Hypertension and Heart Failure Flashcards by Maddie Swannack

Describe the relationship between radius and resistance and explain the consequences of this relationship. (3)

Resistance is proportional to radius^4, meaning a little change in radius gives you a big change in resistance, and so a big change in blood pressure.

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Describe the 4 commonest things that hypertension can be related to. (4)

Vascular remodelling or hypertrophy
Increased vasoactive substances (noradrenaline, AngII)
Hyperinsulinaemia and hyperglycaemia
Endothelial dysfunction leading to lower NO- activity.

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Define hypertension. (3)

A persistently raised blood pressure (over 140/90) that is associated with increased risk of some harm (eg CVD).

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Describe the three categories for causes of hypertension (3)

Essential or primary - 90%
Secondary
White coat effect

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Describe the best practice with regards to taking a blood pressure measurement. (4)

Sitting, relaxed, arm supported.

Minimise the white coat effect with at home readings if appropriate.

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Describe the values of bp that are used to categorise hypertension. (7)

Stage 1 = 140/90 or 135/85 home
Stage 2 = 160/100 of 155/95 home
Severe = systolic > 180 or diastolic > 110
In diabetic or renal compromise - lower all readings by 10mmHg.

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Describe prehypertension. Explain why it is worth making changes early in this diagnosis. (3)

Below stage 1 diagnosis with no end organ damage is treated initially with lifestyle changes.
Prevents further worsening which would lead to end organ damage.

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Describe lifestyle changes that would help to lower blood pressure. (6)

Exercise
Healthy diet (less salt)
Reduced stress
Reduced alcohol
Reduced caffeine 
Smoking cessation

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Describe the four classes of drug used most commonly to treat hypertension. (4)

ACE inhibitors
Angiotensin receptor blockers
Calcium channel blockers
Diuretics

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Describe the mechanism of action of an ACEi. (3)

Limits conversion of Angiotensin I to Angiotensin II by inhibiting Angiotensin converting enzyme.

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Describe the effects of an ACEi. (4)

Vasodilation
Reduced aldosterone release
Reduced ADH release
Reduced cell growth and proliferation

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Give an example of an ACEi. (1)

Ramipril

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Give the constant in all ACEi names. (1)

-pril

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Describe the adverse drug reactions that occur when taking an ACEi. (4)

Dry cough (inhibition of bradykinin)
Angioedema
Renal failure
Hyperkalaemia

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Describe the mechanism of action of ARBs. (3)

Blocks Angiotensin II at the AT1 receptor which causes vasodilation

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Describe the proper name for an ARB (2)

Angiotensin II receptor antagonist

Angiotensin Receptor Blocker

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Name to ARBs (2)

Iosartan

Candesartan

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Describe the common feature to the names of all ARBs. (1)

-sartan

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Describe why ARBs are often preferred to ACEi by patients. (2)

Doesn’t present with a dry cough on ARBs because doesn’t inhibit bradykinin.

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Describe the adverse drug reactions common to ARBs. (2)

Renal failure

Hyperkalaemia

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Describe the proper name for a CCB. (1)

L-type calcium channel blockers.

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Describe the mechanism of action of a CCB. (2)

Inhibiting VOCC In smooth muscle and cardiac myocytes prevents Ca2+ mediated smooth muscle contraction.

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Name the three classes of CCB (3)

Dihydropyridine
Phenylalkyamine
Benzothiazapine

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Describe the mechanism of action of a dihydropyridine CCB. (2)

Selective for the peripheral VOCC (so no chronotropic or inotropic effects).

Describe the pharmacokinetics of a dihydropyridine CCB. (3)

Good oral absorption, protein bound, liver metabolised.

Describe the side effects of a dihydropyridine CCB and explain why they occur. (5)

Can cause SNS activation: | Palpitations, headache, sweating, oedema.

Describe a common drug interaction with amlodipine. (1)

Simvastatin

Name a dihydropyridine CCB. (1)

Amlodipine.

Describe the common feature of all names of CCBs of the dihydropyridine class. (1)

-ipine

Describe the mechanism of action of a phenylalkylamine CCB. (2)

Depresses SA node and slows AV conduction causing negative inotropy.

Explain why a phenylalkylamine CCB is not commonly used in hypertension or heart failure. Describe what they are used for. (8)

Not used in hypertension because impede Ca2+ transport, which reduces vasodilation. Not used in heart failure because is a negative inotrope, so can worsen heart failure. Only given in this case with a Beta blocker. Used in arrhythmia and angina.

Name one phenylalkylamine (1)

Verapamil.

Describe two common adverse drug reactions of a phenylalkylamine CCB and explain why they occur. (4)

Constipation - reduced smooth muscle contraction. | Bradycardia - negative inotrope.

Describe the mechanism of action of a benzothiazapine class of CCB. (2)

Impeded Ca2+ transport to prolong the action potential.

Describe the main side effect of a benzothiazapine CCB and describe how to combat it. (3)

Can cause bradycardia, so can make heart failure worse, so give with a beta blocker.

Name one benzothiazapine. (1)

Diltiazem.

Describe the mechanism of action of the diuretics used in hypertension. Name this class of diuretic. (5)

Inhibits Na+ reabsorption in the DCT to reduce blood volume, to reduce TPR. Thiazides diuretics.

Describe the adverse effects of diuretics used in hypertension. (5)

``` Hypokalaemia Increased blood urea Decreased glucose tolerance Increased blood cholesterol RAAS activation ```

Describe the NICE guidelines for treating hypertension. (8)

If under 55 or diabetic begin with ACEi or ARB If over 55 or Afro-Caribbean begin with CCB or diuretic. If this is inadequate control, add in one of the other categories (A+C or A+D) If this in inadequate, add in the other category (A+C+D) If this is inadequate, add in additional diuretics, alpha blockers, beta blockers, or spironolactone.

Describe spironolactone. (1)

A mineralocorticoid / aldosterone receptor antagonist.

Describe aliskirin. (1)

A direct Renin inhibitor.

Describe other hypertensive treatment options if A+C+D isn’t working or are contraindicated. (7)

``` Alpha-adrenoceptor blockers Beta-adrenoceptor blockers Spironolactone Amiloride (K+ sparing diuretic) Aliskirin (direct Renin inhibitor) NO- (vasodilator) Labetalol (reduces sympathetic outflow). ```

Describe the main treatment for gestational hypertension. (3)

Labetalol Centrally acting reduction of sympathetic outflow. Safe PO in gestational hypertension.

Describe the mechanism of action of alpha adrenoceptor blockers. (2)

Selective antagonist at post-synaptic alpha 1 adrenoceptors to antagonist the effects of noradrenaline. Stops peripheral vasoconstriction.

Give one indication for the use of alpha blockers and one contraindication of alpha blockers. (3)

Use in renal disease. | Do not use with amlodipine (high oedema risk)

Describe the adverse effects of alpha blockers. (3)

Postural hypertension Headache Oedema (esp with amlodipine).

Name one alpha blocker. (1)

Dixazosin.

Describe the common feature of all alpha blocker names. (1)

-zosin

Describe the mechanism of action of beta blockers. (2)

Descrease sympathetic tone by blocking noradrenaline action and reducing myocardial contraction

Describe the adverse drug reactions common with beta blockers (4)

Bronchoconstriction Can mask tachycardia Bradycardia Raynauds.

Name one beta blocker. (1)

Bisoprolol

Describe the common feature of the names of all beta blockers. (1)

-rolol

Define heart failure. (2) Describe the symptoms. (4) Describe the causes. (9)

Abnormal cardiac function which results in inadequate blood flow rate to metabolic tissues. Presents later with exercise intolerance, breathlessness, fatigue, oedema. Usually precipitated by cardiomyopathy: Inherited - congenital, arrhythmic Acquired - ischaemic, pressure overload, valve disease, infection, inflammation, alcohol.

Describe the viscous cycle of heart failure. (6)

Decreased CO > SNS and RAAS activation > Increased vasoconstriction and increased volume > increased preload and afterload > increased workload > decreased CO

Describe the management of heart failure. (11)

Correct underlying cause (eg valve failure) Change lifestyle (decrease salt and water intake) Furosemide to reduce symtoms ACEi or ARB to reduce afterload through vasodilation and reduced ADH release. Spironolactone - only with max ACEi and diuretics. Beta blockers - all CHF patients, because “blunts” sympathetic response, by descreasing heart rate and increasing filling and output.

Describe why ARBs or ACEi need to be started on the lowest possible dose in heart failure. (1)

To avoid a sudden and dangerous drop in BP.

Describe the aims of treatment of heart failure. (4)

Reduction in symptoms - dyspnoea, fatigue, oedema | Reduction in mortality - arrhythmia, hyperlipidaemia.

Describe the treatment of heart failure in pregnancy. (2)

Labetalol - Beta blocker safe in pregnancy | Don’t give diuretics.