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PRE-REG-Thuri > CVD- HYPERTENSION > Flashcards

CVD- HYPERTENSION Flashcards

1
Q

What is hypertension and why is it bad

A

High blood pressure which can increase the risk factor of CVD

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2
Q

What are the 2 stages of Hyper tension?

A

Stage 1

Stage 2

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3
Q

What is BP target clinic?

A

140/90 mmhg

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4
Q

What is BP clinic target for 80+ years patient?

A

150/90 mm hg

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5
Q

What is first line HTN treatment for T1 diabetes?

A

ACEi or ARB

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6
Q

What is first line treatment for hypertension for patient UNDER 55 and not african?

A

ACEi (ARB if not tolerated)

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7
Q

What is 1st line tx for hypertension if patient OVER 55 years and black?

A

CCB (thiazide-like diuretic if not tolerated e.g. indapamide )

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8
Q

What is 1st line tx for hypertension and type 2 DM?

A

ARB or ACEi

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9
Q

What is 1st line tx for hypertension with T2 DM?

A

ACEi or ARB

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10
Q

What is step 3 if all meds not working for HTN?

A

ACT- test

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11
Q

What to give if K+ is LESS than 4.5?

A

Low dose spironolactone

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12
Q

What to give if K+ is more than 4.5?

A

High dose alpha blocker or BB.

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13
Q

What is 1ST line HTN treatment in pregnancy?

A

oral Labetalol

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14
Q

What is one negative about labetalol?

A

hepatotoxic

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15
Q

What is HTN BP target in pregnancy?

A

135/85mmhg

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16
Q

What is an alternative to labetalol in HTN?

A

Nifedipine MR

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17
Q

What is last case med given in HTN pregnant women if nifedipine MR not working?

A

Methyldopa - unlicensed- stop 2 days AFTER birth

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18
Q

What is BP monitoring target for under 80 year?

A

less than 140/90 mm hg

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19
Q

What is BP target in patient with kidney disease?

A

<140/90mm hg

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20
Q

What is BP target in patient with T1 DM and kidney disease with ACR>70?

A

<130/80mmhg

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21
Q

What is ACR?

A

Albumin creatinine ratio in urine

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22
Q

What is BP target for T1 diabetes ?

A

<140/90 mm hg

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23
Q

What is BP target for T1 diabetic and ACR <70?

A

<140/90 mm hg

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24
Q

What is BP target in T1 diabetic who is over 80?

A

<150/90mm hg regardless of ACR

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25
Q

What is T2 diabetic BP target?

A

T2 DM= same as normal adult target

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26
Q

What is MOA of ACEI and ARB?

A

Blocks Angiotensin converting enzyme.
Prevents conversion of Angiotensin 1 to angiotensin 2.

Angiotensin 2 receptor blocker (ARB)- alternative

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27
Q

How does prevention of angiotensin 2 lower BP?

A

vasodilation, aldosterone modulated.

Decreases blood plasma volume = lowers BP

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28
Q

What is Dose regimen for ACEi + ARBs?

A

OD dose

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29
Q

What specific ACEi is used BD?

A

Captopril

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30
Q

List 9 ACEi?

A

Captopril
Enalapril
Fosinopril
Imidapril
Lisinopril
Perindopril
Quinapril
Ramipril
Trandolapril

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31
Q

What ACEi is meant to be taken 30-60 mins before food?

A

Perindopril

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32
Q

List 8 ARBs?

A

Azilsartan
Candesartan
Eprosartan
Irbesartan
Losartan
Olmesartan
Telmisartan
Valsartan

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33
Q

What 2 drug classes are used 1st line for HTN + HF?

A

ACEi and ARB

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34
Q

What are 3 common side effects of ACEi/ARB?

A

Persistent dry cough

HypERkalaemia

1st dose hypOtension

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35
Q

What is a counselling point to say if patient experiences 1st dose hypotension?

A

Take first dose night time

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36
Q

What drug causes dry cough?

A

ACEi so try ARB.

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37
Q

Who is at risk of hyperkalaemia caused by ACEI/ARB?

A

Patients with renal impairment and diabetes.

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38
Q

What is a caution for high dose diuretics?

A

caution in HF - >80mg furosemide or similar= specialist

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39
Q

What is a main organ related SE of ARB/ACEI?

A

Nephrotoxicity

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40
Q

What to monitor when on ACEI/ARB?

A

renal function - electrolytes e.g. K+

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41
Q

What is a caution for ARB/ACEi as it is nephrotoxic?

A

Patients with atherosclerosis + peripheral vascular disease

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42
Q

What to do with ARB/ACEi on sick days/AKI?

A

Temporarily stop - it

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43
Q

What 3 drug classes should be temporarily stopped on sick days due to AKI?

A

NSAIDS- cause vasoconstriction

ACEI/ARB - Vasodilation

Diuretic - Reduces plasma volume

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44
Q

What are some side effects of captopril?

A

Cough
Angioedema
Postural hypotension
Taste disturbance
Oral thrush
Potassium - high , hyperkalaemia
Renal impairment
Indigestion
Low BP- 1st dose

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45
Q

Can ACEi be used in pregnancy?

A

NO- teratogenic

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46
Q

What can happen if patient given ACEI and other anti-hypertensive drugs?

A

Increased Hypotension

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47
Q

What anti-hypertensives can interact with ACEI?

A

Alpha-blocker e.g doxazosin
BB
CCB

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48
Q

What drug classes interact with ACEi to cause low BP?

A

Anti-hypertensives
Dopaminergic drugs
Antipsychotics/ phosphodiesterase type-5 inhibitors, TCAs

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49
Q

What drug class can interact with ACEi and increase AKI?

A

NDAIDS

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50
Q

interaction between ACEi and spironolactone?

A

HypERkalaemia

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51
Q

What can interact with ACEi to cause increased renal impairment/ high k+ and hypotension?

A

other ACEi/ARB and aliskiren (renin inhibitors).

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52
Q

What is a MOA of CCB?

A

affects ca+ influx in vascular smooth muscle + heart.

Reduces BP, HR + contraction force

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53
Q

What are CCBs split into?

A
  1. Dihydropyridine
  2. Rate limiting
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54
Q

List 7 Dihdropyridine CCBs?

A

Amlodipine
Felodipine
Lacidipine
Lercanadipine
Nicardipine
Nifedipine
Nimodipine

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55
Q

List 2 Rate limiting CCBs?

A

Diltiazem

Verapamil

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56
Q

What is Verapamil used for?

A

Arrhythmia

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57
Q

What 2 CCBs are taken OD?

A

Amlodipine

Felodipine

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58
Q

What is Nimodipine used for specifically?

A

Aneurysmal subarachnoid haemorrhage

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59
Q

When is diltiazem dose the same for MR as?

A

When it is above 60mg

The standard formulations containing 60 mg diltiazem hydrochloride are licensed as generics + there is no requirement for brand name dispensing

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60
Q

What dihydropyridine CCB has same brand for MR?

A

Nifedipine

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61
Q

What is CCB indication?

A

Hypertension - 1st line

Can treat angina + arrhythmias

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62
Q

What condition should CCBs be avoided in?

A

Heart failure - can increase symptoms + depress cardiac function.

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63
Q

What are the 6 key SE of CCBs?

A

Ankle swelling, flushing, headache,

Tachycardia/ palpitations

Angioedema, gingival hyperplasia

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64
Q

What SE does verapamil cause?

A

Constipation

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65
Q

What mouth related SE is linked to CCB?

A

Gingival hyperplasia

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66
Q

What CCB can be used in HF?

A

Amlodipine - fewer SE

67
Q

What are the SE of CCB - DEATHFOG?

A

Dizziness
Erectile dysfunction
Ankle swelling/ angioedema
Tachycardia
Head ache

Flushing
Oedema
Gingival hyperplasia

68
Q

What can increased CCB levels do?

A

toxicity

69
Q

What 2 drug classes interact with CCB to increase toxicity?

A

Macrolides
Azole anti-fungals

70
Q

What food/drink avoided when on CCB?

A

Grapefruit juice

71
Q

What are macrolides and azole antifungals?

A

Enzyme inhibitors

72
Q

What warning label is usually on BB?

A

Do NOT STOP taking this medicine unless your doctor tells you to stop

73
Q

What 4 drugs decrease CCB levels?

A

Carbamazepine
phenytoin
Rifampicin
St John’s wort

74
Q

What drug class interacts with CCB to cause hypotension?

A

Diuretics - volume depletion

75
Q

What other 2 drug classes can increase risk of hypotension when using CCB?

A

Anti-hypertensive + dopaminergic drugs

76
Q

Give some examples of dopaminergic drugs?

A

Levodopa
Nitrates
phosphodiesterase type-5 inhibitor e.g. sildenafil
SGLT2 inhibitor -e.g. canagliflozin
TCA anti-depressants

77
Q

What 2 drugs increase bradycardia when with CCB?

A
  1. Verampamil
  2. Diltiazem
78
Q

What does verapamil and beta blocker together do?

A

Bradycardia

Severe hypotension
Heart failure in ischaemic heart disease

79
Q

What is a dihydropyridine CCB?

A

type of (CCB), which refer to a group of medications that block calcium channels located in the muscle cells of heart.

80
Q

What other drug used in arrhythmia can interact with CCB to cause Bradycardia?

A

Amiodarone

81
Q

What is MOA of Beta blocker?

A

Blocks B- adrenoceptor in peripheral vasculature + heart.

Lowers BP, HR, force of contraction, SA node automaticity + AV node conductivity.

82
Q

List 15 beta blockers?

A

Acebutolol
Atenolol*
Bisoprolol*
Carvedilol
Celiprolol
Esmolol
Labetalol
Metoprolol
Nadalol
Nebivolol
Oxprenolol
Pindolol
Propranolol *
Sotalol
TIMOLOL

83
Q

What BB is taken IV only?

A

Esmolol

84
Q

What Beta blocker is used for pregnancy?

A

Labetalol

85
Q

What is a SE of labetalol?

A

Hepatoxicity

86
Q

What beta blocker is good for elderly patient with stable mild-moderate HF?

A

Nebivolol

87
Q

What 3 conditions can propranolol be used for?

A

Anxiety

Migraine prophylaxis

Thyrotoxicosis - aka hyperthyroidism.

88
Q

What is sotalol?

A

Class 3 anti-arrhythmic

89
Q

What is ONE dangerous SE of sotatlol?

A

Can cause torsade de pointes

90
Q

What is the 1st line indication of BB?

A

HF + angina

  • HTN, arrhythmia + MI
91
Q

What 4 BB are given OD? TIP - ABC-N

A

Atenolol
Bisoprolol
Celiprolol

Nadolol

92
Q

What 4 BB can reduce bradycardia and cold extremity? PACO

A

Pindolol
Acebutolol
Celiprolol
Oxprenolol

93
Q

What 4 BB are water soluble? - CANS

A

Celiprolol
Atenolol
Nadolol
Sotalol

94
Q

What should be done to water-soluble BB in RI patients?

A

reduce dose - as excreted by kidneys usually

95
Q

What 4 BB are cardio-selective + reduce bronchospasm? BAN-Me

A

Bisoprolol
Atenolol
Nebivolol

Metoprolol

96
Q

What can non- soluble BB cause?

A

Sleep disturbances

97
Q

What are the 7 main SE of BB? -BADFISH

A

Bradycardia + bronchospasm
Atrioventricular block
Disturbs glucose metabolism
Fainting + dizziness
Impotence
Sleep disturbances
HypOtension, HF + cold HF

98
Q

What 5 conditions are BB contra-indicated in?

A

Marked bradycardia

Asthma

2nd or 3rd heart block
HypOtension
Uncontrolled HF.

99
Q

What 2 cautions for BB?

A

Diabetes - can cause hypoglycaemia in patients with and without DM.

Masks hypoglycaemia

100
Q

What drug class increases hypOtension when combined with BB?

A

Diuretics- causes volume depletion

101
Q

What effect can BB and rate-limiting CCB or digoxin/amiodarone cause?

A

Cardio depression

102
Q

What 4 BB have a peripheral vasodilating effect?

A

Labetalol
Celiprolol
Carvedilol
Nebivolol

103
Q

Give 2 vasodilator names?

A

Hydralazine

Minoxidil

104
Q

When is Minoxidil used?

A

Treatment of severe HTN resistant to other drugs.

105
Q

What is given with minoxidil for severe HTN + why?

A

Vasodilatation is accompanied by increased cardiac output and tachycardia and children develop fluid retention.

106
Q

What does Minoxidil cause?

A

Hypertrichosis (excess hair growth)

Drug unsuitable for females.

107
Q

What is Hydralazine used for?

A

given adjunct to other antihypertensives for the treatment of resistant HTN but is rarely used.

108
Q

What happens when hydralazine is used alone?

A

when used alone it causes tachycardia and fluid retention.

109
Q

What are 3 centrally acting anti-hypertensives?

A
  1. Methyldopa
  2. Clonidine
  3. Moxonidine
110
Q

What is a SE of prolonged use of centrally acting anti-hypertensives?

A

fluid retention

111
Q

What is Methyldopa also useful for?

A

HTN in pregnancy

112
Q

What is the disadvantage of using clonidine as anti-hypertensive?

A

Sudden withdrawal may cause a hypertensive crisis

113
Q

What other indications is clonidine used for?

A

pain management, sedation, + opioid withdrawal, ADHD, and Tourette syndrome.

114
Q

What is pulmonary HTN?

A

Condition affects the blood vessels in lungs.

Develops when the BP in your lungs is higher than normal.

115
Q

What is phaechromocytoma?

A

Type of neuroendocrine tumor that grows from cells called chromaffin cells.

116
Q

What is a hypertensive crisis?

A

sudden, severe increase in blood pressure.

BP reading is 180/120 (mm Hg) or greater.

117
Q

What is shock?

A

Threatening medical emergency due to profound hypOtension.

118
Q

What 2 alpha blockers are used in hypertension?

A

Doxazosin + pazosin

119
Q

Why 2 alpha blockers are used in hypertension?

A

lowers BP + rarely causes tachycardia.

120
Q

Why are Adrenergic neurone blocking drugs not used in HTN anymore?

A

do NOT control supine blood pressure + may cause postural hypotension

121
Q

How do we monitor midodrine?

A

Hepatic + renal function BEFORE treatment and at regular intervals during treatment.

Regular monitoring of supine + standing blood pressure due to the risk of HTN in the supine position.

122
Q

What is indication of midodrine?

A

Severe orthostatic hypotension

123
Q

What is 1st line treatment for shock?

A

Inotrope + vasoconstrictor sympathomimetics

124
Q

What are 5 causes of shock?

A

Sepsis
Neurogenic
Cardiogenic
Hypovolemic- bleed
Anaphylactic

125
Q

What is MOA of vasoconstrictor sympathomimetic?

A

Acts on alpha- receptors on peripheral vasculature.
Causes vasoconstriction + Increases BP

126
Q

What is use of vasoconstrictor sympathomimetic?

A

for acute hypotension - if other methods fail

127
Q

Give 5 examples of vasoconstrictor sympathomimetic?

A

Ephedrine
Midodrine
Noradrenaline
Phenylephrine

128
Q

What is long acting vasoconstrictor sympathomimetic?

A

phenylephrine

129
Q

What vasocontrictor sympathomimetic has a dual action of Increasing BP + HR?

A

Ephedrine

130
Q

What is 1 SE of vasoconstrictor sympathomimetics?

A

reduced organ perfusion (fluid circulation).

131
Q

What is stage 1 hypertension?

A

Clinic BP ranging from 140/90 -159/99 mmHg,

AND

ambulatory daytime average/ home BP average ranging from 135/85 -149/94 mmHg.

132
Q

What is stage 2 hypertension

A

Clinic BP of 160/100 mmHg - less than 180/120 mmHg,

AND

an ambulatory daytime average/ home BP average of 150/95 mmHg or higher.

133
Q

What 5 criteria points should patients under 80 have in order to start stage 1 HTN tx? (1 or more)

A

target-organ damage (for example left ventricular hypertrophy,

chronic kidney disease or hypertensive retinopathy),

established cardiovascular disease,

renal disease, diabetes,

or a 10 year cardiovascular risk ≥10%.

134
Q

For patients aged under 40 years with stage 1 hypertension what to do?

A

specialist advice for evaluation of secondary causes of hypertension

135
Q

what is Severe hypertension?

A

clinic systolic BP of 180 mmHg or higher, or a clinic diastolic BP of 120 mmHg or higher.

136
Q

When would patients need for same day referral done for HTN? (3)

A

phaeochromocytoma (e.g labile or postural hypotension, headache, palpitations, pallor, abdominal pain, or diaphoresis).

Clinic BP of 180/120 mmHg or higher with signs of retinal haemorrhage or papilloedema (accelerated hypertension),

OR

Life-threatening symptoms for example new onset confusion, chest pain, signs of heart failure, or acute kidney injury.

137
Q

What is home BP target in under 80s?

A

<135/85 mm hg

138
Q

What is home BP target in patients over 80?

A

<145/85 mmhg

139
Q

What is clinic BP target for those with stroke before?

A

<130/80 mm hg

home = <125 mmhg

140
Q

What is BP target for patients with severe bilateral carotid artery stenosis?

A

140-150mm hg

141
Q

If ACEi not tolerated due to cough, what to give?

A

ARB

142
Q

In HTN, if CCB not tolerated due to oedema, what to give?

A

TLD e.g. indapamide

143
Q

What is preferred - thiazide like or conventional diuretics?

A

Thiazide.

144
Q

What 2 thiazides can be used for patients with HTN, stable + controlled BP?

A

Bendro + hydrochlorothiazide

145
Q

What to give patients with isolated systolic HTN?

A

same treatment

146
Q

What is isolated systolic HTN?

A

BP >160 or more

147
Q

What to give 1st line in HTN if patient black despite age?

A

CCB always

148
Q

What are 7 symptoms of pre-eclampsia?

A

Severe headache

vision issues

severe pain below ribs

swelling hands, feet

Proteinuria

BP >140/90

vomiting

149
Q

What should be done if HTN in pregnancy after 20 weeks?

A

Secondary care referral - seen within 24 hrs

150
Q

What should be done if severe HTN in pregnancy after 20 weeks?

A

same day assessment

151
Q

Pregnant women at high risk of developing pre-eclampsia if they have:?

A

CKD

DM

Autoimmune disease

HTN before

Chronic HTN

152
Q

What are females at high risk of pre-eclampsia recommended to take from week 12 of pregnancy until baby born?

A

Aspirin

153
Q

Can mothers breastfeed with antihypertensives?

A

Yes - low levels present

risk vs benefit

154
Q

What HTN drug for females who breastfeed as 1st line HTN during post-natal period?

A

Enalapril

155
Q

What HTN drug for black females who breastfeed as 1st line HTN during post-natal period?

A

Nifedipine or amlodipine

156
Q

When should females be reviewed for HTN post birth?

A

2 weeks after birth

157
Q

In under 80s when to start HTN tx with stage 1 who have 1 or more of the 4 following:

A

target organ damage

established cardiovascular disease

renal disease

diabetes

an estimated 10‑year risk of cardiovascular disease of 10% or more.

158
Q

What is recommended in african patients with DM?

A

ARB

159
Q

Most common SE of CCB?

A

Oedema

160
Q

Most common SE of verapamil?

A

constipation

161
Q

When to offer BP treatment ?

A

For stage 2 hypertension (clinic blood pressure of 160/100 mmHg or more but less than 180/120 mmHg and subsequent ambulatory daytime average or home blood pressure average of 150/95 mmHg or higher):

Offer antihypertensive drug treatment + lifestyle advice to adults with persistent stage 2 hypertension, regardless of age.

162
Q

When to offer BP treatment in stage 1?

A

under 60 years with stage 1 HTN + an estimated 10-year CVD risk below 10%. Bear in mind that 10-year cardiovascular risk may underestimate the lifetime probability of developing CVD.

> 80 years with a clinic blood pressure more than 150/90 mmHg.

163
Q

When to discuss BP treatment in Stage 1?

A

People under 80 years with persistent stage 1 HTN who have one or more of the following: target organ damage, established cardiovascular disease (CVD), renal disease, diabetes, an estimated 10-year risk of CVD of 10% or more.

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