Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Cardiovascular System > Hypertension - Treatment > Flashcards

Hypertension - Treatment Flashcards

1
Q

What investigation is essential to confirm it is true hypertension?

A

ABPM (gives true reading)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

At what time of the day are ABPM readings usually taken?

A

daytime, nighttime is best but can be uncomfortable for patient.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the risk factors of morbidity to look out for in the history of a hypertensive?

(6)

A
  • Previous MI, stroke, IHD
  • Smoker
  • Diabetes
  • Hyperlipidaemia
  • Family history (of CVD)
  • Physical Examination
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Other than ABPM, outline other investigations which may be carried out to diagnose hypertension.

(4)

A
  • ECG
  • Bloods
  • Urine dipstick
  • Renal ultrasound/tests
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is an ECG used to look for in hypertensives?

A

Left ventricular hypertrophy

assess end-organ damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is a urine dipstick used to look for in hypertensives?

2

A
  • haematuria

- proteinuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What conditions should be screened for, which are treatable causes of secondary hypertension (secondary)?

(5)

A
  • Renal artery stenosis
  • Cushings disease
  • Conn’s Syndrome
  • Sleep apnoea
  • Coarctation of the aorta
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the signs of hypertension picked up on an ECG? (2)

What do these indicate?

A
  • deep S waves in V1
  • tall R waves in V5

Left ventricular hypertrophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

The BHS suggest target pressure should be < ________ mmHg.

A

135/80-85

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Why do we treat hypertension?

2

A
  • to reduce risk of further complications

- e.g. MI, stroke, CVD, renal impairment, retinopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What type of approach is taken to treat hypertension? (1)

Why is this approach used? (1)

A
  • stepped
  • increasing the dose of the initial medication comes with an increased likelihood of side effects.
  • therefore it is better to use low doses of several drugs.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the first step of medication treatment for younger hypertensives (<55)?

Why this specific drug?

A

ACE inhibitor/ARB

Young people have higher levels of renin.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the first step of medication treatment for older/black population hypertensives (>55)?

A
  • Ca2+ channel blockers (old)

- thiazide-type diuretic (blacks)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Anti-hypertensive treatment should be offered to patients <80 with ___________ plus one of the following what?

(1)
(5)

A

ABPM of 135/85mmHg (Type I)

  • target organ damage
  • established cardiovascular disease (LVH, CHF, CHD)
  • renal disease
  • diabetes
  • a 10-year cardiovascular risk equivalent to 20% or greater
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Anti-hypertensive treatment should be offered to which type II hypertensives?

What will their ABPM be if they are stage 2 hypertensive?

A

People of any age

150/95mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Who should be referred to a specialist for further evaluation?

Why should they be referred to a specialist?

A

Patients <40 with type I hypertension or greater.

They are likely to have secondary hypertension, and further investigation is required to find the treatable cause.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How does treatment of hypertension differ in people aged 80 or greater?

(2)

A
  • they are offered the same anti-hypertensive drugs as age group 55-80.
  • they have a higher target BP = <145/85
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What must be carried out or measured when a patient is suspected of white coat hypertension?

A

ABPM or HBPM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the step 1 treatment of hypertensives >55 and for black populations?

(2)

A
  • calcium channel blockers

- given to black people of any age (not only >55)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Why might a calcium channel blocker be unsuitable i.e. what might it lead to?

(3)

A
  • intolerance
  • oedema
  • evidence/risk of heart failure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What alternative drug may be offered if CCBs are unsuitable e.g. intolerance?

A
  • thiazide-type diuretics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How should you treat if the BP does not seem to be lowering after starting a CCB?

A
  • add on treatment of another drug

- do not increases dosage of original drug

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Who should ACE inhibitors and ARBs not be offered to?

Why?

A
  • black/afro-caribbean: less effective, leads to angioedema

- women of child baring age: teratogenicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is step 2 of treatment for hypertension?

A
  • add thiazide-type diuretic to treatment regime (on top of ACEI or CCB depending on age)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is step 3 of treatment for hypertension?

A
  • Add CCB, ACEI, thiazide-type

diuretic together – see what happens.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is the main issue at step 3 of anti-hypertensive treatment?

A

compliance in taking medications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is step 4 of treatment for hypertension?

3

A

Refer for add on therapy (diuretic):

  • spironolactone (if low K level)
  • alpha-blocker
  • beta-blocker
28
Q

What side effect does spirnolactone have an increased risk of?

A

hyperkalaemia

29
Q

When initiating or changing a diuretic what should be offered?

A

a thiazide-like diuretic (as opposed to a thiazide-type diuretic)

30
Q

Name some thiazide-like diuretics?

2

A
  • chlortalidone

- indapamide

31
Q

What type of hypertension should be treated by step 4 treatment?

A

resistant hypertension

32
Q

What is the step 4 treatment of hypertensives with high potassium levels or reduced GFR?

A

higher-dose thiazide-like diuretic treatment

33
Q

Name the ACE inhibitor widely used?

A

Ramipril

34
Q

What is the advantage of ACE inhibitors? (1)

A

Prevent end-organ damage

35
Q

What are the contraindications of ramipril?

3

A
  • Renal artery stenosis
  • Renal failure
  • Hyperkalaemia
36
Q

What are the adverse drug reactions of ramipril?

5

A
  • cough
  • first dose hypotension
  • taste disturbance
  • renal impairment
  • angioneurotic oedema
37
Q

What are possible harmful Drug-Drug interactions involving ramipril?

What can they lead to?

(3)

A

NSAIDS - acute renal failure

Potassium supplements - hyperkalaemia

Potassium sparing diuretics - hyperkalaemia

38
Q

Name the common ARBs (Angiotensin II receptor blockers) used?

(4)

A
  • losartan
  • valsartan
  • candesartan
  • irbesartan
39
Q

What are ARBs mechanism of action i.e. what do they interact with?

A

block the actions of AT II at the AT1 receptor.

40
Q

What is the advantage of ARBs over ACE inhibitors?

A

no cough

41
Q

Name the common CCBs (Calcium channel blockers) used? (4)

Which are the more common drugs used? (2)

A
  • amlodipine
  • felodipine
  • verapamil
  • diltiazem
  • amlodipine & felodipine
42
Q

How do amlodipine and felodipine work?

A
  • vasodilators
43
Q

How do verapamil and diltiazem work?

A
  • heart rate limiting
44
Q

How do CCBs work?

5

A
  • blocking L type calcium channels.
  • selectivity between vascular and cardiac L type channels.
  • relaxes large and small arteries.
  • reduced TPR.
  • reduced CO.
45
Q

What are the contraindications of CCBs?

A
  • acute MI

- heart failure, bradycardia (rate limiting CCBs)

46
Q

What are the adverse drug reactions caused by CCBs?

4

A
  • Flushing
  • Headache
  • Ankle oedema
  • Indigestion and reflux oesophagitis
47
Q

What are the adverse drug reactions caused by rate limiting CCBs specifically?

(2)

A
  • constipation

- bradycardia

48
Q

Name the common thiazide-type diuretics used?

2

A
  • Indapamide

- Clortalidone

49
Q

What do thiazide-type diuretics reduce the risks of?

2

A
  • stroke

- MI

50
Q

What are thiazide-type diuretics mechanism of action?

A

Increase urinary secretion of Na

natriuresis

51
Q

What are the side effects (uncommon) of indapamide?

2

A
  • gout

- impotence

52
Q

What is the alpha-blocker less commonly used to treat hypertension?

A

doxasozin

53
Q

What are the contraindications of alpha-blockers?

4

A
  • First dose hypotension
  • Dizziness
  • Dry mouth
  • Headache
54
Q

What are the less commonly used centrally acting agents for treating hypertension?

(2)

A
  • Methyldopa

- Moxonidine

55
Q

When is methyldopa likely to be used?

A

pregnant women

56
Q

What are the adverse drug reactiona of methyldopa?

3

A
  • Sedation and drowsiness
  • Dry mouth and nasal congestion
  • Orthostatic hypotension
57
Q

What are the less commonly used vasodilators? (2)

Why are they used less frequently?

A
  • Hydralazine
  • Minoxidil

they have horrendous side effects.

58
Q

What is a common treatment regime for a hypertensive for >55?

A
  1. CCB
    • thiazide-type diuretics
    • ACE inhibitor
    • B-blocker
    • add-on therapy
59
Q

What is a common treatment regime for a hypertensive for <55?

A
  1. ACE inhibitor or CCB (pregnant/child baring age)
    • thiazide-type diuretic
    • CCB
    • B-blocker
    • add-on therapy
60
Q

What does blood pressure normally do during pregnancy?

A

falls

61
Q

What is the hypertension that develops during pregnancy called?

A

gestational hypertension

62
Q

Sometimes BP rises severely from about week 20 in pregnancy to BP>140/90 mmHg and proteinuria >300mg/24h.

What is this known as?

A

Preeclampsia

63
Q

What is the treatment for hypertension in a woman prepregnancy?

A
  • nifedipine MR
  • methyl dopa
  • atenolol (predictable)
  • labetalol (more predictable)
64
Q

What is the treatment for hypertension in woman during pregnancy?

A

add thiazide diuretic and/or amlodipine.

65
Q

Which drugs are given to a pregnant woman with preeclampsia?

A

normal drugs during pregnancy plus:

  • IV hydralazine
  • esmolol
  • labetalol
66
Q

______ _______ – severely elevated BP with evidence of acute target organ damage.

A

Hypertensive emergency

Cardiovascular System (37 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions