HTN Flashcards
What is malignant hypertension?
Extremely high BP that develops rapidly and symptoms such as headache, congestive heart failure
Properties of ideal antihypertensive
Good BP control
Reduction in MI/Stroke
Few side effects
Once daily dosage and cost effectiveness
Examples of dihydropyridines
Nifedipine
Amlodipine
What can you not use nondihydropyridines with?
Beta blockers
Examples of directly acting vasodilators
Minoxodil
Minoxodil
Nitroprusside
Side effects of centrally acting drugs
Tiredness
Depression
What is the mechanism of action of alpha blockers?
Exert thier effects by blocking alpha receptors on vascular muscle which prevents reflex vasoconstriction reducing BP
Half life of doxazosin
22 hours
Half life of terazosin
12 hours
Treatment for hypertensive emergency
IV sodium nitroprusside or ACEI oral (15 mins onset)
Example of renin inhibitor
Aliskiren
When can you consider further diuretic therapy with low dose spironolactone?
Step 4 resistant hypertenson when blood potassium is 4.5mmol/l or lower
What if further diuretic therapy for resistant hypertension at step 4 is not tolerated what would you give?
Alpha blocker or beta blocker
Which drugs cause drug induced HTN?
Lithium, NSAIDs, liquorice, disulfiram, MAOIs, cyclosporine A, oestrogen and progesterone, glucocorticoids
Treatment option for PAH for less severe stages
Ambrisentan - endothelin receptor antagonists
What is gestational HTN?
New HTN presenting after 20 weeks without significant proteinura
What can use of beta blockers cause near term in pregnancy?
Beta receptor blockade - leading to neonatal bradycardia, hypotension, hypoglycaemia
What is second line for pregnancy HTN?
Nifedipine or methyldopa
What is pre eclampsia?
New HTN after 20 weeks WITH significant proteinura
What is the mechanism of methyldopa?
A2 adrenoceptor agonist
How often should you measure BP in moderate HTN in pregnancy?
Twice a week
How often should you do blood tests in severe HTN in pregnancy hypertension?
Test at presentation and then monitor weekly for LFTs, U&Es, FBC
What is iloprost?
Treatment for severe PAH - prostanoid analogue (potent pulmonary vasodilators synthesised by endothelin)
How is the heart vulnerable to hypoxic damage?
- Myocardium has high o2 uptake but small blood supply
- muscle only perfused in diastole
- Heart cant divert work from damaged to normal area
- Flow in coronary vessels is turbulent - leading to endothelial damage promoting atheromas
- More blood flows to epicardium but endocardium requires more o2
1st line treatment for stable angina
Beta blockers or CCB
2nd line treatment for stable angina
If they cant tolerate BB/CCB then switch to the other or a combination
If they cant tolerate either then monotherapy with
Long acting nitrate, ivabradine, nicorandil, ranalozine
When you would initiate treatment with oral labetolol in pregancy with gestational HTN?
Moderate and severe
How does liquorice increase BP?
deficiency of 11B-hydroxysteroid dehydrogenase and this enzyme converts cortisol to cortisone so increase in cortisol
What is stage 1 hypertension in clinic?
140/90
What is stage 2 hypertension at home measurement?
150/90
