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5TH YR- CMS2 > hypertension > Flashcards

hypertension Flashcards

1
Q

What is hypertension

A

Raised blood pressure

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2
Q

List some consequences of hypertension

A
  1. Risk factor for cardiovascular problems
  2. Myocardial infarction
  3. Renal failure
  4. Heart failure due to left ventricular hypertrophy
  5. Left ventricular dysfunction
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3
Q

List some pathological changes linked with hypertension

A
  1. Thickening of the blood vessels walls
  2. Atherosclerosis
  3. Aneurysm formation
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4
Q

What can aneurysms and arterial wall thickening affect

A

Small arteries and arterioles and fibrinoid necrosis of the arteriolar wall

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5
Q

Why does hypertrophy of the left ventricle occur in hypertension

A

Due to increased pressure load on the myocardium and pathological changes in the renal glomeruli can also be seen

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6
Q

What can severe hypertension present as

A
  1. Visual disturbanves
  2. Headaches
  3. Changes in in mental function
  4. Impaired consciousness
    5.Fits and florid retinal changes (swelling of optic nerve)
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7
Q

Guidelines state we should treat patients with a blood pressure grater than what

A

Greater than 160/100 mmHg

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8
Q

What blood pressure do we aim to get hypertensive patients

A

140/85mmHg

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9
Q

Give examples of lifestyle choices that can increase risk of hypertension

A
  1. High salt intake
  2. Alcohol excess
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10
Q

Give examples of causes of secondary hypertension

A
  1. Renal diseases including renal artery stenosis and polycystic kidneys
  2. Cushing’s syndrome (cortisol excess, including steroid treatment)
  3. Conn’s syndrome (aldosterone excess)
  4. Phaeochromocytoma (catecholamine excess)
  5. Acromegaly
  6. Hyperparathyroidism
  7. Coarctation of the aorta
  8. Drugs including oral contraceptives and monoamine oxidase
    inhibitors
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11
Q

Give examples of drugs used to treat hypertension

A
  1. Diuretics
  2. Angiotensin-converting enzyme (ACE) inhibitors 3. Angiotensin II receptor antagonists (ARBs)
  3. Calcium channel blockers
  4. β-Adrenoreceptor antagonists (β-blockers)
  5. α-Adrenoreceptor blockers
  6. Vasodilators
  7. Centrally acting drugs.
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12
Q

What are diuretics classified into:

A
  1. Thiazides, e.g. bendroflumethiazide
  2. Loop, e.g. furosemide and bumetanide
  3. Potassium-sparing, e.g. amiloride
  4. Osmotic, e.g. mannitol
  5. Aldosterone antagonists including spironolactone
    and eplerenone.
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13
Q

Describe the mechanism of action of diuretics

A

Decrease reabsorption of sodium in the kidneys
this rise in excretion of sodium causes a greater loss of water which results in a drop in plasma volume

all diuretics do this apart from osmotic diuretics

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14
Q

Describe the mechanism of action for osmotic diuretics

A

Osmotic diuretics interfere with water reabsorption but they are not used for the management of hypertension.

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15
Q

Give examples of side effects of diuretics

A

Dry mouth
Thiazide diuretics may produce lichenoid reactions and Stevens–Johnson syndrome.

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16
Q

Give examples of interactions diuretics can have in the dental setting

A
  1. Thiazides and loop diuretics result in potassium loss, and exacerbate the hypokalaemia produced by adrena- line in dental local anaesthetic solutions. not a concern in low doses
  2. Aspirin reduces the action of spironolactone and acetazolamide.
17
Q

Give examples of ACE inhibitors

A

captopril,
enalapril,
lisinopril,
perindopril
ramipril.

18
Q

Describe the mechanism of action of ACE inhibitors

A

ACE inhibitors exert their antihypertensive action by inhibiting the production of angiotensin II which stimulates aldoestone which is important in fluid balance
ACE inhibitors prevent the breakdown of bradykinin, which mediates certain allergic reactions.
As bradykinin is a vasodilator, this action contributes to the antihypertensive action of ACE inhibitors.

19
Q

Give examples of side effects caused by ACE inhibitors

A
  1. Dry cough
  2. Dry mouth
  3. glossitis,
  4. erythema multiforme
  5. lichenoid reactions
  6. May cause loss of taste
  7. Angioedema
  8. Captopril may cause bone marrow depression that can result in anaemia, leukopaenia and thrombocytopaenia.
20
Q

Give examples of drug interactions ACE inhibitor have relevant to dental practice

A

ACE inhibitors can be antagonised by ibuprofen. In addition, this combination may lead to hyperkalaemia and renal impairment.
The absorption of tetracyclines is reduced by quinapril.

21
Q

Give examples of receptor a Angiotensin II receptor antagonists

A

candesartan, irbesartan and losartan.

22
Q

Describe the mechanism of action for Angiotensin II receptor antagonists

A

block type 1 Angiotensin II receptors
this results in vasodilation and a fall in blood pressure

23
Q

list soem dental side effects of Angiotensin II receptor antagonists

A

Some reports of taste disturbances

24
Q

What interactions can Angiotensin II receptor antagonists have in the dental setting

A

NSAIDS including aspirin reduce the hypotensive effects of Angiotensin II receptor antagonists
corticosteroids also reduce the hypotensive effects
anxiolytic drugs enhance hypotension

25
Q

What can calcium channel blockers be divided into

A
  1. Dihydropyridines, e.g. nifedipine, amlodipine, nicar- dipine and felodopine
  2. Non-dihydropyridines, e.g. verapamil and diltiazem.
26
Q

What can calcium channel blockers be divided into

A
  1. Dihydropyridines,
  2. Non-dihydropyridines,
27
Q

Give examples of Dihydropyridines

A

nifedipine, amlodipine, nicar- dipine and felodopine

28
Q

give examples of non Dihydropyridines

A

verapamil and diltiazem.

29
Q

Describe the mechanism of action of calcium channel blockers

A

They bind to L type calcium channels in Smooth muscle
they interfere with the entry of calcium into cells reducing contractility
they exert the effect on blood pressure by arterial vasodilation and a negative inotropic action

30
Q

Describe the mechanism of action of calcium channel blockers

A

dilate coronary and peripheral vessels

31
Q

What dental side effects can calcium channel blockers have on the oral mucosa

A

Gingival hyperplasia
taste disturbances

32
Q

What can calcium channel blockers interact with in a dental setting

A
  1. Can increase toxicity of lidocaine (not usually a problem)
  2. may exacerbate the hypokalae- mia induced by adrenaline in dental local anaesthetic cartridges.
  3. Diltiazem and verapamil increase the effects of midazolam,
33
Q

Give examples of β-Adrenoreceptor antagonistsused to treat hypertension

A

atenolol, labetolol, metoprolol and pro- pranolol

34
Q

Describe the mechanism of action of β-Adrenoreceptor antagonists

A
  1. Reduce renin release; β-adrenoreceptor agonists stimulate renin release
  2. Reduce cardiac output; β-adrenoreceptor action increases the rate and force of contraction of the heart
  3. Reduce sympathetic activity.
35
Q

What side effects canβ-Adrenoreceptor antagonists have in the mouth

A

Dry mouth
Intra oral luchenoid reactions
perioral numbness

36
Q

How can β-Adrenoreceptor antagonists interact with drugs in the dental setting

A
  1. May increase toxicity of LA (not a major concern)
  2. Ibuprofen antagonises the antihypertensive action of β-adrenoreceptor blockers
37
Q

Give examples of a-Adrenoreceptor blockers

A

Doxazosin and prazosin

38
Q

Describe the mechanism of action of a-Adrenoreceptor blockers

A

Selective a- agonist produce vasodilation

39
Q

What side effect can a-Adrenoreceptor blockers have

A

Postural hypotension seen

5TH YR- CMS2 (7 decks)

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