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MBCHB3 RBF > Lecture 12: Antihypertensives > Flashcards

Lecture 12: Antihypertensives Flashcards

1
Q

What are the risk factors associated with hypertension?

A

Major risk for:
- Stroke
- CAD
- Renal disease

CVS death doubles for each 20mmHg systolic rise and 10mmHg diastolic rise

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2
Q

Does treatment of hypertension help?

A

J shaped curve (yes/no)

10mmHg systolic BP fall: Reduction in morbidity and mortality

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3
Q

What are the hypertension treatments?

A

Lifestyle changes
- Diet (salt)
- Weight loss
- Exercise
- Reduce alcohol

Drug therapy
- Polypharmacy

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4
Q

Whats the target BP?

A

Contentious

Aim 130/80

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5
Q

What are the available drugs for hypertension?

A

A - ACEi/ARB
B - Beta blockers
C - Ca channel blockers
D - Diuretics (thiazide, loop, aldosterone antagonists)

Alpha blockers and others

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6
Q

What ACE/ARBs are recommended for hypertension?

A

ACEi
Cilazapril (Enalapril, lisinopril)
S/E: Hypotension, cough, angiooedema, hyperkalemia

ARBs
Candesartan (Losartan, valsartan)
S/E: Hypotension, Hyperkalemia

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7
Q

What are the C/I for ACEi and ARB?

A
  • Bilateral renovascular disease (B/c AII maintains perfusion gradient and ACEi/ARB -> Marked hypotension and AKI)
  • Pregnancy: Cross placenta and angiotensin has role in renal development
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8
Q

What are the S/E of beta blockers?

A
  • Fatigue
  • Bradycardia
  • -ive inotrope
  • ED
  • Asthma exacerbation
  • Cold peripheries
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9
Q

What are some thiazide diuretics and where do they act?

A

Thiazide:
- Hydrochlorothiazide

MoA
- Inhibit Na/Cl in DCT
- Dec. BP with subdiuretic dose
- Vasodilators
Not super clear what its long term action is

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10
Q

What is natriuresis?

A

Na and thus water loss

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11
Q

WHat is diuresis?

A

Water loss

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12
Q

What are the thiazide side effects?

A

Increase glucose
Increased urate
Decreased K, Na, Mg

Diuresis (Mild)
ED

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13
Q

What are some loop diuretics and how do they work?

A

Frusemide

  • Inhibits NKCC
  • Potent diuretic BUT little hypertensive effect alone (super effective if with ACEi)
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14
Q

What are the S/E of loop diuretics?

A
  • Dehydration/polyuria
  • Dec Na, K, Mg
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15
Q

What are some K sparing diuretics? and MoA?

A

Spirinolactone (Aldo antagonist)
- Inhibits Na/K exchanger

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16
Q

What are the S/E of spirinolactone?

A
  • Gynaecomastia
  • Dehydration
  • Hyperkalaemia
17
Q

Whats the approach to treating hypertension?

A

Guidelines vary everywhere

But in essence aim to prevent the organ damage and treat the comorbidities i.e vascular disease, HF, renal

Use rods charts

18
Q

What is young hypertension characterised by?

A

High renin state

Therefore:

Step One: A or B
Step Two: Add C or D
Step Three: A or B, C+D
Step four (resistant) : Either alpha blocker or spironolactone or other diuretic

19
Q

What is older person hypertension characterised by?

A

Low renin state

Therefore:

Step One: C or D
Step Two: Add A or B

Same as young now:
Step Three: A or B, C+D
Step four (resistant) : Either alpha blocker or spironolactone or other diuretic

20
Q

What are some effective drug combos for hypertension?

A

Diuretic + ACEi + Vasodilator

i.e

Bendrofluazide + Cilazapril + Felodipine

21
Q

What are sensible drug prescriptions with comorbidities when it comes to hypertension?

A

ACEi
- Hypertension + HF

B blocker
- Hypertension + Angina/HF

Diuretic
- Hypertension + HF

Alpha blockers
- Hypertension + Prostatism

22
Q

What are the lifestyle changes for reducing BP?

A
  • <5g salt per day
  • Reduce alcohol/binge drinking
  • Diet Veg/fruit/fish/nuts
  • BMI
  • Aerobic exercise
  • Smoking cessation
23
Q

What can happen with gestational hypertension?

A

Maternal complications
- Abrupt
- CVA, Organ dysf., coagulopathy

Fetal complications
- IUGR
- Prem

> 140/90

24
Q

How do you treat maternal hypertension?

A

AVOID:
- ACEi, ARB
- Atenolol (IUGR)
- Diuretics

Can use:
- Central agents: Methyl dopa
- B blockers: Labetalol
- Ca antagonists: Nifedipine
- Vasodilators: Hydralazine

25
Q

What are some rarely used anti-hypertensives?

A

Vasodilators: Hydralazine
Central acting: Methyldopa, Clonidine (dec SNS)

26
Q

Whats the future of anti-hypertensives?

A

Polypil - good combinations

MBCHB3 RBF (39 decks)

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