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Therapeutics > Hypertension > Flashcards

Hypertension Flashcards

1
Q

Define hypertension.

A

Persistently elevated BP measured on 3 separate occasions, minimum of 2 days apart, systolic ≥140 and / or diastolic ≥90 mmHg
OR
When severely elevated, minimum of 3 readings on same visit.
>180mmHg/110mmHg

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2
Q

Outline the 3 causes of hypertension

A

Inappropriately high sympathetic outflow.
Inappropriately high renin release
abnormal renal salt/water handling

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3
Q

Which antihypertensive medication is more effective in a black population?

A

A calcium channel blocker + either thiazide or ACE inhibitor

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4
Q

What are the therapeutic objectives for the management of hypertension?

A

Reduce morbidity and mortality
Obtain target BP goals of <140/90 mmHg or <130/80 mmHg with diabetes or renal disease.
Prevent disease progression
Improve quality of life

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5
Q

On which part of the nephron does Loop diuretics work, give the receptor as well?

A

Thick ascending Loop of Henle
Na/K/2Cl

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6
Q

Which part of the nephron does thiazides work? Provide the receptor as well.

A

Early Distal convoluted tubule
NaCl symporter

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7
Q

Which part of the nephrone does aldosterone antagonist work? Provide the receptor as well.

A

Collecting Ducts
ENaC

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8
Q

Example of high ceiling diuretics.

A

Furosemide. Loop diuretics

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9
Q

Example of a Low ceiling diuretic

A

Thiazide diuretics. Hydrochlorothiazide.

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10
Q

Adverse side effects of Thiazides

A

Hypokalaemia
Hyponatraemia
Gout
Metabolic alkalosis
Glucose intolerance

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11
Q

What is hypo/hyperkalaemia an increased risk for?

A

Ventricular arrhythmias

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12
Q

How does the Thiazide lead to glucose intolerance

A

hypokaelemia, beta pancreatic cell hyperpolarization deceased insulin secretion.

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13
Q

Adverse effects of Loop Diuretics.

A

Hyponatraemia
Hypokalaemia
Hypocalcaemia
Postural Hypotension
Dyslipidaemia
Metabolic Alkalosis
Hearing impairement

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14
Q

Adverse effects of spironolactone,

A

Hyperkalemia
Oestrogen related effects
Erectile dysfunction

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15
Q

Which Diuretic is safe to use in a kidney failure?

A

Loop Diuretics

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16
Q

Adverse effects of ACE inhibitors.

A

Dry cough
Hyperkalaemia
Angioedema
First dose hypotension

17
Q

Benefits of ACE-inhibitors

A

Reduce progression to diabetic glomerulopathy
reduce Glomerulosclerosis
Reduce ANG II and thus eliminates the unnecessary cardiac remodeling that happens after an MI

18
Q

Contraindication for ACE inhibitors

A

Bilateral renal artery stenosis
Pregnancy
Previous History of angiodema

19
Q

The function of Dihyropyridine.

A

Anti-hyertensives, ends in the pine
Vasodilation

Afterload reduction

SNS activation (transient reflex tachycardia)

Can be used with beta blockers.

20
Q

The function of Non-dihydropyridine

A

Anti-arrythmic properties

Slow conduction in the SA and AV nodes

Depress sinus node

Cumulative negative ionotropic effect when used with β-blocker, should not be used with beta blockers

21
Q

Mechanism of action of Calcium channel blockers.

A

Blocks voltage gated Ca2+ channels (L-type/slow channels)
this inhibits the uptake of Ca2+ into the cells and as a result no contraction can occur

22
Q

Adverse effects of Calcium channel blockers.

A

Ankle oedema
Headache
Flushing
Constipation
Gum hypertrophy

23
Q

Contraindications to calcium channel blockers.

A

Hypotension
Bradycardia
Decompensated Congestive Heart Failure

24
Q

Contraindications for Non-dihropyridines.

A

Beta blockers
Pre-existing AV nodal disease

25
Q

Non-selective beta blockers.

A

Propranolol
Carvedilol (has additional a blocking property)
Labetalol

25
Q

Cardioselective B1 blockers.

A

Atenolol
Metoprolol

26
Q

What are beta blockers used for?

A

Heart failure
Angina
Atrial fibrillation – Rate control

27
Q

Contraindications for beta blockers.

A

Asthma
Atrioventricular block or Sinoatrial node dysfunction
Decompensated heart failure

28
Q

Adverse effects of beta blockers.

A

Metabolic
Hypoglycemic unawareness in diabetics on insulin (type 2 diabetes not a contraindication)
Increase triglycerides & lower HDL in plasma
Rebound hypertension
When stopped suddenly
Cold hands

29
Q

Adverse effects of methyldopa.

A

Sedation
Depression
Parkinsonism
Hyperprolactinaemia
Hepatotoxicity

Therapeutics (12 decks)

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