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High - Cardiovascular system > Hypertension > Flashcards

Hypertension Flashcards

1
Q

What are the stages of hypertension

A

One: 140/90
- Lifestyle advice
- Antihypertensive drugs

Two: 160/100
- Antihypertensive for all

Three: >180/110
- Treat promptly

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2
Q

When would you offer medication in stage one hypertension?

A

80+ and BP 150/90

Under 80 w/:

  • Target organ damage (CKD, retinopathy)
  • 10 year CVD risk >10% (consider if under 60)
  • Diabetic, kidney disease
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3
Q

What is given as first line in hypertension?

A

<55 / T2DM
ACE inhibitor (ARB if not tolerated - dry cough)

55+ / Black
CCB (Thiazide related diuretic if not tolerated (oedema) / HF)

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4
Q

What is given for black african w/ type 2 diabetes

A

ARB

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5
Q

What is given for a newly diagnosed patient with hypertension who has a medical history of type 2 diabetes + HF and is already on an ACEi?

A

Thiazide related diuretic

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6
Q

What is second line in hypertension?

A

(before adding, increase dose of monotherapy) +

<55 / T2DM
ADD CCB OR TRD

55+ / Black
ADD ACEi (or ARB) OR TRD

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7
Q

What is third line in hypertension?

A

Offer ALL medication (ACEi/ARB and CCB and thiazide like diuretic)

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8
Q

What is fourth line in hypertension?

A

Confirm resistent hypertension:

K+ <4.5: low dose
spironolactone

K+ > 4.5: high dose alpha blocker OR beta blocker

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9
Q

What is the treatment in pregnant women?

A

Target: <135/85

  • First line: Labetalol (hepatotoxic, STOP if jaundice occurs)
  • Alt: nifedipine MR
  • If both unsuitable: methyldopa (stop 2 days after birth)
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10
Q

What is the BP targets in <80?

A

<140/90

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11
Q

What is the BP targets in >80?

A

<150/90

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12
Q

What is the BP targets in kidney disease?

A

<140/90
ACR >70: 130/80

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13
Q

What are the BP targets in type 1 diabetes?

A

<140/90
- ACR >70: <130/80
- 80: <150/90

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14
Q

What is the MOA of ACEi?

A

Block ACE enzymes that convert angiotensin I to angiotensin II

Angiotensin II raise BP by constricting blood vessels + stimulates release of aldosterone, increasing plasma volume

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15
Q

How is perindopril taken?

A

30-60 min before food

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16
Q

What are the indications of ACEi and ARB?

A
  • First line: HPT + HF
  • LT management after heart attack
  • CVD prevention
  • Diabetic nephropathy
  • CKD
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17
Q

What are the side effects of ACEi/ARBs?

A

CAPTOPRIL

  • Cough dry (ACEi)
  • Angioedema (swollen lips + tongue esp in Black)
  • Postural hypotension
  • Taste disturbance
  • Oral ulcer (ACEi)
  • Potassium INC
  • Renal impairment (RED blood flow to kidneys, lowers GFR by vasodilating the efferent arterial of the glomerulus)
  • Indigestion (ACEi)
  • Lower BP (1st dose)
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18
Q

Can you use ACi/ARB in pregnancy?

A

No - teratogenic

19
Q

What are the interactions of ACEi/ARBs?

A

Hypotension:
- Diuretics - volume depletion (urinate more, RED blood plasma volume, blood pressure is regulated by plasma volume)
- Anti-hypertensive
- Dopaminergic drug: levo-dopa, dopamine-receptor antagonist

Hyperkalaemia:
- Spironolactone
- Potassium supplements
- Potassium sparing diuretics
- NSAIDs - also INC AKI

20
Q

What is the MOA of CCB?

A
  • Interferes w/ Ca2+ influx in vascular smooth muscle and heart
  • DEC BP, HR + force of contraction, SA note automaticity + AV node conductivity
21
Q

What are examples of dyhydropyradine CCB

A

ACT ON BLOOD VESSELS

  • Amlodipine (OD)
  • Felodipine (OD)
  • Nifedipine (SAME brand for MR when dose >60mg)
  • Nimodipine (indication: aneurysmal subrachnoid haemorrhage)
22
Q

Give examples of rate limiting CCB

A

DEPRESS THE HEART BY RED HR + FORCE OF CONTRACTION

  • Diltiazem (SAME brand for MR when dose >60mg)
  • Verapamil (arrhythmias)
23
Q

What are the indications of CCB?

A
  • First line: Hypertension
  • Angina
  • Arrhythmias
  • HF - amlodipine (MUST avoid other CCB due to RED cardiac output)
24
Q

What are the side effects of CCB?

A
  • Oedema, flushing, headache - associated w vasodilation
  • Tachycardia + palpitations
  • Angioedema, gingival hyperplasia (enlargement of gums)
  • Constipation (verapamil)
25
Q

What are the interactions of CCB?

A

Enzyme inhibitors (clarith + eryth, azole antifungal, grapefruit) → INC CCB levels

Enzyme inducers→ DEC CCB levels

Hypotension:
- Diuretics
- Anti-hypertensive:
- Dopaminergic drug: levo-dopa, dopamine-receptor antagonist

Verapamil/diltiazem + beta-blocker → bradycardia, severe hypotension + HF in IHD

Verapamil/diltizem + digoxin → bradycardia

26
Q

What is the MOA of beta blockers?

A

-Blocks B-adrenoreceptors in peripheral vasculature + heart

-DEC BP, HR + force of contraction, SA note automaticity + AV node conductivity

-Part of fight/flight SNS, activated by noradrenaline + adrenaline

27
Q

What is the indication of nebivolol?

A

stable mild-mod HF in 70+

28
Q

What are the indications for propranolol?

A

migraine prophylaxis, anxiety, thyrotoxicosis

29
Q

What is the side effect of sotalol?

A

Torsade de pointes

30
Q

What are the indications for beta blockers?

A
  • First line: HF + angina
  • Hypertension
  • Arrhythmias
  • LT management after heart attack
31
Q

PACO

A

DEC bradycardia
DEC cold extremity
Pindolol Acebutolol Celiprolol Oxprenolol

32
Q

Water CANS

A

Water soluble (red dose in renal impairment)
DEC sleep disturbance
Celiprolol Atenolol Nadolol Sotalol

33
Q

BAN Me

A

Cardio-selective
DEC bronchospasm (best for asthma)
Bisoprolol Atenolol Nebivolol Metoprolol

34
Q

ABC-N

A

Once daily (long duration)
Atenolol Bisoprolol Celiprolol Nadolol

35
Q

What are the side effects of betablockers?

A

BAD FISH
- Bradycardia + bronchospasm
- Atrioventricular block
- Disturbs glucose metabolism
- Fainting + dizziness
- Impotence
- Sleep disturbances
- Hypotension, HF, hands + feet cold

36
Q

What are the CI of betablockers?

A
  • Marked bradycardia
  • Asthma
  • 2nd/3rd heart block
  • Hypotension
  • Uncontrolled HF
37
Q

When would you be cautious to use betablockers?

A

Diabetics - masks hypo

38
Q

What are the interactions of betablockers?

A
  • Verapamil/diltiazem + beta-blocker → bradycardia, severe hypotension + HF in IHD
  • Amiodarone, digoxin, rate limiting CCB → cardiodepression
39
Q

What is the treatment for hypotension + shock?

A

Intrope (Adrenaline + dopamine) → INC heart contracts, pumping more blood + improving cardiac output

Vasoconstrictors

Avoid in cardiogenic shock bc BP will probably already be high + can worsen problem

40
Q

What are the causes of shock?

A
  • Cardiogenic - heart attack
  • Septic
  • Neurogenic - brain/spinal cord injury
  • Anaphylactic
  • Hypovolemic - haemorrhage
41
Q

What is the MOA of vasoconstrictor sympathomimetics?

A

Act on a-adrenergic receptor on peripheral blood vessels, causes vasoconstriction + raises BP

42
Q

What is the indication of vasoconstrictor sympathomimetics?

A

Acute hypotension if other measures fail

43
Q

What are examples of vasoconstrictor sympathomimetics?

A
  • Ephedrine (INC HR, dual action)
  • Midodrine
  • Noradrenaline
  • Phenylephrine (LA: prolonged INC BP)
44
Q

What is the side effect of vasoconstrictor sympathomimetics?

A

RED organ perfusion - INC blood pressure which can reduce blood flow to vital organs like kidneys, leading to organ failure

High - Cardiovascular system (7 decks)

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