CV HTN Flashcards

1
Q

whats stage 1 htn?

A

clinical BP: 140/90-160/100mmHg
or
ABPM: 135/85-149/94mmHg

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2
Q

for stage 1 htn start drug tx in which 4 groups of pts under 80y?

A

kidney disease,
diabetes,
CVD,
QRISK >/= 10%

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3
Q

for stage 1 htn start drug tx AND give lifestyle advice in which group of pts under 60y?

A

pts with <10% risk of CVD in 10 years

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4
Q

for stage 1 htn start drug tx in which pts OVER 80y?

A

BP > 150/90

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5
Q

whats stage 2 htn?

A

clinic BP: 160/100-180/120mmHg
or
ABPM: >150/95mmHg

high risk. treat all pts

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6
Q

whats stage 3 htn?

A

> 180/120mmHg

medical emergency! hospital asap as hypertensive crisis

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7
Q

HYPERTENSION TREATMENT

PATIENTS <55 or with T2DM?

Step 1?
Step 2?

A

Step 1: ACE-I or ARB (in T2DM afro-caribbean pts ARB>ACE-i preferred)

Step 2: ACE-I/ARB+ CCB OR TLD

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8
Q

HYPERTENSION TREATMENT

PATIENTS >55/AFRO-CARIBBEAN?

Step 1?
Step 2?

A

Step 1: CCB

Step 2: CCB+ ACEi/ARB/TLD in HF

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9
Q

for ALL HTN pts, what is step 3 and 4

A

Step 3: ACE-I/ARB + CCB + TLD

Step 4:
if Potassium <4.5mmol/L= low dose spironolactone
if Potassium >4.5mmol/L= alpha/beta-blocker

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10
Q

what two drug classes not recommended ofr use together in htn

A

acei and arb

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11
Q

whats a reason acei may be swapped to arb

A

dry cough se

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12
Q

why may ccb not be well tolerated thus witched to tld

A

oedema se

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13
Q

when to take perindopril for htn

A

30-60 mins before food

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14
Q

ACE-INHIBITORS- ramipril, enalapril, lisinopril and perindopril

SIDE EFFECTS?
CHHAReD

A

Cough
Hyperkalaemia
Hepatic failure
Angioedema
REnal impairment
Dizziness & headaches

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15
Q

angioedema is swelling of what

A

eyes
lips
genitals
hands
feet

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16
Q

ARB: Candesartan/Irbesartan/Losaratan
SEs?

A

Same SEs as ACE-i, except no cough and angioedema!

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17
Q

ACE-INHIBITOR INTERACTIONS?
increased risk of what 3

A

renal failure
hyperkalaemia
volume depletion

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18
Q

a se of acei is renal impairment so giving drugs that increase this risk such as X,Y,Z -> renal failure

A

arbs
k-sparing diuretics
nsaids

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19
Q

acei increase risk of hyperkalaemia so giving them with drugs that increase K+ lvls such as… -> hyperkalemia
BHANK

A

bb
heparins
arbs
nsaids
K sparing diuretics

and trimethoprim

20
Q

which drug class interacts w ACEi to -> volume depletion

21
Q

ACEi can increase plasma levels of what ion

A

Lithium

acei and arbs -> inc conc of Li, major interaction as can -> Li toxicity

22
Q

why are cardio selective beta blockers better for asthma

A

less likely to cause bronchospasms

23
Q

which bbs are cardioselective? BAtMAN

A

Bisoprolol, Atenolol, Metoprolol, Acebutolol & Nebivolol

24
Q

water soluble beta blockers are less likely to cross BBB -> less nightmares. examples
Water CANS

A

Celiprolol, Atenolol, Nadolol & Sotalol

25
Q

INTRINSIC SYMPATHOMIMETIC BBs are less likely to cause cold extremities
examples? Ice PACO

A

Pindolol, Acebutolol, Celiprolol & Oxprenolol

26
Q

4 main SEs of bb?

A

braducardia/ HF
blunts effects of hypOglycaemia
can cause hyperglycaemia
bronchospasms

27
Q

why should you NOT give bb with amiodarone/ digoxin/ RL CCBs?

A

can worsen bradycardia and cause HF

28
Q

bb blunt effects of/ mask hypoglycaemia. which symptoms?

A

sweating
palpitations
tremor

29
Q

a SE of bbs is bronchospams thus contraindicated in asthmatic pts. why?

A

blocks beta receptors on smooth muscle causing bronchospasm
asthma ‘relaxes’ smooth muscle!

30
Q

2 main interactions with bb

A
  • digoxin: can cause heart block as disrupts impulses that control beating of heart muscle
  • any hypotensive drug!
31
Q

what are the Dihydropyridine CCBs?

A

Amlodipine, Felodipine, Lacidipine, Lercanidipine & Nifedipine

32
Q

what are the Rate-limiting CCBs?

A

Diltiazem & Verapamil

33
Q

4 SEs of CCBs?

A

Dizziness
Gingival Hyperplasia- enlarged gums
Vasodilatory: flushing/headaches/ankle swelling: more so in dihydro
Complete AV block- more so in R-L

34
Q

in dihydropyridines what to avoid? interaction food

A

grapefruit juice

35
Q

HYPERTENSION- PREGNANCY

High risk of developing pre-eclampsia?

A

Kidney disease/diabetes/autoimmune disease/hypertension (K-HAD inc risk of pre-eclampsia)

36
Q

if pt taking primary prevention in preg eg statin, acei/ arb what to do?

A

stop as should be avoided!!

37
Q

if pregnant pt at high risk of developing pre eclampsia, what drug to give from week 12 of pregnancy till birth

38
Q

HYPERTENSION- PREGNANCY

what the first and second line if Blood pressure> 140/90mmHg?

A

1: Labetalol (with food)
2: Nifedipine / Methyldopa

aim for 135/85mmHg

can give with aspirin as pregnant pt w HTN are at high risk of pre eclampsia and would need tx for both

39
Q

HYPERTENSION TARGETS- CLINICAL AND AMBULATORY
clinical and ambulatory difference? C-A= 5

<80years?

A

140/90mmHg (clinical)
135/85 (ambulatory)

40
Q

HYPERTENSION TARGETS- CLINICAL AND AMBULATORY
clinical and ambulatory difference? C-A= 5

> 80years?

A

150/90mmHg (clinical)
145/85 (ambulatory)

41
Q

HYPERTENSION TARGETS- CLINICAL AND AMBULATORY
clinical and ambulatory difference? C-A= 5

Renal Disease?

A

140/90mmHg (clinical)

42
Q

HYPERTENSION TARGETS- CLINICAL AND AMBULATORY
clinical and ambulatory difference? C-A= 5

Pregnancy/Type 1 Diabetes?

A

135/85mmHg (clinical)

43
Q

which drugs may cause hypERtension?

clever chemists never liked cheeky vasoconstrictors

A

coc
ciclosporin
nsaids
leflunomide
cortiocosteroids
venlafaxine

44
Q

which drugs may cause hypOtension
antihypertensives always adore night times

A

alpha blockers
arbs
acei
nitrates