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Year 3 > Antihypertensive pharmacology > Flashcards

Antihypertensive pharmacology Flashcards

1
Q

List the features of grade 1 hypertensive retinopathy

A

Increased tortuosity and reflectiveness of retinal arteries (copper/silver wiring)

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2
Q

List the features of grade 2 hypertensive retinopathy

A

Increased tortuosity and reflectiveness of retinal arteries (copper/silver wiring)
PLUS

AV nicking

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3
Q

List the features of grade 3 hypertensive retinopathy

A

Increased tortuosity and reflectiveness of retinal arteries (copper/silver wiring)
PLUS
AV nicking
PLUS
hemorrhages and soft (cotton wool) exudates

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4
Q

List the features of grade 4 hypertensive retinopathy

A

Increased tortuosity and reflectiveness of retinal arteries (copper/silver wiring)
PLUS
AV nicking
PLUS
hemorrhages and soft (cotton will) exudates
PLUS
papilloedema

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5
Q

Name the blood tests and investigations that should be performed for hypertensive patients

A

FBC, U&E’s, TFT’s, fasting lipids, glucose

ECG
CXR
24 hour BP monitor
Echo

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6
Q

NICE guidelines treatment target BP for people < 80 years old (non-diabetic)

A

<140/90 mmHG

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7
Q

NICE guidelines treatment target BP for people > 80 years old (non-diabetic)

A

<150/90 mmHg

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8
Q

NICE guidelines treatment target BP for diabetics

A

<135/85 mmHg

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9
Q

Name some of the conservative/lifestyle factors for managing HTN

A
  • Follow a healthy diet
  • Exercise regularly
  • Reduce dietary salt intake
  • Reduce caffeine consumption
  • Stop smoking
  • Reduce alcohol consumption
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10
Q

Step 1 antihypertensive treatment in someone (non-Afro-Carribbean) < 55 years old and/or diabetic?

A

A =
Ace Inhibitors (Ramipril, Lisinopril, Enalapril)
ARBs (Candesartan, Losartan)

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11
Q

Step 1 antihypertensive treatment in a person > 55 years old or of Afro-Caribbean family origin?

A

C =
CCB (Amlodipine, Diltiazem, Verapamil)

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12
Q

Step 2 antihypertensive treatment in a person < 55 years old

A

Ace inhibitor or ARB + CCB or thiazide diuretic

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13
Q

NICE guidance treatment targets

Diabetes: <135/85 mmHg
Age < 80 years: <140/90 mmHg
Age > 80 years: <150/90 mmHg

A

NICE guidance treatment targets

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14
Q

Step 3 antihypertensive treatment for everyone

A

Ace inhibitor or ARB +
CCB +
Thiazide-like diuretic

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15
Q

Drug class of Amlodipine?

A

Dihydropyridine (calcium channel blocker). This type of CCB is relatively selective for vasculature.

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16
Q

Indications: First or second line treatment of HTN in patients 55 years or older or Afro-Carribean. Reduces risk of stroke, MI, and death from CVD.

A

Amlodipine

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17
Q

Mechanism of action: Blocks the L-type voltage-gated calcium channel, decreasing intracellular calcium levels. This causes relaxation and vasodilation in arterial smooth muscle. Decreases force of contraction in cardiac muscle

A

Calcium channel blockers

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18
Q

Which of the CCB’s is most negatively inotropic, acting to reduce cardiac contractility and reduce the heart rate (most “cardioselective” of the CCB’s)

A

Verapamil

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19
Q

Which anti-hypertensive drug is renowned for causing ankle swelling?

A

Amlodipine (via preferential dilation of pre-capillary arteriole leading to increased hydrostatic pressure)

20
Q

Side effects of this class of anti-hypertensives include palpitations (reflex tachycardia), constipation, flushing, HA, and exacerbation of heart failure -D&V-

A

Calcium channel blockers

21
Q

Mechanism of action of ace-inhibitors?

A

Inhibit angiotensin-converting enzyme (ACE), reducing conversion of angiotensin I to angiotensin II. Blocking the action of Angiotensin II reduces peripheral vascular resistance (afterload) which lowers BP.

22
Q

Important side effects of ace-inihibitors? (3)

A
  1. Dry cough d/t bradykinin accumulation in lungs
  2. HYPERkalaemia- lower aldosterone level promotes potassium retention
  3. Renal impairment/failure- Especially with renal artery stenosis.
22
Q

Losartan belongs to which drug class?

A

ARB’s or angiotensin II receptor antagonist

23
Q

Mechanism of action of Losartan?

A

Blocks action of angiotensin II on the AT1 receptor. Has similar physiological effects to Ace-inhibitors.

24
Q

First and most commonly used ARB in hypertension?

A

Losartan

25
Q

First line drug in hyperaldosteronism?

A

Spironolactone (aldosterone antagonist)

26
Q

MOA of Spironolactone?

A

Blocks the upregulation of Na+ channels in the DCT by aldosterone

27
Q

What are the RENAL secondary causes of HTN?

A

Glomerulonephritis, diabetic nephropathy, renal artery stenosis, and pyelonephritis

28
Q

What are some ENDOCRINE secondary causes of HTN?

A

Cushing’s syndrome, Conn’s syndrome, steroid therapy, pheochromocytoma

29
Q

Treatment recommendations:

Stage 1: BP >140/90 (Treat if end organ damage or diabetic)

Stage 2: BP >160/100 (Treat once confirmed on 24hr BP)

Stage 3: SBP > 180 (Treat immediately)

A

:)

30
Q

Side effects of calcium channel blockers?

A

Palpitations (reflex tachycardia)
Constipation
Flushing
Headache
Exacerbation of heart failure (D&V)

31
Q

Side effects of Spironolactone?

A

Gynaecomastia
Hyperkalaemia
Impaired renal function

32
Q

Which of the anti-hypertensive drugs acts to block the Na/Cl symporter in the distal convoluted tubule?

A

Thiazide diuretics (Bendroflumethiazide)

33
Q

Which antihypertensive drug activates ATP-sensitive potassium channels in smooth muscle of blood vessels to dilate arterioles?

A

Indapamide (“Thiazide-like” diuretic)

34
Q

Side effects of this drug class include:

(Kidney)
HYPOnatraemia
HYPOmagnesaemia
HYPOkalaemia
Alkalosis
HYPERcalcaemia
Increase in urate (Gout)

Increase in glucose –> diabetes, insulin resistance

?Liver
Increase in lipids –> arterial disease

A

Thiazide diuretics

35
Q

Which anti-hypertensive drug class is contraindicated in diabetics with recurrent hypoglycaemia?

A

Beta blockers (eg Bisoprolol) as they can mask sx of hypoglycaemia

36
Q

MOA: Blocks Alpha-1 receptors, decreasing intra-cellular calcium release in arteriolar smooth muscle

A

Alpha blockers (eg Doxazosin)

37
Q

Side effects of Doxazosin?

A

Palpitations (reflex tachycardia) and psotural hypotension

38
Q

An assessment tool used to help determine which patients are most at risk of having a stroke or heart attack in the next 10 years

A

QRISK2 score

39
Q

A moderate QRISK2 score of 10-20% means that a patient has between a ____-_____% chance of having a stroke or heart attack in the next 10 years

A

10-20%

40
Q

Drug class of Bumetanide?

A

Loop diuretic

41
Q

This drug class acts primarily on the ascending limb of the loop of Henle, where they inhibit the Na/K/2Cl transporter. This protein is responsible for transporting Na, Cl-, and K+ from the tubular lumen into the epithelial cells

A

Loop diuretics (eg Furosemide, Bumetanide)

42
Q

Side effects of loop diuretics?

A

Dehyrdation
Hypotension
Electrolyte losses: Na+, Cl-, and K+ (as well as Mg, Ca and H+ ions indirectly)

43
Q

Which drug is the “potassium sparing” diuretic?

A

Spironolactone

44
Q

Side effects of ARB’s (Losartan, Candesartan)?

A

Hypotension (particularly after the first dose)
Hyperkalaemia
Renal failure

45
Q

This potent, direct-acting vasodilator breaks down in circulation to release nitric oxide. It can be used in cases of accelerated or malignant HTN

A

sodium nitroprusside

46
Q

These drugs can be used IV in hypertensive emergencies (although other agents such as labetalol or sodium nitroprusside, are preferred)

A

Nitrates

Short-acting- Glyceryl trinitrate
Long-acting- Isosorbide mononitrate

Year 3 (23 decks)

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