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Pharmacology > Hypertension + HF > Flashcards

Hypertension + HF Flashcards

1
Q

What are mechanisms of physiological control of blood pressure

A

RAAS:
vasoconstriction
NA + water reabsorption
Aldosterone release

Autonomic nervous system: HR, TPR

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2
Q

What is definition of hypertension

A

Chronically raised blood pressure:
Clinic BP >140/90
ABPM >135/85

Most important risk factor for CVD (stroke,ihd)

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3
Q

What is white coat hypertension

A

Raised clinic BP but normal ABPM

Do not treat

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4
Q

What is malignant hypertension

A

Rapid increase in BP, leading to severe hypertension and vascular damage
>200/130
Treat immediately

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5
Q

What is primary hypertension

A

Without underlying cause

95%

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6
Q

What is secondary hypertension

A

Underlying cause

5%

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7
Q

What are secondary causes of Hypertension

A

Renal: renal artery stenosis, pyelonephritis, glomerulonephritis, PCKD
Endocrine: Conns Syndrome, Cushing’s syndrome, pheochromocytoma, hyperparathyroidism
Drugs: steroids, oral contraceptives, NSAIDs

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8
Q

What are clinical features of hypertension

A

Asymptomatic
Signs of End organ damage
Malignant: headaches, visual disturbance, seizures

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9
Q

What investigations are required to diagnose hypertension

A

Clinic BP
ABPM or Home BP monitoring
Assess CV risk: glucose, cholesterol
Assess end organ damage: fundoscopy, urine dipstick, ECG

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10
Q

What are the stages of hypertension

A

Stage 1: cBP >140/90 And ABPM >135/85
Stage 2: cBP >160/100 and ABPM >150/95
Stage 3: cBP >180 systolic or >110 diastolic

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11
Q

What are treatment goals for hypertension

A

<140/90
<135/85 for DM
<150/90 for >80yo

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12
Q

What are lifestyle management of hypertension

A 
Low Na diet
Stop smoking 
Low caffeine intake
Low alcohol intake
Low fat diet 
Exercise
Weight loss
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13
Q

How do you manage clinic BP <140/90

A

No treatment

Normotensive

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14
Q

How do you manage clinic BP >140/90

A

ABPM or Home BP monitoring
Assess CV risk
Assess end organ damage

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15
Q

How do you manage clinic BP >180/110

A

Treat immediately

Referral if: retinal haemorrhage, papilloedema, suspected phaeochromocytoma

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16
Q

How do you manage ABPM <135/85

A

No treatment

Normotensive

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17
Q

How do you manage ABPM >135/85

A 
Treat if <80yo AND: 
10yr CV risk >20%
End organ damage
Diabetes
Reno-vascular disease 
CV disease
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18
Q

How do you manage ABPM >150/95

A

Treat

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19
Q

What is first step of management

A

<55yo: ACE-I or ARB

>55yo or Afro-carribean: CCB or Thiazide-like diuretic

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20
Q

What is second step of management

A

Ace-I + CCB or

ACE-I + Thiazide

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21
Q

What is third step of management

A

ACE-I + CCB + Thiazide

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22
Q

What is fourth step of management

A 
Add on a fourth drug: 
Spironolactone if K <4.5 mmol/L
Higher dose thiazide if K >4.5 mmol/L
Alpha or beta blocker if diuretic not tolerated
Renin inhibitor If non above tolerated
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23
Q

Why are thiazide-like diuretics preferred over traditional thiazide

A

Lower risk of hyponatraemia and falls

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24
Q

Give examples of ACE inhibitors

A

Ramipril

Lisinopril

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25
What is mechanism of action of ACE inhibitors
``` Reduce Angiotensin II synthesis Reduce vasoconstriction Reduce Na and water reabsorption Reduce aldosterone release Enhance bradykinin activity (vasodilator) ```
26
What are side effects of ace inhibitors
``` Dry cough Angio-oedema Renal failure Hyperkalaemia First dose hypotension ```
27
What are contra indications of ace inhibitors
High dose diuretics Severe aortic stenosis (sudden cardiac death) Renovascular disease Pregnancy + breastfeeding
28
What monitoring is required with ace inhibitors
U+Es Baseline After increasing dose
29
Give examples of ARB
Losartan | Candesartan
30
When is ARB indicated
When ACE-I not tolerated (dry cough)
31
What is mechanism of action of ARB
Inhibit Angiotensin AT1 receptor | Inhibit AII activity
32
What are side effects of ARB
Hyperkalaemia Renal failure Urticaria Pruritus
33
Give examples of CCB
Dihydropyridines: amlodipine Phenylalkylamines: verapamil Benzothiazepenes: Diltiazem
34
What is mechanism of action of CCB
Inhibit L type calcium channels Inhibit Ca influx Smooth muscle relaxation of peripheral, coronary and pulmonary arterioles
35
What are pk properties of amlodipine
Good oral bioavailability Long T1/2 Few active metabolites - safer in renal disease
36
What are side effects of amlodipine
``` Ankle Oedema Flushing sweating tachycardia palpitations ```
37
What is mechanism of action of verapamil
Inhibit Ca channels in SAN/AVN, cardiac myocytes, vascular SM Slow HR Reduce contractility Vasodilation
38
What are side effects of verapamil
Bradycardia Constipation Worsen HF
39
What are contraindications of verapamil
Heart failure
40
Give examples of thiazide diuretics
Bendroflumethiazide Thiazide-like diuretic: Metolazone Chlortalidone
41
What are contra indications of thiazide diuretic
Gout
42
Give examples of alpha blockers
Doxazocin
43
What is mechanism of action of alpha blockers
Inhibit alpha 1 adrenoceptor of Vascular SM Inhibit Ca influx Vascular SM relaxation Reduce TPR
44
What are side effects of alpha blockers
Postural hypotension Ankle oedema Dizziness
45
Give examples of beta blockers
Atenolol, bisoprolol
46
What is mechanism of action of beta blockers
Inhibit beta 2 adrenoceptor of Heart reduce HR and contractility Inhibit renin release
47
What are side effects of beta blockers
``` Bronchospasm Bradycardia Lethargy Impaired glucose tolerance Impaired exercise tolerance Impotence ```
48
What are contraindications of beta blockers
Asthma
49
Give examples of renin inhibitors
Aliskiren
50
What is mechanism of action of renin inhibitors
Inhibit conversion of angiotensinogen to Angiotensin I | Reduce AII levels
51
What are side effects and contra indications of aliskiren
Diarrhoea | Pregnancy
52
Give examples of direct acting vasodilator
Hydralazine | Miroxidil
53
When is direct acting vasodilator indicated
Severe hypertension
54
How do you manage malignant hypertension
Treat immediately Controlled reduction over days Oral admin
55
How do you manage hypertensive encephalopathy
IV sodium nitroprusside | BP reduction to 110 diastolic over 4 hrs
56
What are cautions of sodium nitroprusside
Metabolised to cyanide Caution in liver disease Avoided repeated use
57
What are side effects of hydralazine
Flushing Tachycardia Drug-induced Lupus
58
What drugs are used in pharmacological management of heart failure
``` Beta blocker Ace inhibitor Spironolactone Hydralazine combined with nitrate Digoxin Diuretics: loop, thiazide ```
59
Which medications improve long term mortality in heart failure
Beta blockers Ace inhibitors Spironolactone Hydralazine with nitrates
60
What is the role of diuretics in heart failure management
Symptom relief | No improvement in mortality
61
What is first step of management of heart failure
Beta blocker | Ace inhibitor
62
What is second step of management of HF
Addition of spironolactone or ARB or Hydralazine with nitrates
63
What is third line of management of HF
Addition of Digoxin
64
Which diuretics are used in HF management
Loop: furosemide Add Spironolactone: If hypokalaemic Add thiazide: if refractory oedema
65
What are indications of ACE I
All HF patients
66
What are indications of Beta blockers | What caution is required
All HF patients | Start at low dose, titrate slowly
67
When is spironolactone indicated
Symptomatic despite optimal therapy | Post-MI with LVSD
68
When is Digoxin indicated
Symptomatic despite optimal therapy | AF

Pharmacology (19 decks)

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