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PHRM2102 > Week 4: Hypertension > Flashcards

Week 4: Hypertension Flashcards

1
Q

Persons of a …. racial background do not respond as well to ACE inhibitors and sartans, and are instead recommended thiazide diuretics or dihydropyridine calcium channel blockers

A

black African

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2
Q

T or F
Medications can cure high blood pressure

A

F
Medications can only help control blood pressure

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3
Q

What is the most common type of hypertension?

A

Primary: also known as essential or idiopathic. This is the most common form (95% of cases)

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4
Q

Which type of hypertension has no identifiable cause?

A

Primary hypertension

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5
Q

What are the two main types of hypertension?

A

Primary and secondary

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6
Q

Secondary hypertension is associated with identifiable causes such as…

A

Sleep issues, kidney disease, high levels of hormones that control blood pressure, drugs and complementary medicines

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7
Q

What are some examples of drugs and complementary medicines that can cause secondary hypertension?

A

non-steroidal anti-inflammatories (NSAIDs), corticosteroids, and some recreational drugs

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8
Q

T or F
High blood pressure normally has no symptoms

A

T

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9
Q

T or F
Mercury and aneroid sphygomomanometers are more accurate than electronic meters

A

T
when used by a trained individual

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10
Q

T or F
Wrist blood pressure monitors are the most accurate type of bp monitor

A

F
Wrist blood pressure monitors are less accurate than other types, and thus are not recommended.

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11
Q

What is the smallest blood pressure reading that would be classified as hypertension?

A

140/90

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12
Q

When lowering blood pressure, it is important to monitor for what adverse effects?

A

hypotension (low blood pressure)
syncope (fainting)
electrolyte disturbances, and
acute kidney injury/failure

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13
Q

What does syncope mean?

A

It refers to fainting

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14
Q

What are some OTC medications that may reduce BP?

A

Bitter orange, ginseng, guarana, caffeine pills, caffeine containing products (e.g. tea, cola nut), natural liquorice, St John’s wort, energy drinks

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15
Q

What are the two overarching types of calcium channel blockers?

A

the dihydropyridines and the non-dihydropyridines

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16
Q

T or F
Vasodilatory side effects
are more common in the use of non-dihydropyridines than with dihydropyridines.

A

F
vice versa

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17
Q

T or F
Peripheral oedema can be improved through the use of loop diuretics

A

F

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18
Q

How can peripheral oedema caused by the use of a dihydropyridine be improved?

A
  • lowering the dose of the dihyropyridine
  • the addition of ACE inhibitors or sartans
  • by switching a patient to a non-dihydropyridine CCB
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19
Q

T or F
Non-dihydropyridine calcium channel blockers can lead to an increase in heart rate

A

F
Non-dihydropyridines decrease heart rate. Dihydropyridines can increase heart rate.

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20
Q

Why are only controlled release formulations
of nifedipine recommended for the treatment of hypertension?

A

Dihydropyridine CCBs can lead to an increase in heart rate, heart palpitations,
tachycardia and chest pain, like angina. Especially the shorter acting CCBs.

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21
Q

T or F
CCBs can cause gingival hyperplasia

A

T

22
Q

Dihydropyridine calcium channel blockers are recommended
as first line antihypertensive agents for people of … ethnicity.

A

black African

23
Q

The non-dihydropyridine calcium channel
blockers are inhibitors of cytochrome … enzymes

A

p450

24
Q

T or F
Combinations of beta blockers and non-dihydropyridine calcium channel blockers are very safe.

A

F
This combination may cause heart block
and the potential for sudden death, and so are normally avoided.

24
Q

Which part of the RAAS system to ACE inhibitors block?

A

ACE converting enzyme

25
Q

Why are ACE inhibitors associated with dry coughing as a side effect?

A

ACE inhibitors can metabolise an inflammatory mediator body Keenan which can build up in the body. ACE inhibitors also increase the body concentration of bradykinin. This can cause a dry cough.

26
Q

What is the biological target of Sartans?

A

The AT1 receptor (which is acted upon by angiotensinogen II to cause vasoconstriction and the secretion of aldosterone form the adrenal glands which leads to sodium
resorption in the kidneys and fluid retention,
which leads to increased blood pressure).

27
Q

Why are sartans associated with lower incidences of a dry cough side effect than ACE inhibitors?

A

because Saturns do not affect ACE, the metabolism of Bradykinin is not affected.

28
Q

T or F
ACE inhibitors and statins are generally well tolerated medications.

A

T

29
Q

What are some common adverse effects of ACE inhibitors and sartans?

A

hypertension, headache., nausea, fatigue, dizziness, a dry cough, rise serum potassium levels and renal impairment.

30
Q

What medication classes can cause first dose hypotension?

A

Sartans and ACE inhibitors

31
Q

How can first dose hypotension be avoided?

A
  • By having the patient take their first dose before bed so they will be lying down when drug levels reach their peak.
  • Starting at a lower dose
32
Q

It is recommended to separate the doses of ACE inhibitors and sartans from …

A

diuretics

33
Q

Developing a dry cough side effect when taking ACE inhibitors is more common in those of … ethnicity.

A

Chinese

34
Q

What are some symptoms of hyperkalemia?

A

muscle weakness, a slow pulse, tingling sensations, nausea and abdominal bloating.

35
Q

T or F
The effect of ACE inhibitors and statins
to reduce pressure across the GLOMERULUS can be beneficial.

A

T
it can help to delay the progression of kidney disease.

36
Q

Why should patients call an ambulance if they experience Angioedema as a side effect of taking ACE inhibitors?

A

It can cause oedemas in the tongue or upper airway which limit the ability to breathe

37
Q

T or F
Angioedema is a side effect of ACE inhibitors that can occur 6 months after starting treatment.

A

F
It normally occurs early on in therapy, usually
within the first week to three months

38
Q

T or F
Where patients experience angioedema, we cease their use of the medication class.

A

T
However, they can use a sartan instead as the risk of recurrence is small.

39
Q

There will be a reduction in EGFR on starting ACE inhibitors and sartans.
As long as this decrease remains below …% of the baseline EGFR measurement, this is normally considered acceptable.

A

25

40
Q

Persons of black African ethnicity have been observed to have a reduced response to ACE inhibitors and sartans,
and hence guidelines have recommended that … or … are used as first line in these populations.

A

thiazide-like diuretics, or dihydropyridine calcium channel blockers

41
Q

Drugs with small therapeutic windows are not recommended for use alongside … and … classes of medications as the combo can lead to drug toxicity.

A

ACE inhibitors
sartans

42
Q

Combining ACE inhibitors
or statins with loop directs or high doses of thiazide diuretics can increase the risk of….

A

first dose hypotension.

43
Q

… also reduce blood pressure, lowering the
effects of ACE inhibitors and Sartans and can increase the risk of renal impairment and hyperkalemia.

A

Nonsteroidal anti-inflammatories

44
Q

Why are only low doses of hydrochlorothiazide used to treat hypertension?

A

Increasing the dose results in diuresis effects, which are not desirable.

45
Q

T or F
Raynaud’s phenomenon is less likely with cardioselective beta blockers than other beta blockers.

A

T

46
Q

Why are cardioselective beta blockers, or those with alpha-1 antagonist activity preferred in patients with diabetes?

A

Nonselective beta blockers may retard patients’ recovery from hypoglycaemia.

47
Q

Why are patients slowly weaned off beta blockers?

A

beta receptors are upregulated when blocked for prolonged periods.

48
Q

T or F
The combination of an ACE inhibitor and sartan is generally not recommended

A

T

49
Q

T or F
The diagnosis of hypertension in pregnancy is common

A

T

50
Q

Preeclampsia is associated with a rise in … and … in the urine

A

blood pressure
protein

PHRM2102 (9 decks)

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