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Pharmacy > Chapter 4: Hypertension > Flashcards

Chapter 4: Hypertension Flashcards

1
Q

Hypertension is a major risk factor for Stroke, Myocardial infarction, heart failure, chronic kidney disease, cognitive decline, and premature death. List the causes of hypertension.

A
  • Increased age,
  • Ethnicity (black afro-Caribbean)
  • Male
  • Family history
  • Diet (salt intake, High cholesterol, less fruits consumed)
  • Reduced physical activity
  • Obesity
  • Medications (antidepressants, antidiabetics)
  • Smoking
  • Social deprivation
  • Lifestyle factors (Stress, Anxiety )
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2
Q

What advice could you give to patients with hypertension?

A
  • Benefits of regular exercise (150mins moderate exercise / 75 mins vigorous exercise).
  • Healthy diet
  • Low sodium intake (6g/day = 1 tsp)
  • Reduced alcohol intake (<14 units /wk)
  • Discourage caffeine rich products e.g., coffee
  • Offer smoking cessation programmes
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3
Q

What is the ideal normal blood pressure?

A

90/60 - 120/80mmHg

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4
Q

What is Stage 1 hypertension?

A 
Clinic BP: 140/90mmHg – 160/100mmHg
AND
ABPM: ≥135/85 mmHg 
Offer anti-hypertensive drug treatment to people <80years who have 1 or more of the following:
•	Target organ damage (left ventricular hypertrophy, CKD, retinopathy).
•	Established CVD
•	Renal disease
•	Diabetes
•	10-year CVD risk of 20% or more
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5
Q

What is Stage 2 hypertension?

A

Clinic BP: 160/100mmHg – 180/120mmHg
AND
ABPM: ≥150/95 mmHg
Treat everyone with stage 2 hypertension

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6
Q

What is severe hypertension?

A

Clinic systolic BP: ≥180mmHg
OR
Clinic diastolic BP: ≥120mmHg

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7
Q

What is the step 1, step 2 , step 3 and step 4 treatment for an adult with T2DM with diabetes or for adults ages <55years that are not of black African or African-Caribbean family origin who have hypertension?

A

Step 1 = ACEi/ARB
Step 2= ACEi/ARB + CCB/thiazide like diuretic
Step 3= ACEi/ARB + CCB + Thiazide like diuretic
Step 4= Resistant hypertension
• For those with K+ levels of 4.5mmol/l or less = Consider adding low dose spironolactone
• For those with K+ levels of > 4.5mmol/l = Alpha or beta blocker

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8
Q

What is the step 1, step 2 , step 3 and step 4 treatment for adults aged 55years or over with no T2DM or for those of black African or African-Caribbean family origin?

A

Step 1= CCB
Step 2= ACEi/ARB + CCB/thiazide like diuretic
Step 3= ACEi/ARB + CCB + Thiazide like diuretic
Step 4= Resistant hypertension
• For those with K+ levels of 4.5mmol/l or less = Consider adding low dose spironolactone
• For those with K+ levels of > 4.5mmol/l = Alpha or beta blocker

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9
Q

When using a further diuretic (spironolactone) in resistant hypertension what monitoring must be done?

A
  • Blood Na+
  • Blood K+
  • Renal function
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10
Q

Which CCB should be avoided for patinets with HF?

A

All CCB should be avoided in patients with HF except amlodipine

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11
Q
  1. If a thiazide like diuretic is being started which one is preferred in hypertension?
A

Indapamide (however if certain patients are already having treatment with conventional diuretics such as Bendroflumethiazide or hydrochlorothiazide and are stable with well controlled BP continue with that treatment.
Before moving to each next step in the treatment of hypertension; patients medications must be reviewed to ensure they are being taken at the optimal doses and adherence must be discussed.
Before considering further treatment for a person with resistant hypertension:
• Confirm elevated clinic BP levels using ABPM
• Assess for postural hypotension
• Discuss adherence

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12
Q

What are the clinic and ABPM blood pressure targets for patients over and under 80years.?

A

Target clinic BP for patients under 80years: below 140/90mmHg
Target clinic BP for patients over 80years: below 150/90mmHg

Target ABPM for patients under 80years: below 135/85mmHg
Target ABPM for patients over 80years: below 145/85mmgHg

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13
Q

What is the clinic BP target in renal disease?

A

Below 140/90mmHg

Below 130/80mmHg  if CKD, diabetes, if urine albumin to creatinine ratio exceeds 70mg/mmol.

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14
Q

What is the target BP in pregnancy?

A

<150/100 -chronic hypertension

<140/90 – chronic hypertension and if target organ damage or given birth

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15
Q

What is the target BP in T1DM patients?

A

<135/85mmHg

<130/80mmHg – if complications e.g., eye, kidney, or cerebrovascular disease

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16
Q

What is the target BP in T2DM patients?

A

<140/80mmHg

<130/80mmHg – if complications eye, kidney, or cerebrovascular disease

17
Q

If a patient is taking a dose of anti-hypertensives for the very first time, when should it be taken?

A

At bed time

18
Q

Which ACEi is taken twice a day/BD?

A

Captopril

19
Q

Which ACEi needs to be taken 30-60 min before food?

A

Perindopril

20
Q

What is the common side effect of ACEi?

A

• Persistent dry cough – due to the build-up of bradykinin in the lungs.
Hyperkalaemia- higher risk in renal impairment and diabetes
• Renal impairment- ACEi occasionally cause impairment of renal function
• ACEi reduce glomerular filtration  AVOID in renovascular disease (high BP due to narrowing of arteries that carry blood to kidneys aka renal artery stenosis).
• Hepatic effects  stop ACEi if jaundice occurs

21
Q

Can ACE inhibitors be used in pregnancy?

A

AVOID! Unless essential!

22
Q

Which drugs interact with ACEi?

A
  • Lithium + ACEi = Increases Lithium concentration risk of lithium toxicity
  • Azathioprine + ACEi= increased risk of anaemia/leucopenia
  • NSAIDs + ACEi= Reduced eGFR
  • Diuretics + ACEi = Hypotension
  • ARB+ ACEi = Renal impairment, hyperkalaemia, hypotension
  • ARBS, K+ sparing diuretics and aldosterone antagonists, aliskeren = Hyperkalaemia
23
Q

Which betablocker is not used to treat hypertension?

A

Sotalol

24
Q

Which beta blockers cause less bradycardia and less coldness of extremities?

A

Acebutolol
Celiprolol
Oxprenolol
Pindolol

25
Q

Which beta blockers cause less nightmares and sleep disturbances?

A 
Water soluble BBs:
Atenolol 
Celiprolol 
Nadolol
Sotalol
26
Q

Which beta blockers should be used in asthma if there is no other choice?

A 
Cardio selective BBs
Metoprolol 
Atenolol
Nebivolol 
Bisoprolol 
Acebutolol 
Betaxol 
Esmolol
27
Q

Which beta blockers have a long duration of action hence have a Once daily dosing?

A

Atenolol
Bisoprolol
Celiprolol
Nadolol

28
Q

What are the common side effects of Betablockers?

A
  • Bradycardia
  • Sleep disturbances and nightmares
  • Impotence in men
  • Cold extremities
  • Hyper or hypoglycaemia – BBs can mask the symptoms of hypoglycaemia e.g., tachycardia. Hence best avoided in patients who have frequent hypo episodes
29
Q

Who SHOULD not be on Beta blockers?

A
  • Asthmatics: BB cause bronchospasm (if really necessary give cardio selective BBs)
  • Worsening unstable HF
  • 2nd/3rd degree heart block
  • Severe hypotension and bradycardia
30
Q

What are the common interactions of BB?

A
  • Verapamil + BB = DO NOT USE TOGETHER!! Risk of asystole and hypotension
  • Thiazide like diuretic + BB = both cause hyperglycaemia: avoid in diabetes
31
Q

Which Calcium channel blocker must be maintained on a same modified release brand?

A

Nifedipine

32
Q

What are the most common side effects of CCBs?

A

Ankle swelling, flushing, headaches

33
Q

Which CCBs MUST be avoided in HF?

A

Rate limiting CCBs (verapamil & diltiazem)

Short acting dihydropyridines (nifedipine, nicardipine)

34
Q

Which CCB is safe to take in HF and angina?

A

Amlodipine

35
Q

Which CCB causes constipation?

A

Verapamil

36
Q

Which CCB must be maintained on a same brand when doses >60mg?

A

Diltiazem

37
Q

Is it safe to take grapefruit juice whilst on CCBs?

A

Grapefruit juice is an enzyme inhibitor hence it increases CCB concentration  AVOID

Pharmacy (6 decks)

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