CV HTN Flashcards by X X

whats stage 1 htn?

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

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

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

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

pts with <10% risk of CVD in 10 years

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

BP > 150/90

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whats stage 2 htn?

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

high risk. treat all pts

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whats stage 3 htn?

> 180/120mmHg

medical emergency! hospital asap as hypertensive crisis

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HYPERTENSION TREATMENT

PATIENTS <55 or with T2DM?

Step 1?
Step 2?

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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HYPERTENSION TREATMENT

PATIENTS >55/AFRO-CARIBBEAN?

Step 1?
Step 2?

Step 1: CCB

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

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for ALL HTN pts, what is step 3 and 4

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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what two drug classes not recommended ofr use together in htn

acei and arb

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whats a reason acei may be swapped to arb

dry cough se

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why may ccb not be well tolerated thus witched to tld

oedema se

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when to take perindopril for htn

30-60 mins before food

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ACE-INHIBITORS- ramipril, enalapril, lisinopril and perindopril

SIDE EFFECTS?
CHHAReD

Cough
Hyperkalaemia
Hepatic failure
Angioedema
REnal impairment
Dizziness & headaches

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angioedema is swelling of what

eyes
lips
genitals
hands
feet

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ARB: Candesartan/Irbesartan/Losaratan
SEs?

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

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ACE-INHIBITOR INTERACTIONS?
increased risk of what 3

renal failure
hyperkalaemia
volume depletion

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

arbs
k-sparing diuretics
nsaids

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

bb
heparins
arbs
nsaids
K sparing diuretics

and trimethoprim

which drug class interacts w ACEi to -> volume depletion

diuretics

ACEi can increase plasma levels of what ion

Lithium

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

why are cardio selective beta blockers better for asthma

less likely to cause bronchospasms

which bbs are cardioselective? BAtMAN

Bisoprolol, Atenolol, Metoprolol, Acebutolol & Nebivolol

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

Celiprolol, Atenolol, Nadolol & Sotalol

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

Pindolol, Acebutolol, Celiprolol & Oxprenolol

4 main SEs of bb?

bradycardia/ HF blunts effects of hypOglycaemia can cause hyperglycaemia bronchospasms

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

can worsen bradycardia and cause HF

bb blunt effects of/ mask hypoglycaemia. which symptoms?

sweating palpitations tremor

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

blocks beta receptors on smooth muscle causing bronchospasm asthma 'relaxes' smooth muscle!

2 main interactions with bb

- digoxin: can cause heart block as disrupts impulses that control beating of heart muscle - any hypotensive drug!

what are the Dihydropyridine CCBs?

Amlodipine, Felodipine, Lacidipine, Lercanidipine & Nifedipine

what are the Rate-limiting CCBs?

Diltiazem & Verapamil

4 SEs of CCBs?

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

in dihydropyridines what to avoid? interaction food

grapefruit juice

HYPERTENSION- PREGNANCY High risk of developing pre-eclampsia?

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

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

stop as should be avoided!!

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

aspirin

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

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

HYPERTENSION TARGETS- CLINICAL AND AMBULATORY clinical and ambulatory difference? C-A= 5 <80years?

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

HYPERTENSION TARGETS- CLINICAL AND AMBULATORY clinical and ambulatory difference? C-A= 5 > 80years?

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

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

140/90mmHg (clinical)

HYPERTENSION TARGETS- CLINICAL AND AMBULATORY clinical and ambulatory difference? C-A= 5 Pregnancy/Type 1 Diabetes?

135/85mmHg (clinical)

which drugs may cause hypERtension? clever chemists never liked cheeky vasoconstrictors

coc ciclosporin nsaids leflunomide cortiocosteroids venlafaxine

which drugs may cause hypOtension antihypertensives always adore night times

alpha blockers arbs acei nitrates