HT Flashcards
What is the recommended target blood pressure for patients with athersclerotic CVD, DM, kidney/eye/cerebrovascular disease?
> 130/80mmHg
Unless it is urgent to lower a pts BP how long should you wait to determine a srepsonse of a new BP medication?
4 weeks
What is the guidance for an under 55, white patient?
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
What is the guidance for pt over 55 or who is afro carribean?
CCB or thiazidde if not tolerated -> +ACEi/ARB -> same as patients under 55
What pt population should dual therapy of beta blockers and thiazide be avoided in?
Diabetics or at risk of diabetes
How should you treat a patient who is 80yrs with newly diagnosed HT? Does this differ it it is stage 2?
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
How does management differ for a pt with renal disease?
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.
What HT medication is safe to use in pregnancy?
Labetolol, methyldopa, nifedipine MR (unlicensed)
What is the MOA of methyldopa in HT treatment?
Competitive inhibitor of the enzyme which converts Ldopa to dopamine, dopamine is a precursor for norinephrine/epinephrine, reduces this in the PNS.
How does antihypertensive tx change once the baby is born?
Long-term HT tx should be reviewed 2 weeks after birth, methyldopa stopped and start original antihypertensive treatment within 2 days.
What can be used for prophylaxis of pre eclampsia?
Aspirin OD (unlicensed) from week 12 of pregnancy until birth
What makes a woman at risk of pre-eclampsia?
CKD, DM, autoimmue disease, chronic HT, or if had HT during previous pregnancy
What can develop if blood pressure is reduced too quickly in a hypertensive crisis patient?
Risk of reduced organ perfusion leading to many severe complications
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?
Beta blocker and diuretic (usually furosemide)
Clonidine is a centrally active hypertensive, what can happen if it is suddenly withdrawn?
Severe rebound HT
How do alpha blockers work?
Otherwise known as alpha-adrenoceptor blocking drugs they prevent the release of noradrenaline from post ganglionic adrenergic neurones. Likely to cause postural hypertension
What electrolytes should be monitored when introducing and giving ACEi?
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
Why should pts on high doses of a loop diuretic see a specialist before being initiated on ACEi?
Profound first dose hypotension may occur, temporary withdrawal will decrease risk but can end up causing rebound pulmonary oedema
What is the risk of using NSAIDs with ACEi?
Renal damage
What side effect is less likely to develop in ARB’s compared to ACEi
Persistent dry cough, ACEi inhibit breakdown of bradykinin
ACEi are avoided in HF and renal nephropathy, what is a suitable alternative?
ARB’s
What drug class is aliskiren in?
Renin inhibitor
What are the risks of taking concomitant drugs affecting the raas system?
Hyperkalemia, hypotension, renal i
Atenolol, sotalol, celiprolol and nadolol are beta blockers that can cause less sleep disturbances and nightmares, why is this?
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.
What is ISA (intrinsic sympathomimetic activity)
Measurement of a beta blockers ability to stimulate beta receptors. Oxprenolol, pindolol, acebutolol, celiprolol have ISA
Beta blockers slow the heart and depress the myocardium, what conditions are they CI in?
Second/third degree heart block, worsening unstable HF,
What beta blockers are cardioversion?
Atenolol, bisoprolol, metoprolol, acebutolol.
Beta blockers can affect carb metabolism causing hypo/hypers, interfere with metabolic and autonomic responses of hypos masking their symptoms
.
What can happen in abrupt withdrawal of beta blockers ?
Rebound worsening of myocardial ischaemia. Gradual reduction is recommended.
Why is verapamil and dilitazem avoided in HR?
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.
Name examples of dihydropyridine CCBs
Amlodipine, lacidipine, nifedipine, felodipine
Why can nifedipine, amlodipine, felodipine be used in HF?
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.
CCB’s have side effects typical of vasodilation, what SE are to be expected?
Flushing, headache (become less obstrusive after a few days), ankle swelling
Aliskiren is a renin blocker. True or false, ACEi can be used alongside aliskiren?
True but is CI in eGFR <60
Why should hypotension from shock be treated urgently
Can cause tissue hypoxia and organ failure
Dopamine and Noradrenaline are types of alpha adrenergic receptors, how is does this help in shock?
Constrict peripheral vessel, raises blood pressure. Emergency Method. Can reduce perfusion to vital organs such as kidneys
