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2- Cardiovascular > HT > Flashcards

HT Flashcards

1
Q

What is the recommended target blood pressure for patients with athersclerotic CVD, DM, kidney/eye/cerebrovascular disease?

A

> 130/80mmHg

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2
Q

Unless it is urgent to lower a pts BP how long should you wait to determine a srepsonse of a new BP medication?

A

4 weeks

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3
Q

What is the guidance for an under 55, white patient?

A

ACEi/ARB (or BB if both CI or not tolerated) -> CCB or thiazide related diuretic if CI (avoid if BB given as 1st line and pt diabetic) ->ACEi+CCB+thiazide diuretic -> reistant HT, see specialist

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4
Q

What is the guidance for pt over 55 or who is afro carribean?

A

CCB or thiazidde if not tolerated -> +ACEi/ARB -> same as patients under 55

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5
Q

What pt population should dual therapy of beta blockers and thiazide be avoided in?

A

Diabetics or at risk of diabetes

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6
Q

How should you treat a patient who is 80yrs with newly diagnosed HT? Does this differ it it is stage 2?

A

Decision to treat should be based on comorbidities as pt at higher risk of adverse effects if treated without. In stage 2 pts will be treated in the same way for over 55 . Target BP is 150/90

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7
Q

How does management differ for a pt with renal disease?

A

Target below 130/80 with CKD and diabetes or if proteinuria is high, ACEi used in caution in renal impairment, thiazides may be inneffective and loop diuretics required in higher doses.

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8
Q

What HT medication is safe to use in pregnancy?

A

Labetolol, methyldopa, nifedipine MR (unlicensed)

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9
Q

What is the MOA of methyldopa in HT treatment?

A

Competitive inhibitor of the enzyme which converts Ldopa to dopamine, dopamine is a precursor for norinephrine/epinephrine, reduces this in the PNS.

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10
Q

How does antihypertensive tx change once the baby is born?

A

Long-term HT tx should be reviewed 2 weeks after birth, methyldopa stopped and start original antihypertensive treatment within 2 days.

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11
Q

What can be used for prophylaxis of pre eclampsia?

A

Aspirin OD (unlicensed) from week 12 of pregnancy until birth

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12
Q

What makes a woman at risk of pre-eclampsia?

A

CKD, DM, autoimmue disease, chronic HT, or if had HT during previous pregnancy

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13
Q

What can develop if blood pressure is reduced too quickly in a hypertensive crisis patient?

A

Risk of reduced organ perfusion leading to many severe complications

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14
Q

The vasodilation effects of anti hypertensives increases cardiac output and tachycardia and the patient develops fluid retention. What 2 drug classes are mandatory to relieve and help treat the condition?

A

Beta blocker and diuretic (usually furosemide)

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15
Q

Clonidine is a centrally active hypertensive, what can happen if it is suddenly withdrawn?

A

Severe rebound HT

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16
Q

How do alpha blockers work?

A

Otherwise known as alpha-adrenoceptor blocking drugs they prevent the release of noradrenaline from post ganglionic adrenergic neurones. Likely to cause postural hypertension

17
Q

What electrolytes should be monitored when introducing and giving ACEi?

A

Potassium because of risk of hyperkalaemia, potassium supplements and k-sparing diuretics should be discontinued before starting ACEi. Low dose spironolactone can be used in caution

18
Q

Why should pts on high doses of a loop diuretic see a specialist before being initiated on ACEi?

A

Profound first dose hypotension may occur, temporary withdrawal will decrease risk but can end up causing rebound pulmonary oedema

19
Q

What is the risk of using NSAIDs with ACEi?

A

Renal damage

20
Q

What side effect is less likely to develop in ARB’s compared to ACEi

A

Persistent dry cough, ACEi inhibit breakdown of bradykinin

21
Q

ACEi are avoided in HF and renal nephropathy, what is a suitable alternative?

A

ARB’s

22
Q

What drug class is aliskiren in?

A

Renin inhibitor

23
Q

What are the risks of taking concomitant drugs affecting the raas system?

A

Hyperkalemia, hypotension, renal i

24
Q

Atenolol, sotalol, celiprolol and nadolol are beta blockers that can cause less sleep disturbances and nightmares, why is this?

A

They are more water soluble so less likely to enter CNS. However they are excreted by kidneys so will need dose adjustment in renal impairment.

25
Q

What is ISA (intrinsic sympathomimetic activity)

A

Measurement of a beta blockers ability to stimulate beta receptors. Oxprenolol, pindolol, acebutolol, celiprolol have ISA

26
Q

Beta blockers slow the heart and depress the myocardium, what conditions are they CI in?

A

Second/third degree heart block, worsening unstable HF,

27
Q

What beta blockers are cardioversion?

A

Atenolol, bisoprolol, metoprolol, acebutolol.

28
Q

Beta blockers can affect carb metabolism causing hypo/hypers, interfere with metabolic and autonomic responses of hypos masking their symptoms

A

.

29
Q

What can happen in abrupt withdrawal of beta blockers ?

A

Rebound worsening of myocardial ischaemia. Gradual reduction is recommended.

30
Q

Why is verapamil and dilitazem avoided in HR?

A

Highy negatively ionotropic and reduces cardiac output, slows HR, and may impair atrioventricular conduction. Can precipitate HF, exacerbate conduction disorders. SHould not be used with beta blockers.

31
Q

Name examples of dihydropyridine CCBs

A

Amlodipine, lacidipine, nifedipine, felodipine

32
Q

Why can nifedipine, amlodipine, felodipine be used in HF?

A

They relax SM and can dilate coronary/peripheral arteries but unlike verapamil and dilitazem they have very little effect on the heart and does not precipitate HF, have no anti-arrythmic activity.

33
Q

CCB’s have side effects typical of vasodilation, what SE are to be expected?

A

Flushing, headache (become less obstrusive after a few days), ankle swelling

34
Q

Aliskiren is a renin blocker. True or false, ACEi can be used alongside aliskiren?

A

True but is CI in eGFR <60

35
Q

Why should hypotension from shock be treated urgently

A

Can cause tissue hypoxia and organ failure

36
Q

Dopamine and Noradrenaline are types of alpha adrenergic receptors, how is does this help in shock?

A

Constrict peripheral vessel, raises blood pressure. Emergency Method. Can reduce perfusion to vital organs such as kidneys

2- Cardiovascular (10 decks)

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