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CVS > Hypertension Rx > Flashcards

Hypertension Rx Flashcards

1
Q

What is the aim of treatment

A

BP 140 / 90 if <80 or 135/85APBM
Higher in elderly (150/90) or 145 / 85
Lower in DM if complications - 130/80
Lower in DM if type 1 - 135/80

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2
Q

What are non-pharmacological measures (trial period of this unless severe)

A 
Weight reduction
Low fat / low salt 
Exercise
Limit alcohol 
Stop smoking
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3
Q

When do you start pharmacological Rx

What do you do if <40

A

> 160 / >100 - stage 2 any age
or stage 1 if CVD risk or DM / renal / CVS disease or organ damage or 10% Q risk score

If <40 specialist advice for 2 causes

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4
Q

What is Rx plan for <55 / any DM no matter what

A

Start on ACEI / ARB - more likely to be due to high renin
Add CCB
Add thiazide diuretic (increase dose if K high)
Add alpha / BB if high K >4.5
Add spironolactone if K <4.5

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5
Q

What do you start with in female <55

A

CCB
BB
ARB is teratogenic

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6
Q

What is Rx plan for >55 / African (usually low renin)

A

Start CCB
Add ARB if black (preferred to ACEI)
Add diuretics
Add AB / BB / less common

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7
Q

When would you start with diuretic first

A

If oedema, HF or CCB not suitable

CCB CI in HF and oedema

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8
Q

What would you do if hypertension is still resistant

A 
CHECK COMPLIANCE 
Consider further diuretic dose 
Lose dose spironolactone but risk of hyperkalaemia in reduced GFR 
Alpha blocker
Beta blocker 
Monitor U+E closely
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9
Q

Why would you not give diuretic and BB together or BB + rate limiting CCB

A

Aggravate asthma

Conduction block

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10
Q

What are less common hypertension agents

A

Alpha antagonist
BB
Methylodopa
Vasodilators

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11
Q

What is Rx plan in pregnancy

A

Labetalol / atenolol
CCB (nifedipine / amlodipine)
Methydopa
Add diuretic during pregnancy

If PET

  • Add IV lavetalol / esmolol
  • Add hydralazine
  • May require termination
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12
Q

What does ACEI do (Ramipril / Perindopirl)

A

Inhibit angiotensin converting enzyme
Preventions conversion to angiotensin II
Reduce preload and after load
Useful in DM / nephropathy / poor LV function / HF

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13
Q

When are ACEI CI

A 
Renal stenosis / failure
Hyperkalaemia - stop ACEI and recheck 
Pregnancy 
Breast feeding
High dose diuretics
Can cause hyperkalaemia is used with NSAID
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14
Q

What are the SE of ACEI

A

Cough
First dose hypo (common with diuretic)
Renal impairment - check U+E before starting and 2 months after
Interact with NSAID, K supplement and K sparing diuretics = renal + hyperkalamia
Angioedema - stop if develop

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15
Q

What do you suspect if low K and give an ACEI and K doesn’t increase

A

Conns disease - aldosterone secreted by adrenal

  • Hypokalaemia
  • Hypernatraemia
  • Hypertension
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16
Q

What does ARB do (Larsartan)

A

Block angiotensin II
No cough and less renal dysfunction
DONT use ARB and ACEI as renal failure

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17
Q

What are benefits of ARB

A

No cough
Less renal dysfunction
More effective than a BB in preventing CVD / stroke / DM

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18
Q

What shouldn’t you use together and how do you monitor ACEI

A

ACEI and ARB due to renal
U+E prior to starting and if increase dose
Creatinie and K may rise initially

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19
Q

What is an ARNI

A

ACEI, ARB and nephrilysen together

20
Q

What does nephrilysen do

A

Block ANP / BNP (vasodilators)

21
Q

What do CCB do

A

Block L type Ca channels present in myocardial cells and vascular smooth muscles
Relax arteries, reduce resistance and CO
Useful in IHD, angina and hypertension

22
Q

What are the types of CCB

A 
Vasodilator 
- Amlodopine
- Nifedipine 
Rate Limiting - reduce HR
- Verapamil
- Diltazem
23
Q

When are CCB CI

A

Acute MI
UAP
HF as -ve inotropic
Bradycardia

24
Q

What are the SE CCB

A 
Rate Limiting
Hypotension 
Conduction block 
HF
Bradycardia 
Palpitations 
Vasodilators - no affect on heart 
Peripheral oedema so don't give if swelling 
Flushing
Headache
Indigestion
25
Q

What should you never use

A

Mifidepine immediate release as precipitate stroke / MI

26
Q

What do thiazide diuretics do (Indapamide)

A

Block reabsorption of sodium at DCT

Reduce stroke and MI risk

27
Q

What are SE of thiazide

A 
Gout due to dehydration 
Impotence
Dehydration
Postural hypo
Impaired glucose 
Hyponatraemia
Hypercalcaemia - loop causes hypo
Hypokalaemia
Hypouric - useful in renal stone
28
Q

What is a potassium sparing diuretic

A

Spironolactone 50-200mg / Eplenerone

Aldosterone antagonist that acts in DCT

29
Q

What do alpha blockers do (Doxazosin)

A

Block A1
Oppose contraction
Vasodilation
Useful in BPH

30
Q

What are the SE of A blockers

A 
Hypotension
HF - dyspnoea 
Dizzy
Dry mouth
Headache
Cough
31
Q

When should you use BB

A

Young intolerance to ACEI

Always add CCB NOT diuretic

32
Q

What do BB do

A

Attenuate effects of sympathetic and renin

Don’t protect against heart disease

33
Q

When are BB CI

A 
Asthma 
COPD 
Diuretic - worsen asthma
Sick sinus 
Caution in HF / PVD / DM 
NEVER with verapamil
34
Q

What are the SE of BB

A 
HF
Bradycardia 
Bronchospasm
COld periphery 
Lethargy
Impotence
Sleep disturbance
Insulin resistance
35
Q

What are the central acting agents

A

Methyldopa

Hydralazine

36
Q

What does methyldopa do

A

Decrease sympathetic outflow

Always sustained release

37
Q

What are the SE of methyldopa

A 
Drowsy
Dry mouth
Nasal congestion
Orthostatic hypo
Depression - never give after pregnancy
38
Q

When are vasodilators used (Hydralazine / Minoxidil)

A

If resistant to everything in combination with BB

39
Q

What are SE of vasodilator

A 
Bronchospasm
Postural hypo 
Bradycardia
Fatigue
Hallucinations
40
Q

What should be offered as well as Rx

A

Annual review
Monitor BP
Provide support
Discuss lifestyle, symptoms and medication

41
Q

What should you do before starting ACEI

A

Baseline U+E

42
Q

Why do you start with ACEI in DM

A

Renoprotective

43
Q

How do you monitor ACEI

A

Baseline U+E
U+E if increase dose
U+E annual

44
Q

Other indications for K sparing diuretic

A

Ascites
HF
Nephrotic
Conn’s

45
Q

What do you do if BP >180 / >120

A

Same day Rx / referral

CVS (30 decks)

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