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My MRCP > Management of Hypertension > Flashcards

Management of Hypertension Flashcards

1
Q

What tool do we use for assessing risk of cardiac disease/stroke based on someones hypertension?

A

The Assign Risk Calculator (Q-Risk)

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2
Q

What do we do after assessing someones risk before we plan treatment?

A

Set a target blood pressure.

Recommended to aim for <135/80mmHg (145/85 in people over 80)

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3
Q

What level of CVD risk are we recommended to start treatment at?

A

20% risk of CVD within the next 10 years

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4
Q

We take a ‘stepped’ approach to treatment, what does this mean? [1]

A

We introduce one new drug to current treatment at a time until they begin to work

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5
Q

What are the 3 classes of drugs used for hypertension treatment?

A

A - ACE Inhibitor (angiotensin converting enzyme inhibitor)
C - Calcium Channel Blocker
D - Thiazide Type Diuretic

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6
Q

What kind of drug do we start with in young hypertensives? [1] <55yo

A

An ACE inhibitor

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7
Q

What drug type do we start with in the elderly (>=55yo) or black? If they are intolerant (edema), what would be the next choice? [2]

A

A calcium channel blocker or thiazide type diuretic

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8
Q

We don’t always treat stage 1 hypertension, in what case would we? [6]

A

If theyre under 80 with stage 1 hypertension and any of the following:

  • Target Organ Damage
  • Establised CVD
  • Renal Disease
  • Diabetes
  • A 20% CVD risk over 10 years
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9
Q

Do we treat everyone with stage 2 hypertension?

A

Yes no matter theyre age.

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10
Q

The patient is <40 yrs old with atleast stage 1 hypertension, what extra do you do for them? [3]

A

Refer to a specialist for:

  • Evaluation of target organ damage
  • Evaluation of possible secondary causes
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11
Q

How do you monitor the BP of someone your treating if they ‘white coat effect’?

A

With ABPM or HBPM

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12
Q

Black people are genetic salt retainers and should be managed differently if have hypertension. How?

A

Yes we treat black people of any age the same as we treat other races over 55 yrs.

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13
Q

What do we give under 55s for step 1 treatment? [2]

A

An ACE inhibitor or ARB

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14
Q

What do we add for step 2 treatment?

A

A+C

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15
Q

What do we add for step 3 treatment?

A

A+C+D

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16
Q

What do we do for step 4 treatment? Give dose as well as choice of drug [3]

A

Depends on blood potassium level [1]

If <4.5mmol/L give further diuretics and low dose spironolactone (25mg once a day) [1]

If >4.5mmol/L give higher dose Thiazide Type Diuretics [1]

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17
Q

Name 2 ACE inhibitors?

What effect will ACEIs have physiologically? [2]

A

Ramipril & Perindopril

They will prevent Angiotensin II forming and so cause vasodilation and reduced water reabsorption.

They also lower future organ damage, to which angiotensin II is a main contributor

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18
Q

What are 3 contraindications for ACEIs?

A

Renal Artery Stenosis
Renal Failure
Hyperkalemia

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19
Q

Name 5 Adverse Drug Reactions to ACEIs?

A
  • Cough
  • Postural hypotension
  • Taste Disturbance
  • Renal Impairment
  • Angioedema
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20
Q

Name 3 drugs with which ACEIs react and the reactions:

A

NSAIDs - Acute Renal Failure
Potassium supplement - Hyperkalemia
Potassium Sparing Diuretics - Hyperkalemia

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21
Q

What are ARBs?

A

Angiotensin II antagonists

22
Q

Compare ARBs to ACEIs [2]

A

ACEIs are more effective [1]

ARBs have far fewer side effects, almost removes the cough [1]

23
Q

What is the pharmacological action of ARBs? [2]

A

They competetively inhibit angiotensin II [1] at the AT1 receptor [1]

24
Q

Name 4 ARBs:

A

Losartan
Candesartan
Valsartan
Irbesartan

25
Q

What are the 2 types of CCBs?

A

Vasodilators, used commonly

Rate limiting CCBs, used by specialist clinics when other options are exhausted

26
Q

Name 3 vasodilating CCBs:

A

Amlodipine
Felodipine
Nifedipine

27
Q

Name 2 Rate Limiting CCBs?

A

Verapamil

Diltiazem

28
Q

What is the treatment of choice for over 55s and women of child bearing age?

A

A vasodilating CCB such as Amlodipine or Felodipine

29
Q

What are 3 contraindications of CCBs?

A

Acute MI
Heart Failure
Bradycardia

30
Q

What are 6 ADRs of CCBs?

A 
Flushing
Headache
Ankle Oedema
Indigestion and reflux oesophagitis
Bradycardia - Rate Limiting only
Constipation - Rate Limiting Only
31
Q

Name 2 Thiazide Type Diuretics?

A

Indapamide

Clortalidone

32
Q

Whats the action of TTDs? [2]

A

They block sodium reabsorption and icnrease the amount lost in the urine

33
Q

Name 2 ADRs of TTDs?

A

Gout

Impotence

34
Q

In what group are TTDs most commonly used as a 1st step treatment?

A

Afro-Carribeans

35
Q

Name 3 classes of less common hypertension medications:

A
  • Centrally Acting Agents
  • Alpha-Adrenoreceptor antagonists
  • Vasodilators
36
Q

Name 2 centrally acting agents:

A

Methyldopa

Moxonidine

37
Q

When is methyldopa used over other antihypertensives?

A

During pregnancy

38
Q

How does methyldopa work? [4]

A

1) Converted to alpha-methylnoradrenaline
2) Acts on CNS alpha-adrenoreceptors
3) Decreases Symp. Outflow
4) Lowers MAP

39
Q

Name 4 ADRs of methyldopa?

A

Sedation, Drowsiness
Orthostatic Hypotension
Nasal Congestion
Dry Mouth

40
Q

Name 2 vasodilators used less commonly in hypertension treatment:

A

Hydralazine

Minoxidil

41
Q

Name a alpha-adrenoreceptor antagonist?

42
Q

What does Doxazosin do? [2]

A

Opposes smooth muscle contraction [1] by blocking post synaptic alpha1-adrenoreceptors [1]

43
Q

Give 4 ADRs of Doxazosin?

A

Dizziness
Dry Mouth
Headache
1st Dose hypotension

44
Q

Give a brief common treatment regime for someone over 55 [5]

A

Step 1: CCB
Step 2: A + D
Step 3: A + C + D
Step 4: + Spironolactone or higher dose TTD (depending on K level)

45
Q

Give a brief common treatment regime for a young person <=55yo [4]

A

Step 1: ACEI/ARB. If child bearing age, CCB
Step 2: A + C
Step 3: A + C + D
Step 4: Spironolactone or higher dose TTD (depending on K level)

46
Q

Condition specific preferences for anti-hypertensives

Angina

A

BB and CCB

47
Q

Condition specific preferences for anti-hypertensives

Heart failure

A

ACEi, BB, spironolactone

shown to have impact on prognosis of HF

48
Q

Condition specific preferences for anti-hypertensives

Atrial fibrillation

permanent not paroxysmal

49
Q

Condition specific preferences for anti-hypertensives

Renal dysfunction

A

ACEi, ARAs

50
Q

Condition specific preferences for anti-hypertensives

PVD

My MRCP (43 decks)

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