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ZA - Cardio Diseases > Hypertension and Anti-Hypertensive Drug Pharmacology > Flashcards

Hypertension and Anti-Hypertensive Drug Pharmacology Flashcards

1
Q

What is stage 1 hypertension?

A

140/90

ABPM - 135/85

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2
Q

What is stage 2 hypertension?

A

160/100

ABPM - 150/95

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3
Q

What is severe hypertension?

A

When either

S is >180
D is >110

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4
Q

What would you look for in a history to assess the risk of hypertension in the patient?

A

Smoking
Family history
Diabetic
Hypercholesterolaemia

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5
Q

What would you look for in the examination?

A

Assess if there is end organ damage

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6
Q

How would you look for LVH?

A

ECG and echocardiograms

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7
Q

How would you look for renal failure?

A

Renal ultrasounds
Estimated GFRs
Proteinuria (urine tests)

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8
Q

What is the step 1 treatment for a <55?

A

ACEI/ARBs

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9
Q

What is the step 1 treatment for >55s OR Afro-Caribbean OR of child bearing age?

A

CCBs

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10
Q

Step 2?

A

Add thiazide type diuretic

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11
Q

Step 3?

A

Add all three in

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12
Q

Step 4 if blood K+ is UNDER 4.5mmol/l?

A

Low dose SPIRONOLACTONE - 25mg/once daily. Can cause hyperkalaemia so careful in patients with a reduced GFR

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13
Q

Step 4 if blood K+ is OVER 4.5mmol/l

A

Use a higher dose thiazide type diuretic

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14
Q

Step 5?

A

Add a beta blocker

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15
Q

Step 6?

A

Use a “less common agent”

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16
Q

What is ramipril or perindopril and how do they work?

A

ACEIs - work by inhibiting ACE converting Angiotensin I to Angiotensin II

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17
Q

What does Angiotensin II do?

A

Makes aldesterone which retains Na+ therefore retaining fluid and increasing BP

Is also a vasoconstricor also increasing BP

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18
Q

What else can Angiotensin II do regarding organs?

A

Causes end organ damage - example is LVH as A2 is a hypertrophic agent

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19
Q

What is Conns and why does it produce HT as a symptom?

A

Excess aldesterone is made - increases BP

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20
Q

Contraindications of ACEIs?

A

Renal artery stenosis
Renal failure
Hyperkalaemia

21
Q

Adverse drug reactions of ACEIs?

A

Cough main one
1st dose HYPOtension a risk
Renal impairment

22
Q

Drug-drug interactions of ACEIs?

A

NSAIDS - precipitate acture renal failure

K+ supplements or K+ sparing diuretics - spironolactone

23
Q

Why is using ACEIs when hyperkalaemic bad?

A

Aldesterone used to remove K+ - if already got too much and you inhibit this removal response messes things up

24
Q

Name some ARBs

A

Losartan
Valsartan
Candesartan
Irbesartan

(SARTAN)

25
Q

What receptor does ARBs block?

A

AT1

26
Q

Do ARBS produce a cough?

A

No

27
Q

What 2 types of CCBs we got?

A

Vasodilators and Rate limiting

28
Q

Name the rate limiting CCBs.

A

Verapamil or diltiazem

29
Q

How do the rate limiting CCBs limit the rate?

A

Block the L type channels - negative inotropic effect

Also relax arteries which reduces TPR and CO - reduced myocardial O2 demand

30
Q

Name some vasodilating CCBs

A

Amlodipine and Felodipine

31
Q

When are vasodilating CCBs used?

A

In over 55s or women of child bearing age

32
Q

CCBS contraindications?

A

Rapid vasodilators can precipitate stroke or MI so NEVER use in at risk patients

33
Q

Adverse drug reactions of all CCBs?

A

Flushing
Headache
Ankle Oedema

34
Q

Adverse drug reactions of Rate limiting?

A

Bradycardia and Constipation

35
Q

Name some thiazide type diuretics?

A

Indapemide

36
Q

How to thiazides Ds work?

A

Block Na+ reabsorption (antinaurtic) and cause you to pee

37
Q

How long can thiazides take to show antiHT effects?

A

Weeks

38
Q

Adverse effects of thiazide Ds?

A

Gout
Impotence

These not common

39
Q

What are the “less commonly used” agents?

A

Alpha-1-adrenoreceptor antagonists

Centrally acting agents

Vasodilators

40
Q

Name a A1-adrenoreceptor antagonist.

A

Doxazosin

41
Q

How does doxazosin work?

A

Blocks the receptor and opposes smooth muscle contraction in arteries

42
Q

Adverse drug reactions of doxazosin?

A

1st dose HYPOtension
Dizziness
Headache
Dry mouth

43
Q

When should doxazosin be used?

A

Young patients who cannot tolerate other drugs

44
Q

Name a centrally acting agent, how does this drug work?

A

Methyldopa - alpha-2 receptor agonist causing vasodilation

45
Q

When is methyldopa used?

A

HT in pregnancy

46
Q

Adverse drug reactions of methyldopa?

A

Sedation
Dry mouth
Postural hypotension

47
Q

What is postural hypotension?

A

Rapid fall of BP when you stand up

48
Q

Name 2 vasodilators?

A

Hydralazine

Minioxidil

ZA - Cardio Diseases (36 decks)

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