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Cardiovascular > HTN > Flashcards

HTN Flashcards

1
Q

normal bp
stage 1,stage 2 and severe + a bpm

A

90/60-120/80 mmhg
clinical stage 1: 140/90+ (abpm - 135/85+)
stage 2: 160/100 (apbm 150/95)
severe: 180/11 + treat prompt

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2
Q

pre-eclampsia bp

A

sustained >140/90
severe h/a vision problem pain below ribs, von sudden swelling hands and feet
if high risk = chronic HT,CKD,DM, autoimmune disease , past pre-eclamptic pregnancy give aspirin (unlincesed week 12 till birth)

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3
Q

cardiac output calculation

A

CO=HR X SV

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4
Q

stage 1 treatment

A

1) lifestyle advice 1st line
2) consider if 80+ bp 180/90
3) or if under 80 but target organ damage i.e ckd, 10 year cvd risk>10%
dm and ckd

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5
Q

stage 2 tx

A

treat all above 160/100

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6
Q

risk factor

A

over 65,lots sat fats,afro-carribaean, diabetic ,limit exercise , lack fruit veg, smoke , no exercise

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7
Q

diagnosis htn

A

spyhghmanonmeter at least 2 readings usual wakinhrs
-confirm via abpm not clinical

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8
Q

lifestyle advice

A

relaxation, min 6hrs a day sleep, <6g salt, no more 14 units alohcol , reg exercise, less caffeine inc fruit and veg
bmi 20-25
treat underlying diabetes or dysleidesmiea, mediterannean diet

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9
Q

target bp in ckd oe diabetes

A

<130/80

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10
Q

1)HT before 1st 20 week gestation
2) ht after 20 weeks
3) ht after 20 weeks with organ damage

A

1)chronic htn
2) gestational diabetes
3) pre-eclampsia

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11
Q

what two drugs to avoid in diabetes

A

beta blocker and TZD cause hyperglycamesi

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12
Q

what is q risk

A

risk of cvd event next 10 yrs (%age smoking fh vmi diabetes cholesterol HDL/ af)

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13
Q

1st line HTN

A

age less than 55 /T2DM= acei (arb if not tolerated i.e due to dry cough)
r 55 and over and black: ccb (i.e amlodipine)/ (3rd if not tolerated or HFi.e chortalidone or indapamide)

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14
Q

2nd line HTN

A

dual therapy
for acei/arb (1st line ) +ccb or TRD(HF)
FOR ccb or trd +acei/arb

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15
Q

step 3 HTN

A

TRIPPLE THERPAY
A+C+T

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16
Q

step 4 if K+ <4.5
if >4.5

A

<4.5= low dose spironolactone
>4.5 alpha blockers or beta blockers

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17
Q

step 4 if K+ <4.5
if >4.5

A

<4.5= low dose spironolactone
>4.5 alpha blockers or beta blockers

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18
Q

htn in pregnancy 1st line and target

A

<135/85
1st line labetalol (c/I asthma or jaundice = hepatoxici)
alt = nifedipine mr (unlicensed) then methyldopa (unlincesed ) stop 2 days after brith

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19
Q

tx severe htn preg planned 24 hrs

A

IV magnesium sulfate

20
Q

target bp
over 80 <150/90
under 80/ ren, DISESA <140/90
acr>70 IN RENAL DISEASE , diabetes in presence of kidney eye or cerebrovasc disease, establish artherosclerotic disease= <130/80

A
21
Q

target bp dm

A

<140/90

22
Q

high risk drugs :ACEI/ARBS
MOA

A

acei= inhibit conversion of angiotensin 1 to 2
arbs= block angiotensin 2 receptor (doesn’t inhibit breakdown of bradykinin)

23
Q

dose of acei/arb

A

all OD except captopril (bd) and 1st dose at bedtime
- renoprotective in renal disease- ckd
nephrotoxic - cause aki
reduce egfr in afferent arteriole sick day rule- stop 24-48 hr in sickness after feeling better) prevent dehydration lead to Aki
- dont drink excessive fluid volumes
- avoid in pregnancy and renovascular disease i.e renal artery stenosis

24
Q

monitor acei /arb

A

serum electrolyte (inc K+, CA2+AND DECREASE na+)
- renal function
bp after initial dose and 4 weeks after every dose change

25
Q

when to monitor fluid electrolyte in acid and arb

A

every 1 - two weeks on initiation and 1-2 weeks after each dose change

26
Q

s/e acei /arb

A
  • dry irritating cough- after 8-12 weeks in acei (switch to arb)
  • hyperkalaemia (inc risk ri or diabetes)
  • water rentention
  • cholestatic jaundice or marker liver impairment where enzyme 3x normal stop
  • dizziness blurred vision faint- postural hypo
  • renal stenosis abnormal rot
  • aki - n/v / confusion anuria n/v
  • angiodema
27
Q

other s/e acei arb

A

oral ulcer, taste change, hypoglcyaemia

28
Q

interaction with acei arb

A

increase plasma conc- lithium
hyperkaelaeima - had beans
nephrotoxcitiy and reduced egfr with nsaid
hypotension with diuretic (volume depletion)

29
Q

central acting antihypertensives

A

methyldopa= drowsiness drivinh
clonidine= flushing
moxonidine

30
Q

vasodilator antihypertensive

A

hydralazine s/e fluid retention tachycardia

minoxidil = tachycardia flurd retention and increase cardiac output

31
Q

beta blockermoa

A

bloc beta adrenorecpetor in heart, peripheral vasculature, bronchi pancreas and liver

32
Q

what antihypertensives to avoid pregnancy

A

acei arb , TRD ,TZD

33
Q

severe htn tx preg >160/110

A

iv labetalol, iv hydralazine oral nifedipinem/r

34
Q

name some special beta blockers

A

esmolol - htn peri operative ; short half life)
labetalol (preg; hepatoxic)
sotalol class 3 anti arrhythmic s/e tornadoes des pointes prolong Qt

35
Q

s/e beta blockers

A

hyperglycaemia or hypoglycaemia
masks hypoglycaemia
bradycardia , fatigue, hypotnesion

36
Q

c/ I beta blockers

A

bronchospasm with asthma (even in eye drops )
2) worsen unstable HF
3)2ND/3RD DEGREE heart block
4) severe hypo or bradycardia
-

37
Q

interaction beta blocker

A

verapamil injection (systole and hypotension )- hyperglycaemia; avoid in diabetes/ high risk diabetes i.e tRD O TLD

38
Q

type of beta blocker 4 TYPES

A

1) ice PACO
intrinsic sympathomimetic activity- pindolol acebutol (less bradycardia, less coldness of extremities)
celiprol oxprenolol
2) water CANS (water soluble less likely cross BBB; no sleep disturb or night mares) celiprolol, atenolol, nadolol , celiprolol
3) Be A MAN cardioselective less brochospasm ( okay for asthma under specialist - Bisoprolol, acebutol, metoprolol, atenolol , nevibolol
4) BACoN - intrinsically long duration action OD
bisoprolol, atenolol, celiprolol nadolol

39
Q

name alpha blockers

A

doxazosin, terazosin, alfuzosin , tamsulosin

40
Q

CCB moa and example of dihydropyridine

A

reduce force of contraction block calcium channels

nifedipine amolodopine felodopine

41
Q

same brand of ccb

A

nifedipine

42
Q

s/e of ccb

A

ankle swelling, flush , h/a , palpitation

43
Q

what are rate limiting ccb

A

diltizem (prescribe by brand esp >60mg)
verapamil (causes constipation only rlccb licensed in arryhtmai

44
Q

interaction ccb

A

enzyme inhibitor inc conc ie grapefruit juice

45
Q

what anti hypertensive would u not prescribe with rl ccb

A

beta blocker as inc risk bradycardia and cardio depression

46
Q

experience ankle swelling in amlodipine ?

A

switch to TRD

Cardiovascular (12 decks)

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