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Maddie’s Pharm > Hypertension and Heart Failure > Flashcards

Hypertension and Heart Failure Flashcards

1
Q

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

A

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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2
Q

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

A

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

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3
Q

Define hypertension. (3)

A

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

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4
Q

Describe the three categories for causes of hypertension (3)

A

Essential or primary - 90%
Secondary
White coat effect

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5
Q

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

A

Sitting, relaxed, arm supported.

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

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6
Q

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

A

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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7
Q

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

A

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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8
Q

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

A 
Exercise
Healthy diet (less salt)
Reduced stress
Reduced alcohol
Reduced caffeine 
Smoking cessation
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9
Q

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

A

ACE inhibitors
Angiotensin receptor blockers
Calcium channel blockers
Diuretics

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10
Q

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

A

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

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11
Q

Describe the effects of an ACEi. (4)

A

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

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12
Q

Give an example of an ACEi. (1)

A

Ramipril

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13
Q

Give the constant in all ACEi names. (1)

A

-pril

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14
Q

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

A

Dry cough (inhibition of bradykinin)
Angioedema
Renal failure
Hyperkalaemia

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15
Q

Describe the mechanism of action of ARBs. (3)

A

Blocks Angiotensin II at the AT1 receptor which causes vasodilation

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16
Q

Describe the proper name for an ARB (2)

A

Angiotensin II receptor antagonist

Angiotensin Receptor Blocker

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17
Q

Name to ARBs (2)

A

Iosartan

Candesartan

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18
Q

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

A

-sartan

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19
Q

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

A

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

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20
Q

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

A

Renal failure

Hyperkalaemia

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21
Q

Describe the proper name for a CCB. (1)

A

L-type calcium channel blockers.

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22
Q

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

A

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

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23
Q

Name the three classes of CCB (3)

A

Dihydropyridine
Phenylalkyamine
Benzothiazapine

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24
Q

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

A

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

25
Q

Describe the pharmacokinetics of a dihydropyridine CCB. (3)

A

Good oral absorption, protein bound, liver metabolised.

26
Q

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

A

Can cause SNS activation:

Palpitations, headache, sweating, oedema.

27
Q

Describe a common drug interaction with amlodipine. (1)

A

Simvastatin

28
Q

Name a dihydropyridine CCB. (1)

A

Amlodipine.

29
Q

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

30
Q

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

A

Depresses SA node and slows AV conduction causing negative inotropy.

31
Q

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

A

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.

32
Q

Name one phenylalkylamine (1)

A

Verapamil.

33
Q

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

A

Constipation - reduced smooth muscle contraction.

Bradycardia - negative inotrope.

34
Q

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

A

Impeded Ca2+ transport to prolong the action potential.

35
Q

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

A

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

36
Q

Name one benzothiazapine. (1)

A

Diltiazem.

37
Q

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

A

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

38
Q

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

A 
Hypokalaemia 
Increased blood urea
Decreased glucose tolerance 
Increased blood cholesterol 
RAAS activation
39
Q

Describe the NICE guidelines for treating hypertension. (8)

A

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.

40
Q

Describe spironolactone. (1)

A

A mineralocorticoid / aldosterone receptor antagonist.

41
Q

Describe aliskirin. (1)

A

A direct Renin inhibitor.

42
Q

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

A 
Alpha-adrenoceptor blockers
Beta-adrenoceptor blockers
Spironolactone
Amiloride (K+ sparing diuretic) 
Aliskirin (direct Renin inhibitor) 
NO- (vasodilator)
Labetalol (reduces sympathetic outflow).
43
Q

Describe the main treatment for gestational hypertension. (3)

A

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

44
Q

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

A

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

45
Q

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

A

Use in renal disease.

Do not use with amlodipine (high oedema risk)

46
Q

Describe the adverse effects of alpha blockers. (3)

A

Postural hypertension
Headache
Oedema (esp with amlodipine).

47
Q

Name one alpha blocker. (1)

A

Dixazosin.

48
Q

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

49
Q

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

A

Descrease sympathetic tone by blocking noradrenaline action and reducing myocardial contraction

50
Q

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

A

Bronchoconstriction
Can mask tachycardia
Bradycardia
Raynauds.

51
Q

Name one beta blocker. (1)

A

Bisoprolol

52
Q

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

53
Q

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

A

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.

54
Q

Describe the viscous cycle of heart failure. (6)

A

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

55
Q

Describe the management of heart failure. (11)

A

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.

56
Q

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

A

To avoid a sudden and dangerous drop in BP.

57
Q

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

A

Reduction in symptoms - dyspnoea, fatigue, oedema

Reduction in mortality - arrhythmia, hyperlipidaemia.

58
Q

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

A

Labetalol - Beta blocker safe in pregnancy

Don’t give diuretics.

Maddie’s Pharm (23 decks)

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