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Adele Cardiovascular > Hypertension > Flashcards

Hypertension Flashcards

1
Q

what are the values for stage 1 hypertension?

A

clinic blood pressure 140/90 mmHg or higher

ABPM daytime average 135/85 mmHg or higher

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2
Q

what are the values for stage 2 hypertension?

A

clinic blood pressure 160/100 mmHg or higher

ABPM daytime average 150/95 mmHg or higher

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3
Q

what are the values for severe hypertension?

A

clinic systolic blood pressure is 180 mmHg or higher or diastolic blood pressure is 110 mmHg or higher

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4
Q

how does the target blood pressure differ in patients aged over 80 years compared with those aged 55-80 years?

A

55-80 - target is <135/85

80+ - target is <145/85

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5
Q

what is step 1 in antihypertensive treatment for people aged over 55 / black people of African or Caribbean family origin?

A

calcium channel blocker (CCB)

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6
Q

in patients where a CCB is not suitable (oedema, intolerance) or there is evidence of heart failure or a high risk of heart failure, what is the alternative?

A

thiazide-like diuretic

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7
Q

what is the first step in antihypertensive treatment for patients under the age of 55?

A

ace inhibitor / ARB

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8
Q

what are the contraindications for ACEI / ARB?

A

afro-caribbean or women of child bearing age

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9
Q

how do you treat resistant hypertension when the blood potassium level is <4.5 mmol/L?

A

consider further diuretic therapy with low dose spironolactone (25 mg once daily)

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10
Q

how do you treat resistant hypertension when the blood potassium level is >4.5 mmol/L?

A

consider higher dose thiazide-like diuretic

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11
Q

why should you exercise caution with certain patients when prescribing spironolactone?

A

people with a reduced estimated GFR may have an increased risk of hyperkalaemia

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12
Q

give an example of an angiotensin converting enzyme inhibitor

A

ramipril

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13
Q

what are the contraindications of prescribing ACEIs?

A

renal artery stenosis
renal failure
hyperkalaemia

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14
Q

what are the adverse drug reactions associated with ACEIs?

A 
cough
first dose hypotension
taste disturbance
renal impairment
angioneurotic oedema
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15
Q

which other drugs do ACEIs interact with?

A

NSAIDs (precipitates acute renal failure)

potassium supplements / potassium sparing diuretics (hyperkalaemia)

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16
Q

give an example of an angiotensin II antagonist

A

losartan
valsartan
candesartan
irbesartan

17
Q

what is an advantage of using an angiotensin II antagonist over an angiotensin converting enzyme inhibitor?

A

no cough

18
Q

give an example of a calcium channel blocker

A

amlodipine, felodipine (vasodilator)

verapamil, diltiazem (rate limiting)

19
Q

what are the contraindications of using calcium channel blockers?

A

acute MI

heart failure, bradycardia (rate limiting CCBs)

20
Q

what are the adverse drug reactions of calcium channel blockers?

A 
flushing
headache
ankle oedema
indigestion and reflux oesophagitis
bradycardia, constipation (rate limiting)
21
Q

give an example of a thiazide type diuretic

A

indapamide

clortalidone

22
Q

what are the adverse drug reactions of thiazide type diuretics?

A

gout

impotence

23
Q

give an example of an alpha-adrenoceptor antagonist

A

doxazosin

24
Q

give an example of a centrally acting agent

A

methyldopa

moxonidine

25
Q

give an example of a vasodilator

A

hydralazine

minoxidil

26
Q

what are the adverse drug reactions of alpha-adrenoceptor antagonists?

A

first dose hypotension
dizziness
dry mouth
headache

27
Q

what are the adverse drug reactions of centrally acting agents?

A

sedation and drowsiness
dry mouth and nasal congestion
orthostatic hypotension

28
Q

how do you treat hypertension in a woman of child bearing age (not yet pregnant)?

A 
nifedipine mr (CCB)
methyldopa (CAA)
atenolol, labetalol (BB)
29
Q

how do you treat hypertension once a woman becomes pregnant?

A

add thiazide diuretic and / or amlodipine (CCB)

30
Q

how do you treat preeclampsia?

A

as previous plus IV hydralazine, esmolol, labetalol

31
Q

how do ACEIs work?

A

competitively inhibit the actions of angiotensin converting enzyme, which converts angiotensin I to angiotensin II, a potent vasoconstrictor and hypertrophogenic agent (wtv that means)

32
Q

how do ARBs work?

A

competitively block the actions of angiotensin II at the angiotensin AT1 receptor

33
Q

how do CCBs work?

A

blocking the L type calcium channels
selectivity between vascular and cardiac L type channels
relaxing large and small arteries and reducing peripheral resistance
reducing cardiac output

34
Q

how do thiazide type diuretics work?

A

urinary excretion of sodium

resistance vessel dilatation

35
Q

how do alpha-adrenoceptor antagonists work?

A

selectively block post synaptic alpha1-adrenoceptors

oppose vascular smooth muscle contraction in arteries

36
Q

how do centrally acting agents work?

A

converted to alpha-methylnoradrenaline which acts on CNS alpha adrenoceptors which decrease central sympathetic outflow

Adele Cardiovascular (14 decks)

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