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Therapeutics > W24 - Hypertension > Flashcards

W24 - Hypertension Flashcards

1
Q

What are 4 key cardiovascular disease

A

Hpertension
Ischaemic heart disease
Heart failure
Arrhythmia

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2
Q

what is hypertension

A

high blood pressure

when clinic blood pressure is > 140/90 mmHg for people ages under 80

Bp up to 150/90 if those over 80

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3
Q

what are the three stages of hypertension

A

> 140/90 stage 1 hypertension
160/100 stage 2 hypertension
180 or DBP >110 mmHg severe hypertension

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4
Q

why should we even bother with hypertension treatment what can it cause

A 
stroke
blindness
heart attack
heart faillure 
kidney failure
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5
Q

who should be offered lifestyle advise

A

offer lifestyle advice in anyone under 80 stage 1 hypertension who has at least one of the following

target organ damage
established cardiovascular disease
renal disease diabetes
high cardiovascular risk
under 40 years old
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6
Q

when should we consider treatment

A

anyone with stage 2 or severe (urgent)

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7
Q

what can be given to treat hypertension

A

ACE inhibitor (Diabetes)
Angiotensin Receptor Blocker (Diabetes)
Calcium channel blocker
Thiazide like diuretic

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8
Q

Outline treatment plan for hypertension non diabetic

A

Calcium channel blocker combined with lifestyle advice

calcium channel blocker + Ace inhibitor, Angiotensin Receptor blocker or thiazide like diuretic

Ace inhib + calcium channel blocker + thiazide like diuretic

confirm resistant hypertension, confirm elevated BP

consider seeking expert advicE

ADD low dose pironolactone if blood potassium <4.5
Alpha blocker or beta blocker >4.5

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9
Q

Outline treatment plan for hypertension diabetic

A

Ace inhibitor or ARB

CCB

Thiazide like duiretic

confirm resistant hypertension, confirm elevated BP

consider seeking expert advicE

ADD low dose pironolactone if blood potassium <4.5
Alpha blocker or beta blocker >4.5

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10
Q

What monitoring should be taken into account for ACE/ARB

A

urea and creatinine

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11
Q

what monitoring should be looked at for calcium channel blocker

A

heart rate

ankle oedemea

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12
Q

what monitoring should be looked at for thiazide like diuretics

A

urea and creatinine
electrolytes
uric acid if at risk of suspect gout

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13
Q

what might drug drug interactions cause

A

increase or decrease effects of the antihypertensive drug

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14
Q

what might an example of drug disease interaction be

A

some drugs may increase or reduce BP

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15
Q

what is an example of Co morbidity

A

pre existing or new condition may increase

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16
Q

what is coronary heart disease

A

umbrella term covering a range of conditions all caused by atherosclerosis

angina
non st segment myocardial infarction
st segment myocardial infarction

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17
Q

What are cardiac symptoms of CHD

A

central or band like pressure or pain

sub-sternal pain

radiation to jaw arm or back

fast pulse

may be relieved by GTN/rest

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18
Q

what are respiratory symptoms of CHD

A

fast respiratory rate

persistant localised pain

pain worsens on breathing deeply or coughing

knife like

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19
Q

what are GI symptoms of CHD

A

epigastric burning pain

often after food or at night

relieved by antacid

difficulty swallowing

tenderness

20
Q

what are infection symptoms of CHD

A

High temperature

Previous viral illness

Fast pulse

infected sputum

21
Q

what are some mental health symptoms of CHD

A

stressed

anxious

not radiating

fast pulse

palpitation

fast respiratory rate

relieved by breathing techniques and distractions

22
Q

what might a patient with MI have

A

Patients having an MI often look grey in colour, sweaty, feel dizzy, short of breath, feel or be sick, pain may be felt in the back or radiating down the left arm or jaw.

diabetics not always feel the severity of pain but are especially high risk.

23
Q

what are the locations of pain for myocardial infarction (Heart attack)

A

left arm radiation

irradiation in the back

24
Q

What is ACS

A

acute coronary syndrome ACS is unpredictable and not relieved by GTN and is classed as an emergency

25
Q

how can ACS and stable angina be differentiated

A

relieved by GTN

26
Q

What is CHD - Stable Angina

A

Stable atherosclerotic plaque
predictable onset - usually on exertion
Offer short acting nitrate

27
Q

what counselling can be given for CHD - stable angina

A

use immediately upon symptoms or before any planned exercise

sit or lie down before using as causes vasodilation so can drop BP

hold spray upright, spray 1 or 2 sprays under tongue

close mouth

repeat dose after 5 minutes if pain not subsided

28
Q

How can we treat stable angina

A

Licensed beta blocker or licensed calcium channel blocker

switch or combine

long acting nitrate
Nicorandil

Ivabradine
Ranolzaine

29
Q

Consideration of aspirin

A

use depending upon individual risks / benefits

30
Q

consideration of Ace inhibitors

A

use in those with diabetes

use for hyperetension in line with guidance

31
Q

consideration of statins

A

recommend use

intensity dose dependant upon patient

risk/ preference

32
Q

what should all patient presenting Mi go through

A

risk stratification.

33
Q

why should mi presenters go through risk stratification

A

allow future planning by clinicians, patients and their family. helps guide clinicians advice and action and to prioritise high risk patients.

34
Q

what techniques are used to diagnose ACS

A

ECG

  • St segment elevation = stemi
  • NSTEMI seen as other markers of ischaemia
  • No changes seen in UA

Troponin

  • 2 tests taken 3 hours apart
  • if increase >10 then +ve

Percutaneous coronary intervention
- visualisation of coronary blood vessels is the only way to confirm diagnosis

35
Q

what can we use to treat acute coronary syndrome

A

GTN (Glyceryl trinatrate)
Morphine/ Diamorphine
Aspirin/Ticagrelor/CLopidogrel/Prasugrel
Statin/beta blocker/ace inhibitor

36
Q

what secondary exists for CHD

A

aspirin + second antiplatelet medication

atorvastatin

ace inhibitor

beta blocker

GTN spray

37
Q

what monitoring parameter exist for CHD

A

BP and HR

Blood sugars

GI effects

Signs of bleeding or bruising

Platelets

Hyper sensitivity reactions

Cholesterol

U and Es

Pain

Liver Transaminase enzymes

38
Q

what are side effects of aspirin + antiplatelets

A

GI upset

Bleeding

Wheeze

Thrombocytopenia

39
Q

what is Thrombocytopenia

A

shortage of platelets in your blood

40
Q

what are the side effects of beta blockers

A

fatigue

cold extremities

bronchoconstriction

hypotension

impotence

bradycardia

mask hypoglycaemia

sleep disturbances

41
Q

what are the side effects of statin

A

muscle cramp

Deranged LFT

hyperglycaemia

abdominal pain

headache

rarely rhabodymolysis

42
Q

what are the side effects of GTN

A

headache

flushing

dizziness / hypotension

43
Q

CHD drug drug interactions

A

ADRs usually as an additive effect of multiple cardiac meds

e.g. hypotension due to use of bisoprolol and ramipril

44
Q

CHD drug disease interaction

A

broncho constriction from beta blockers usually only in asthma

45
Q

COmorbidity

A

anxiety, depression , anaemia , COPD

Therapeutics (50 decks)

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