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BNF Cardiovascular > Hypertension > Flashcards

Hypertension Flashcards

1
Q

What are the BP measurements for stage 1, stage 2 and severe HTN?

A

Stage 1: 140/90
Stage 2: 160/100
Severe: 180mmhg systolic or 110mmhg diastolic

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2
Q

Causes of HTN

A

Renal disease, obesity, hereditary, vascualar causes, Drugs (NSAIDS, COC)

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3
Q

Complications of HTN

A

MI, Stoke, AF, Renal failure, Peripheral vascular disease, HF

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4
Q

Non-pharmacological management of HTN

A

Diet (low salt, high veg, low caffeine etc)
Smoking cessation
Exercise
Aim for BMI 20- 25

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5
Q

What does NICE suggest if clinic BP is 140/90 to 179/119?

A

Offer ABPM, investigate target organ damage, assess CV risk

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6
Q

What does NICE suggest if clinic BP is 180/120 or more?

A

Offer ABPM, investigate target organ damage, assess CV risk, start drugs immediately, refer if life threatening symptoms / retinal haemorrhage / phaeochromocytoma

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7
Q

What are the clinic and ABPM blood pressure targets for an 80 year old?

A

clinic: 150/90, ABPM 145/85mmHg

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8
Q

What are the clinic and ABPM blood pressure targets for an <80 year old?

A

Clinic: <140/90mmHG, ABPM <135/85mmHg

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9
Q

What are the clinic BP targets for an 80 year old who is treated for HTN?

A

150/90

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10
Q

What are the clinic BP targets for an <80 year old who is treated for HTN?

A

140/90

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11
Q

What is the clinic BP target for a diabetic patient?

A

140/80mmHg

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12
Q

What is the clinic BP target for a diabetic patient with eye/CV risk involved?

A

130/80mmHg

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13
Q

What is the BP aim for a pregnant lady?

A

135/85mmHg

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14
Q

Patient with HTN or T2DM or <55 first line drug

A

ACEI / ARB

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15
Q

When would a CCB be first line for HTN?

A
  1. > 55

2. Black/afro carribbean

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16
Q

What is second line for HTN for a 20 year old?

A

ACEI / ARB + CCB or TL diuretic

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17
Q

If a patient has had a ACEi + CCB + TL diuretic with no sucess in lowering BP, what else can be used?

A
  1. lose dose spironolactose if K+ <4.5mmol/L

2. alpha blocker or beta blocker if K+ >4.5mmol/L

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18
Q

Example of a Thiazide diuretic

A

Bendroflumethiazide

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19
Q

how long does it take for complete diuresis with bendroflumethiazide?

A

12 to 24 hours

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20
Q

Example of Thiazide like diuretics

A

Indapamide, Chlortalidone

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21
Q

At what eGFR are thiazide + thiazide-like duretics ineffective?

A

CrCl < 30ml/min

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22
Q

Metolazone gives profound diuresis. What indication is it used for?

A

CHF (alongside loop diuretics)

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23
Q

Example of a loop diuretic

A

Furosemide

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24
Q

What is the first line diuretic in CHF?

A

Furosemide

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25
What is the maximum rate of IV furosemide?
4mg/min
26
What can loop + thiazide diuretics do to glucose levels?
Hyperglycaemia
27
What rheumatological condition can be caused by diuretics?
Gout
28
Two main counselling points for ACEI initiation
1. Dry cough | 2. first dose postural hypotension
29
Monitoring parameters and duration of monitoring of ACEi
BP, U&Es ( particularly K+) at baseline, 6 months and 12 months
30
ARBS licensed for HF
Candesartan and Valsartan
31
Renin inhibitor example
Aliskiren
32
What percentage does BP need to be reduced by in the first 2 hours of a hypertensive emergency?
20 - 25%
33
What IV treatment is given in a hypertensive emergency?
sodium nitroprusside, GTN, nicardipine, labetalol, pendtolamine
34
How quickly should BP be reduced in hypertensive urgency?
Gradually over 24 - 48 hours
35
Oral treatment in hypertensive urgency
Amlodipine, labetalol, Felodipine
36
Three drugs used for HTN in pregnancy
Labetalol. methyldopa and nifedipine
37
How many days after birth should methyldopa be discontinued and switched to original HTN meds?
2 days after birth
38
What drug should women with risk of pre-eclampsia take for 12 weeks prior to birth?
Aspirin
39
Risk factors for pre-eclampsia
HTN, first pregancy, >40years, Pregnancy interval > 10 years, BMI > 35
40
What drug is used first line for pre-eclampsia treatment
Labetalol
41
If a pregnant lady had a BP of >150/90 how would we treat?
critical care needed - oral or IV labetalol / IV hydralazine / nifedipine MR (PO)
42
What is given for lung maturation in women who have pre-eclampsia and are expecting a baby within 7 days?
IV betamethasone
43
How are side effects of methyldopa reduced?
limit dose to 1g OD
44
What is a risk associated with sudden clonidine withdrawal?
Rebound hypertension
45
If a patient is on Moxonidine + Beta blocker and needs to discontinue one, which is discontinued first?
Beta blocker
46
What is a side effect of Minoxidil that makes its inappropriate for women?
Hirsuitism
47
Water soluble beta blockers
Soltalol, atenolol, nadiolol
48
What is a benefit of water soluble beta blockers?
Less likely to cross BBB so reduced risk of nightmare side effect
49
What heart condition are Beta blockers contra-indicated in?
2nd and 3rd degree heart block
50
What conditions are beta blockers to be avoided in?
Asthma, Heart failure
51
If an asthma patient has no other option but to start a beta blocker what does the BNF suggest you chose?
A cardioselective Beta blocker
52
Example of cardioselective beta blockers
Atenolol, Bisoprolol, Nebivolol, Acebutolol
53
Side effects of beta blockers
Fatigue, cold extremities, nightmares, hypoglycaemia or hypergylcaemia, masked tacycardia
54
What type of beta blockers are preferred in diabetes?
Cardioselective
55
Indications for beta blocker use
1. Angina 2. MI 3. anxiety 4. HF 5. Arrythmia 6. Thyroidtoxicosis 7. migraine propylaxis
56
What beta blocker is licensed for stable - moderate HF in > 70 year olds?
Nebivolol
57
What beta blocker can be used to reverse thyroidtoxicosis?
Propanolol (takes 4 days)
58
Examples of dihydropyridine CCB
amlodipine, felodipine, lercapidine, nifedipine
59
Phenylalkylamine CCB
Verapamil
60
Benzothiazine CCB
Diltiaziem
61
Rate limiting CCB examples
Verapamil + Diltiaziem
62
What heart condition should CCB be avoided in (except amlodipine)
HF
63
What other anti-arrhythmic drug class should NOT be used alongside verapamil?
Beta blockers ( can ppt HF)
64
Common side effect of verapamil
Constipation
65
What CCB can be used in Raynaurds disease?
Nifedipine
66
CCB side effects
gum hypertrophy, ankle oedema, flushing
67
What CCB only have a licensed indication for HTN?
Lercapidine + Lacidipine
68
What is Nimodipine used to treat?
SAH
69
When can diltiaziem be prescribed as a generic?
If dose is <60mg in a standard formulation
70
When is a specific brand needed to be specified for Diltiaziem?
If dose >60 + M/R preparation
71
CCB that may pass through the GIT unchanged
Tildiem retard + Adalat LA
72
What type of diuretic is hypokalaemia more common with?
Thiazide
73
What diuretics are not to be used in gestational HTN due to risk of neonatal thrombocytopenia + reduced placental perfusion?
Thiazides + TL diuretics
74
At what eGFR are Thiazide/ TL diuretics not effective?
<30ml/min
75
Constituents of Co-amilozide
amiloride + hydrochlorthiazide
76
What is the main electrolyte to monitor with co-amilozide
Potassium
77
MHRA warning with hydrochlorthiazide
risk of non-melanoma skin cancer. Avoid sun, do not use in history of skin cancer or suspected moles
78
What is the life threatening risk associated with starting ACEi
Angiodema
79
In what patient group should ACEi be avoided
pregnant women
80
When should perindopril be taken?
30 to 60 mins before food
81
Maximum dose of Ramipril in hepatic impairment
2.5mg OD
82
What type of drug is hydralazine?
Vasodilator
83
What condition is the anti-hypertensive Phenoxybenzamine used in?
Phaechromocytoma
84
What drug can be used to raise BP by acting on alpha receptors e.g if patient has have spinal anaesthetic?
Vasoconstrictors e.g. Metaraminol
85
What condition is Midrodrine used in?
Severe orthostatic hypotension
86
If a patient has oedema due to CHF which class of diuretics is most suitable?
Thiazides
87
If a patient has pulmonary oedema which class of diuretics is most suitable?
Loop
88
What class of duiretic inhibit sodium reabsorption at the beginning of the DCT?
Thiazides
89
How long does it take for thiazides to work
1-2 hours, duration of action for 12 - 24 hours
90
What osmotic diuretic can be used to treat cerebral oedema and raised IOP?
Mannitol
91
What diuretics inhibit reabsorption from the ascending loop of henle?
Loop diuretics

BNF Cardiovascular (10 decks)

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