vision, dizzy, SOB, palpitations
MANGEMENT OF HTN
i) what question needs to be asked first?
ii) name four things that are included in lifestyle modification? which one reduces systolic blood pressure the most?
i) is there end organ damage
- if yes > need drugs + lifestyle
- if no > just lifestyle
ii) weight reduction, DASH eating plan, dietary sodium restric, physical activity, alcohol moderation
- DASH eating plan can reduce by 8-15mmHg
DRUG TREATMENT FOR HTN
i) what should be prescribed first line if patient has T2DM?
ii) what should be prescribed first line if patient doesnt have T2DM but is <55 and not black?
iii) what should be prescribed if patient doesnt have T2DM but is >55yrs or black
iv) what can be added if first line tx is not effective alone?
i) T2DM > ACEi or ARB
ii) ACEi or ARB
iii) calcium channel blocker
iv) add a thiazide diuretic (or ACEi/CCB whichever was not tried)
MONITORING DRUG TREATMENT
i) what should be target clinic BP under 80 and over 80?
ii) what is the white coat effect? how is it different to white coat hypertension?
iii) which techniques should be used to monitor patients who have white coat effect? what targets should be aimed for?
i) under 80 > aim for 140/90
over 80 > aim for 150/90
ii) WC effect > people who do have HTN but its higher in clinic (but also high at home)
WC HTN is people who dont have HTN but its raised in clinic (not at home)
iii) use ABPM or HBPM to monitor BP of people with white coat effect
- aim for 135/85 if under 80
- aim for 145/65 if over 80
HTN TREATMENT FAILURE
i) name three things that can cause pseudo-resistant hypertension? what needs to be decided on
ii) what is resistant HTN? what drug may be effective for these patients?
i) non adherence, white coat effect, drug intolerance
- need to decide if they are actually taking the medication
ii) resistant is uncontrolled on 3 or more drugs (inc a diuretic)
- spiro may be effective / alpha or beta blocers if L+ >4.5
TREATMENT OF HTN IN OLDER PATIENTS
i) what needs to be checked?
ii) which BP needs to be treated?
i) check for postural hypotension
ii) treat standing BP
SEVERE HYPERTENSION
i) what is it defined as?
ii) what is a hypertensive emergency? how quickly does BP need to be lowered? what tx is needed?
iii) what is hypertensive urgency? how quickly does BP need to be lowered?
iv) name three clinical features? name three symptoms that cant be missed
i) clinic BP >180/120
ii) severe hypertension >180/120 with acute damage to target organs
- need to lower BP in mins to hrs and need IV therapy in hospital
iii) severe hypertension without acute damage to target organs
- lower BP within 7 days
iv) asymp, headache, epistaxis, presyncope, palp
- cant miss chest pain, dyspnoea, neuro deficit
HYPERTENSIVE CRISES
i) name a sign of acute end organ damage in - eyes, brain, heart, kidneys, abdomen? what treatment is needed?
ii) name non acute target organ damage in eyes, urine, ECG, bloods? what treatment is needed for these?
i) eyes = papilloedema (need head CT)
brain = encephalopathy/stroke (headache/confused)
heart = pulm oedema, MI, HF
kidneys = AKI
abdo = aortic dissection
- need same day specialist review and IV therapy with labetalol, GTN
ii) eyes = hypertensive retinopathy
urine = proteinuria
ECG = LVH, AF
bloods = deranged U&Es (that dont indic AKI)
- need GP follow up in 7 days, do ABPM,HBPM and give oral treatment
STATINS FOR PRIMARY PREVENTION OF CVD
i) patients under which age should have CV risk estimated?
ii) what should be offered if there is a 10% or greater risk of developing CVD?
iii) which two patient groups should be offered a statin without CV risk calculation?
iv) what stage CKD should patients be offered a statin? which one?
i) under 84
ii) offer atorvastatin
iii) patients with T1DM over 50 and patients with CKD
iv) adults with CKD 3 should be offered atorvastatin (most renal friendly)
EZETIMIBE
i) which patient group is this reccomended for? why may it be given?
ii) what can be it be co admin with?
iii) name another instance it may be given in
i) reccom for treatig primary hypercholesterolaemia in adults who dont tolerate statins/contrainidcated
ii) can be co admin with a statin if appropriate
iii) if statins are contraindicated
ALTERNATIVES TO STATINS
i) name a drug that can be given instead of a statin and how it works?
ii) how do PCSK9 inhibitors work?
iii) how does ezeimibe work?
i) bempedoic acid (decreases choles synth in liver) works similar to statin and can be given with ezeimibe
ii) inhibits PCSK9 which gets rid of LDLR therefore there are more LDL receptors on liver surface therefore can mop up more cholesterol
iii) decreases intestinal cholesterol uptake
HYPERTRYCLYCERIDEAEMIA
i) name two things that can cause it
ii) at what level should the patient be referred to a specalist?
iii) between what levels should tryglycerides be repeated as a fasting sample in two weeks?
iv) what should be done for trygly 4.5-9.9?
i) excess alcohol and poor glycaemic control
ii) >20mmol/l
iii) 10-20mmmol/k
iv) 4.5-9.9 > check CVD risk and correlate with cholesterol
