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CPT > Hypertension & Heart Failure > Flashcards

Hypertension & Heart Failure Flashcards

1
Q

What is the difference between primary and secondary hypertension?

A

Primary - no known cause, just associated risk factors.

Secondary - caused by an underlying disease e.g. Kidney disease, coarctation of the aorta, taking COCP.

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2
Q

What is prehypertensive hypertension?

A

Slight increase in BP that can be reduced by non-pharmacological measures such as increased exercise.

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3
Q

What is white coat syndrome?

A

A real phenomenon where people’s BP increases in a clinical setting.

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4
Q

What BP defines hypertension?

A

140/90mmHg.

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5
Q

What is malignant hypertension?

A

Extremely high BP that develops rapidly and is a medical emergency, causes organ damage.

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6
Q

If BP records differently on each arm, which measurement is used?

A

Higher reading.

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7
Q

How is stage 1 hypertension classified?

A

> 140/90, or >135/85 for HBPM, or >130/80 for people that have diabetes or renal disease.

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8
Q

How is stage 2 hypertension classified?

A

> 160/100, or >150/95 for HBPM

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9
Q

How is severe hypertension classified?

A

> 180 systolic or >110 diastolic.

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10
Q

What is isolated systolic hypertension?

A

When the diastolic pressure is normal <90mmHg but systolic pressure is raised - >140 is mild and >160 is moderate.

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11
Q

Name some non-therapeutic options to initially manage prehypertension or hypertension.

A
  • regular exercise
  • healthy/balanced diet
  • reduction in stress
  • reduced alcohol intake
  • reduced caffeine intake
  • smoking cessation
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12
Q

Name 2 ACEi.

A

Ramipril

Lisinopril

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13
Q

For a patient who is <55 years old and Caucasian, what is the first line hypertension treatment?

A

ACEi or ARB.

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14
Q

For a patient who is >55 or African/Caribbean, what is the first line hypertension treatment?

A

CCB or thiazide diuretic

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15
Q

Why is there no point in giving ACEi or ARBs to patients >55 or African/Caribbean origin?

A

As they already have low renin states and little RAAS action, therefore the ACEi or ARB would be quite ineffective.

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16
Q

What is the MOA of ACEi?

A

Limits conversion of angiotensin I to angiotensin II by inhibiting ACE, resulting in vasodilation, reduced aldosterone, reduced ADH release and reduced cell growth and proliferation.

17
Q

What is the most common side effect of ACEi and why?

A

Persistent dry cough.

Because bradykinin is a substrate for ACE, therefore with ACEi there is increased free bradykinin.

18
Q

Name 4 side effects of ACEi.

A
  • persistent dry cough
  • angioedema
  • renal failure
  • hyperkalaemia
19
Q

Name 2 Angiotensin Receptor Blockers.

A

Losartan

Candesartan

20
Q

What is the MOA of ARBs?

A

Block AT1 receptors to inhibit angiotensin II mediated vasoconstriction.

21
Q

Name some side effects of ARBs.

A
  • hyperkalaemia

- renal failure

22
Q

Name a CCB from each class.

A

Benzothiazapines - diltiazem
Dihydropyridines - amlodipine
Phenyalkylamines - verapamil

23
Q

What is the MOA of CCB in hypertension?

A

Block L-type Ca2+ channels found o smooth muscle of vasculature, this prevents Ca2+ influx and vasoconstriction.

24
Q

What is the primary choice antihypertensive in a low renin hypertensive state?

A

Calcium channel blocker

25
Q

Name 2 thiazide diuretics.

A

Bendroflumethiazide

Indapamide

26
Q

What is the MOA of thiazide diuretics?

A

Block NCC in early CT, resulting in natriuresis and diuresis which lowers ECF volume, decreasing TPR and BP.

27
Q

Why is there a risk of hypokalaemia with loop and thiazide diuretics?

A

Increased delivery of Na+ to distal DCT, which increases Na+ reabsorption at ENaC and increases K+ secretion.

28
Q

Which drug is a statin and also a calcium channel blocker?

A

Simvastatin

29
Q

Name a drug that can be used as an antihypertensive during pregnancy.

A

Labetalol (beta blocker).

30
Q

Name some symptoms of heart failure.

A
  • exercise intolerance
  • breathlessness
  • fatigue
  • oedema
31
Q

Why is heart failure known as the self-perpetuating spiral?

A

Baroreceptor trigger increased sympathetic drive which increases afterload, and reduced renal perfusion activates RAAS, which increases preload.

32
Q

What drug is used to relieve congestive symptoms in heart failure?

A

Furosemide

33
Q

What is refractory hyperaldosteronism/aldosterone escape? What drug is used instead?

A

Failure of both ACEi and ARBs to work on a patient, caused by RAAS gene polymorphism.
Spironolactone can be used instead.

34
Q

What is the benefit of using beta blockers for heart failure?

A

Blunts sympathetic influences, slower HR leads to longer diastolic filling period, better filling and improved CO.

CPT (24 decks)

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