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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
Q

What is the maximum rate of IV furosemide?

A

4mg/min

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26
Q

What can loop + thiazide diuretics do to glucose levels?

A

Hyperglycaemia

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27
Q

What rheumatological condition can be caused by diuretics?

A

Gout

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28
Q

Two main counselling points for ACEI initiation

A
  1. Dry cough

2. first dose postural hypotension

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29
Q

Monitoring parameters and duration of monitoring of ACEi

A

BP, U&Es ( particularly K+) at baseline, 6 months and 12 months

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30
Q

ARBS licensed for HF

A

Candesartan and Valsartan

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31
Q

Renin inhibitor example

A

Aliskiren

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32
Q

What percentage does BP need to be reduced by in the first 2 hours of a hypertensive emergency?

A

20 - 25%

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33
Q

What IV treatment is given in a hypertensive emergency?

A

sodium nitroprusside, GTN, nicardipine, labetalol, pendtolamine

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34
Q

How quickly should BP be reduced in hypertensive urgency?

A

Gradually over 24 - 48 hours

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35
Q

Oral treatment in hypertensive urgency

A

Amlodipine, labetalol, Felodipine

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36
Q

Three drugs used for HTN in pregnancy

A

Labetalol. methyldopa and nifedipine

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37
Q

How many days after birth should methyldopa be discontinued and switched to original HTN meds?

A

2 days after birth

38
Q

What drug should women with risk of pre-eclampsia take for 12 weeks prior to birth?

A

Aspirin

39
Q

Risk factors for pre-eclampsia

A

HTN, first pregancy, >40years, Pregnancy interval > 10 years, BMI > 35

40
Q

What drug is used first line for pre-eclampsia treatment

A

Labetalol

41
Q

If a pregnant lady had a BP of >150/90 how would we treat?

A

critical care needed - oral or IV labetalol / IV hydralazine / nifedipine MR (PO)

42
Q

What is given for lung maturation in women who have pre-eclampsia and are expecting a baby within 7 days?

A

IV betamethasone

43
Q

How are side effects of methyldopa reduced?

A

limit dose to 1g OD

44
Q

What is a risk associated with sudden clonidine withdrawal?

A

Rebound hypertension

45
Q

If a patient is on Moxonidine + Beta blocker and needs to discontinue one, which is discontinued first?

A

Beta blocker

46
Q

What is a side effect of Minoxidil that makes its inappropriate for women?

A

Hirsuitism

47
Q

Water soluble beta blockers

A

Soltalol, atenolol, nadiolol

48
Q

What is a benefit of water soluble beta blockers?

A

Less likely to cross BBB so reduced risk of nightmare side effect

49
Q

What heart condition are Beta blockers contra-indicated in?

A

2nd and 3rd degree heart block

50
Q

What conditions are beta blockers to be avoided in?

A

Asthma, Heart failure

51
Q

If an asthma patient has no other option but to start a beta blocker what does the BNF suggest you chose?

A

A cardioselective Beta blocker

52
Q

Example of cardioselective beta blockers

A

Atenolol, Bisoprolol, Nebivolol, Acebutolol

53
Q

Side effects of beta blockers

A

Fatigue, cold extremities, nightmares, hypoglycaemia or hypergylcaemia, masked tacycardia

54
Q

What type of beta blockers are preferred in diabetes?

A

Cardioselective

55
Q

Indications for beta blocker use

A
  1. Angina
  2. MI
  3. anxiety
  4. HF
  5. Arrythmia
  6. Thyroidtoxicosis
  7. migraine propylaxis
56
Q

What beta blocker is licensed for stable - moderate HF in > 70 year olds?

A

Nebivolol

57
Q

What beta blocker can be used to reverse thyroidtoxicosis?

A

Propanolol (takes 4 days)

58
Q

Examples of dihydropyridine CCB

A

amlodipine, felodipine, lercapidine, nifedipine

59
Q

Phenylalkylamine CCB

A

Verapamil

60
Q

Benzothiazine CCB

A

Diltiaziem

61
Q

Rate limiting CCB examples

A

Verapamil + Diltiaziem

62
Q

What heart condition should CCB be avoided in (except amlodipine)

A

HF

63
Q

What other anti-arrhythmic drug class should NOT be used alongside verapamil?

A

Beta blockers ( can ppt HF)

64
Q

Common side effect of verapamil

A

Constipation

65
Q

What CCB can be used in Raynaurds disease?

A

Nifedipine

66
Q

CCB side effects

A

gum hypertrophy, ankle oedema, flushing

67
Q

What CCB only have a licensed indication for HTN?

A

Lercapidine + Lacidipine

68
Q

What is Nimodipine used to treat?

A

SAH

69
Q

When can diltiaziem be prescribed as a generic?

A

If dose is <60mg in a standard formulation

70
Q

When is a specific brand needed to be specified for Diltiaziem?

A

If dose >60 + M/R preparation

71
Q

CCB that may pass through the GIT unchanged

A

Tildiem retard + Adalat LA

72
Q

What type of diuretic is hypokalaemia more common with?

A

Thiazide

73
Q

What diuretics are not to be used in gestational HTN due to risk of neonatal thrombocytopenia + reduced placental perfusion?

A

Thiazides + TL diuretics

74
Q

At what eGFR are Thiazide/ TL diuretics not effective?

A

<30ml/min

75
Q

Constituents of Co-amilozide

A

amiloride + hydrochlorthiazide

76
Q

What is the main electrolyte to monitor with co-amilozide

A

Potassium

77
Q

MHRA warning with hydrochlorthiazide

A

risk of non-melanoma skin cancer. Avoid sun, do not use in history of skin cancer or suspected moles

78
Q

What is the life threatening risk associated with starting ACEi

A

Angiodema

79
Q

In what patient group should ACEi be avoided

A

pregnant women

80
Q

When should perindopril be taken?

A

30 to 60 mins before food

81
Q

Maximum dose of Ramipril in hepatic impairment

A

2.5mg OD

82
Q

What type of drug is hydralazine?

A

Vasodilator

83
Q

What condition is the anti-hypertensive Phenoxybenzamine used in?

A

Phaechromocytoma

84
Q

What drug can be used to raise BP by acting on alpha receptors e.g if patient has have spinal anaesthetic?

A

Vasoconstrictors e.g. Metaraminol

85
Q

What condition is Midrodrine used in?

A

Severe orthostatic hypotension

86
Q

If a patient has oedema due to CHF which class of diuretics is most suitable?

A

Thiazides

87
Q

If a patient has pulmonary oedema which class of diuretics is most suitable?

A

Loop

88
Q

What class of duiretic inhibit sodium reabsorption at the beginning of the DCT?

A

Thiazides

89
Q

How long does it take for thiazides to work

A

1-2 hours, duration of action for 12 - 24 hours

90
Q

What osmotic diuretic can be used to treat cerebral oedema and raised IOP?

A

Mannitol

91
Q

What diuretics inhibit reabsorption from the ascending loop of henle?

A

Loop diuretics

BNF Cardiovascular (10 decks)

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