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Clinical pharmacology and therapeutics > Hypertension > Flashcards

Hypertension Flashcards

1
Q

Why is controlling bp important

A 
Reduction in CV damage
Preservation of renal function
Limit or reverse left ventricular hypertrophy
PRevention of IHD
Reduction in mortality due to strole/MIs
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2
Q

BP hypertension in clinic?

A

140/90

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3
Q

BP in home/ambukatory

A

130/85

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4
Q

What BP requires same day referral

A

> 180/120

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5
Q

When is renin released by kidney

A

When it detects low levels of sodium, and when it detects low blood pressure

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6
Q

What is the RAAS system

A

Renin turns angiotensin (formed by liver) into angiotensin 1. ACE then turns this into angiotensin 2.

Angiotensin 2 causes vasoconstriction and acts on adrenal gland to release aldosterone.

Aldosterone then acts on distal convuluting tubule of kidney and early collecting duct of the kidney to cause sodium retention and potassium loss. This then increases retention of water which increases circulating volume

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7
Q

Role of ACEI

A

Inhibit ACE. Therefore:

  • Reduce arterial and venous vasoconstriction
  • Reduced aldosterone production
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8
Q

Side effects of ACEI

A

Potentiate bradykinin which leads to cough

May increase Potassium (interaction with salt KCL substitute)

Angioedema (increased incidence in black patients)

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9
Q

When should ACEI be avoided

A 
Renovascular disease (bilateral renal artery stenosis)
-Renin-dependent hypertension. ACEI lead to renal underperfusion and severe hypotension
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10
Q

What should you monitor before and during treatment of ACEI

A
  • eGFR

- K+

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11
Q

What is the best antihypertensive in patients with diabetes and why

A

ACEi

They’re effective in preventing nephropathy in DM

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12
Q

Action of AT1 receptor antagonists

A

Block the effect of angiotensin 2 which acts at the AT1 receptor to cause vasoconstriction

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13
Q

Do AT1 receptor antagonists give rise to cough

A

no

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14
Q

Two classes of calcium channel inhibitors

A

Rate limiting (e.g. verapamil): have greater effecrs on cardiac tissue

Dihydropyridines (e.g. amlodipine) more on vascular smooth muscle

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15
Q

Mechanism of action of calcium channel inhibitors

A

Inhibit voltage operated Ca2+ channels on vascular smooth muscle leading to vasodilatation and reduction in BP

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16
Q

Action of thiazide like diuretics and what line treatment it is

A

Second line

Inhibit Na+/Cl- trasnporter system in distal convuluting tubule which leads to a reduction in circulating volume. It also causes vasodilatation

17
Q

Are thiazide like diuretics effective in moderate renal impairment

A

No

-But measure eGFR before and during use

18
Q

Important side effects of thiazide like diuretics

A

Hypokalaemia
Postural hypotension
Impaired glucose control
Do not use in gout

19
Q

When not to use thiazide like diuretics

A

Gout

20
Q

Mode of action of alpha blockers

A

Competitive receptor antagonists of a1 adrenoceptors which cause vasodilation

21
Q

Why are alpha blockers last choice antihypertensives

A

Widespread side effects, which makes them poorly tolerated

22
Q

Mode of action of beta blockers

A

Mechanism unclear -
-Reduction in sympathetic drive to the heart, reducing cardiac output

-Reduction in sympathetically evoked renin release

23
Q

WHen are beta blockers contraindicated

A

Asthma

  • Caution in COPD
  • Heart block
24
Q

Side effects of calcium channel blockers

A

Peripheral oedema

some- constipation

25
Q

When are people told to take ACEi

A

At night as can cause severe first dose hypotension

26
Q

What should be monitored in thiazide like diuretics

A

K+

Glucose as can be diabetogenic

27
Q

What should be used in a patient with ischaemic heart disease

A

Beta blocker

28
Q

First line treatment for those with
-Hypertension and 2DM
or
-<55yo and non black

A

ACEi or ATRA (AT1 receptor antagonist)

29
Q

First line treatment for those
->55yo
or
-Black

A

CCI

30
Q

Second line treatment in those with hypertension and
-2DM
or
-<55yo and non black

A

ACEi/ATRA

+

CCI or diuretic

31
Q

Second line treatment in those with hypertension and
->55yo
or black

A

CCI

+ ACEi/ATRA or diuretic

32
Q

Third line treatment for hypertension for everyone

A

ACEi/ATRA +CCI + diuretic

33
Q

Fourth line treatment for hypertension

A

Referral or add spironolactone or alpha blocker or beta blocker

34
Q

What to use if patient has IHD and hypertension

A

CCI

35
Q

WHat to not use if patient has renovascular disease

A

ACEi and ATRA

36
Q

What causes potential hyperkalaemia in use of ACEi

A

Decreased release of aldosterone

Clinical pharmacology and therapeutics (16 decks)

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