Hypertention & ACEi Flashcards

1
Q

Target BP for those under 80

A

Clinic:
140/90 mmHg
135/85mmHg

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2
Q

Target BP for those with CV disease/high risk

What conditions are included in this?

A

130/80

Artherosclerotic CV disease, diabetes in presence of kidney, eye or cerebrovascular disease

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3
Q

How long is a new antihypertensive used for to establish response

A

4 weeks

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4
Q

Define stage 1 hypertension and when should you treat?
Stage 2?
Severe?

A

Stage 1 - 140/90mmHg - treat those under 80 who have target-organ damage, CV disease, renal disease , diabetes, 10 year risk over 20%
If under 40 and no target organ damage refer.

Stage 2 - 160/100 - treat all
Severe - 180/110 - treat promptly

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5
Q

Treatment steps for patient under 55

A
ACEi ( if not tolerated ARB or BB)
CCB
thiazide like diuretic
Spironolactone and specialist referral
Alpha blocker
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6
Q

Treatments steps for over 55, or black people of any age

A

CCB ( or if evidence of HF try thiazide like diuretic)
ACEi
Then as with under 55

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7
Q

Who should get low dose aspirin

A

Only those with establish pec CV disease

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8
Q

Target BP for over 80 years

A

150/90

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9
Q

Target BP for patients with diabetes

A

140/80

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10
Q

In T1DM hypertension usually indicates ….

A

Diabetic nephropathy

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11
Q

ACEi should be considered for all patients with …… (Sign of renal disease)

A

Proteinuria

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12
Q

Choices for treating hypertension in pregnancy

A

Labetalol
Mehthyldopa
MR nifedipine

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13
Q

Target of BP for pregnancy

  • uncomplicated hypertension
  • target organ damage
A

150/100

140/90

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14
Q

Risk factors for developing preeclampsia 5

A
Hypertension
CKD
diabetes
Autoimmune disease
Hypertension in previous pregnancy
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15
Q

Women at risk of preeclampsia should take… From when…

A

Aspirin low dose - from week 12 to term

Also applies for those over 40, over 10 years since last pregnancy, BMI over 35, multiple pregnancy, FH

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16
Q

Risks of reducing BP to fast during hypertensive crisis

A

Reduced organ percussion leading to cerebral infraction, blindness, deterioration in renal function, myocardial ischaemia

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17
Q

what class of drugs may be used to treat phaechromocytoma (tumour of the adrenal gland releasing noadrenaline)

A

alpha blockers such as phenocybenzaine and phentolamine

18
Q

what classes of drugs are doxazoxcin and prazosin

A

alpha blockers (and vasodilators)

19
Q

what class of drug is hydralazine and why do we not often use it

A

alphablocker

used as an adjunt in hypertensive treatment but causes tachycardia and fluid retention when used alon

20
Q

when is methyl dopa used as an antihypertensive

A

pregnancy

it is a centrally acting antihypertensive

21
Q

why is clonidine not often used

A

centrally acting antihypertensive but causes rebound hypertension on withdrawl

22
Q

what is the mode of action of alfuzosin, terazocin and tamsulosin
what are they used for

A

alpha blockers for BPH

23
Q

when starting ACEi what electrolyte discturbance should first be addressed

A

-stop K supplements and K sparing diuretics as ACEi may cause hyperkalaemia

24
Q

what is a caution when introducing an ACEi to a patient already taking a high dose of loop diuretic in HF?
what is classed as high dose

A

profound first dose hypertension
(temporary withdrawl of the loop may reduce risk but conversely cause pulmonary oedema)

furosemide 80mg OD

25
ACEi have a role in managing what side effect of diabetes
nephropathy
26
why should ACEi not be given with NSAIDs
increased risk of renal damage
27
what renal condition should we never used ACEi/ARB in?
renal artery stenosis {bilateral or severe unilateral} (ACEi would reduce glomerular filtration causing failure) - also caution ACEi in peripheral vascular disease
28
what to change ACEi to if patient experiences dry cough? why does this help?
ARB they don't inhibit breakdown of bradykinin (bradykinin causes the cough(
29
why should you not use more than one drug affecting the renin angiotensin system
increased risk of hyperkalaemia, hypotension and renal impairment
30
why should afro-carribean pt not receive ACEi? (2)
less likely to respond (as likely to have low rennin hypertension) more likely to develop angioedema
31
what should you do with ACEi pt develops altered LFTs
stop ACEi - reports of cholestatic jaundice, hepatitis, hepatic necrosis etc.
32
what time of day should the first dose of ACEi be given
bedtime
33
what is aliskiren?
renin inhibitor
34
if someone has HF what antihypertensive are we thinking about first line
thiazide like diuretic
35
if a pt has a STEMI how fast should there BP be reduced
reduce over period of 2 mins to 2 hours by 20-25%
36
mode of action of sildenafil
vasodilator
37
mode of action of iloprost
vasodilator
38
mode of action of doxasosin
alpha blocker
39
mode of action of methyldopa
centrally acting
40
mode of action of guanethidine monosulfate
adrenergic neurone blocker
41
mode of action of aliskiren
renin inhibitor (so probs dont give with ACE/ARBs!)
42
how fast do ACEi reduce BP
2 hours