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Pharmacology year 2 > UMP2007 pharmacology of hypertension > Flashcards

UMP2007 pharmacology of hypertension Flashcards

1
Q

why is hypertension such a big issue?

A
  • most prevalent modifiable risk factor cardiovascular disease worldwide
  • 45-50% of strokes and heart attacks are due to hypertension
  • common cause of heart failure
  • accounts for over 10 million deaths worldwide per year
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2
Q

what 4 organs does hypertension mainly effect?

A
  • eyes, brain, heart, kidney
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3
Q

what is the definition of hypertension?

A
  • systolic blood pressure over 140mmHg and diastolic blood pressure over 90mmHg
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4
Q

what are the different methods of measuring blood pressure?

A
  • standard clinic measurement (manual or automatic by healthcare professional in a clinic) = white coat syndrome?
  • unattended office BP = patient uses automatic machine themselves in clinic = avoid white coat syndrome but patient error?
  • home BP monitoring
  • ambulatory BP monitoring = wear cuff for 24 hours, measures throughout to see patterns
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5
Q

what is ambulatory BP monitoring and why is it useful?

A
  • when patient wears a bp cuff for 24 hours to measure and monitor bp and how it changes
  • gives more information and context and causes
  • better predictor of cardiovascular risk
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6
Q

what are the 2 types of causes of hypertension?

A
  • primary, essential idiopathic = not always a known cause, may have many factors involved like genetics and environment (more common)
  • secondary = clear factor/disease causing hypertension
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7
Q

give some examples of primary/essential/idiopathic causes of hypertension

A
  • age
  • genetics
  • overweight
  • alchohol
  • salt intake
  • lack of exercise
  • stress
  • caffeine
  • anxiety
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8
Q

give some examples of secondary causes of hypertension

A
  • Coarction of aorta
  • problems with renavasculature
  • endocrine e.g. Conn’s, pheochromocytoma, Cushing’s
  • drugs e.g. contraceptive pill
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9
Q

what is the equation for blood pressure?

A
  • bp = cardiac output x total peripheral resistance
  • cardiac output = stroke volume x heart rate
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10
Q

who should you screen for secondary hypertension?

A
  • patients with resistant hypertension (BP>140/90 mmHg on 3 antihypertensive)
  • young patients (<40) with high blood pressure
  • patients presenting with severe hypertension e.g. bp>180/110 mmHg
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11
Q

how would you investigate renal parenchymal diseases as a secondary cause of hypertension?

A
  • renal ultrasound
  • biopsy
  • kidney function tests
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12
Q

how would you investigate renovascular disease as a secondary cause of hypertension?

A
  • MR/CT renal angiogram
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13
Q

how would you investigate primary aldosteronism as a secondary cause of hypertension?

A
  • renin/aldosterone ratio
  • adrenal CT
  • blood tests
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14
Q

how would you investigate phaeochromocytoma as a secondary cause of hypertension?

A
  • urinary catecholamines
  • serum metanephrines
  • MIBG scan
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15
Q

how would you investigate Cushings syndrome as a secondary cause of hypertension?

A
  • 24hr urinary cortisol
  • low dose dexamethasone supression test
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16
Q

what are some high risk groups for hypertension?

A
  • secondary prevention for people with pre-existing cardiovascular disease
  • other cardiovascular risk factors e.g. diabetes, CKD
  • 10 year cardiovascular risk
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17
Q

what is used to calculate someone’s cardiovascular risk?

A
  • QRisk-3 calculator
  • takes into account sex, age, ethnicity, medical diagnosis and lifestyle factors to calculate risk of heart attack or stroke in next 10 years
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18
Q

what does QRisk-3 calculate?

A
  • risk of someone having a stroke or heart attack in the next 10 years
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19
Q

how would you check for hypertension damage to the eyes?

A
  • fundoscopy (check for burst blood vessels)
20
Q

how would you check for hypertension damage to the brain?v

A
  • CT or MRI scan
21
Q

how would you check for hypertension damage to the heart?

A
  • ECG, then Echocardiogram, then cardiac MRI
  • looking for left ventricular hypertrophy (heart working too hard)
22
Q

how would you check for hypertension damage to the kidneys?

A
  • renal function tests and urine protein test
23
Q

what are the NICE guideline targets for hypertension?

A
  • adults under 80 to maintain bp < 140/90 mmHg
  • adults over 80 to maintain bp < 150/90 mmHg
    (obviously dependent on patient and their comorbidities)
24
Q

what none pharmacological treatment can be given for hypertension?

A
  • advice to increase exercise, stop smoking, reduce alcohol, reduce stress, reduce fats in diet
25
Q

what are the NICE guidelines for lines of treatment for
type 2 diabetic with hypertension?

A
  • ACE inhibitor or angiotensin 2 receptor blocker (ARB) first line
  • if not under control, add Ca channel blocker or thiazide-like diuretic
  • if still not under control, ACEi/ARB + CCB + thiazide like diuretic
  • if still not under control = resistant hypertension ( check for postural hypotension, adherence to drugs and other conditions) may add spironolactone or alpha/beta blocker
26
Q

what are the NICE guidelines for treatment for hypertension for someone aged less than 55 and not black origin and not diabetic?

A
  • ACEi/ARB
  • then ACEi/ARB + CCB or thiazide like diuretic
  • then ACEi/ARB + CCB + thiazide like diuretic
  • then resistant hypertension, investigate more, may add spironolactone or alpha/beta blocker
27
Q

what are the NICE guidlines for treatment for hypertension for someone over 55 or black origin but not diabetic?

A
  • CCB
  • then CCB + ACEi/ARB or thiazide-like diuretic
  • then CCB + ACEi/ARB + thiazide-like diuretic
  • then reistant hypertension, investigate more, may add spironolactone or alpha/beta blocker
28
Q

what is resistant hypertension?

A
  • bp > 140/90 mmHg with 3 antihypertensives
29
Q

what is the NICE guidelines on treating hypertension based on?

A
  • if aged over 55, not given ACEi/ARB/ beta blockers first line as though as less effective as renin is suppressed with age
  • ethnicity = higher prevalence of hypertension in African origin, lower levels of plasma renin, more salt-sensitive hypertension, ACEi side effects are more common
30
Q

what is the ABCD most common antihypertensive drugs?

A
  • A = ACEi /ARBs
  • B = beta blockers
  • C = calcium channel blockers (dihydropyridines = blood vessels only, not heart)
  • D = diuretics ( thiazide/thiazide like and K sparing)
31
Q

give some examples of ACE inhibitors

A
  • ramipril
  • lisinopril
  • perindopril
  • enalapril
32
Q

give some cautions/side effects of ACE inhibitors

A
  • hyperkaleamia
  • angioedema
  • renal impairment (if already damaged)
  • cough
  • older patients and African origin may be less effective in (less sensitive to renin)
33
Q

give some examples or ARBs (angiotensin receptor blockers)

A
  • losartan
  • irbesartan
  • valsartan
  • candesartan
34
Q

give some cautions/side effects of ARBs

A
  • hyperkalaemia
  • angioedema
  • renal impairment (if already damaged)
  • older patients and African origin may be less effective in (less sensitive to renin)
35
Q

why do you want selective Beta-1 receptor blockers for hypertension?

A
  • B-1 blocker= decrease heart contractability = decrease cardiac output and also it decreases renin release
  • B2 blocker = cause vasoconstriction and bronchoconstriction and glycogenolysis = not good for asthma or diabetic patients
36
Q

give some examples of commonly used beta blockers for hypertension and when they would be used/features

A
  • propranolol = not selective, not a- blocker, may cause many side effects
  • bisoprolol = selective for B1, not a-blocker, long acting
  • atenolol = selective for B1, not a-blocker, long acting, water soluble (less likely to enter brain)
  • labetelol = not selective, also a-blocker, used in pregnancy
  • carvedilol = not selective, also a-blocker
37
Q

what are some cautions/side effects with beta blockers?

A
  • can cause bradycardia/AV block
  • can worsen asthma/COPD if not selective
  • uncontrolled heart failure
  • could worsen hypoglycaemia in diabetic patients
38
Q

what are the 3 classes of Ca channel blockers used to treat hypertension?

A
  • dihydropyridines = peripheral only = vasodilation
  • phenylakyamine = cardiac and peripheral
  • benxothiazepine = cardiac and peripheral
39
Q

give some examples of dihydropyridine CCBs and their uses

A
  • amlodipine
  • nifedipine
  • felodipine
  • causes vasodilation
  • used only for hypertension
  • amlodipine has the longest half life
40
Q

give an example of a phenylalkyamine CCB and their use

A
  • verapamil
    = cardiac and vasodilator
    = used more for heart rate control
41
Q

give an example of a benzothiazepine CCB and their use

A
  • diltiazem
    = cardiac and vasodilator
    = used more for heart rate control
42
Q

give some examples of calcium channel blocker cautions and side effects

A
  • headache (vasodilation)
  • tachycardia (reflex activation of sympathetic nervous system)
  • ankle swelling
  • bradycardia
  • verapamil = very neagtively iontropic = may cause heart failure
43
Q

what are the 3 classes of diuretics used to treat hypertension?

A
  • thiazides
  • thiazide-like
  • K sparing
44
Q

give an example of thiazide diuretic and how it works to treat hypertension

A
  • bendroflumethiazide
  • thiazide sensitive Na-Cl symporter = causes more Na and thus more H2O to be excreted = less blood volume
45
Q

give an example of a thiazide-like diuretic and how it works to treat hypertension

A
  • indapamide or chlortalidone
  • thiazide Na-Cl symporter = casues more Na and thus more H2O to be excreted = less blood volume
  • favoured in NICE guidlines
46
Q

give some examples of K sparing diuretics and how they work to treat hypertension

A
  • spironolactone, eplerenon = aldosterone antagonists
  • amiloride = ENaC blocker
  • may cause hyperkalaemia
47
Q

give some cautions/side effects for diuretics for hypertension

A
  • hypokalaemia
  • hypercalcaemia
  • hyponatraemia
  • gout
  • alkalosis

Pharmacology year 2 (8 decks)

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