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Yr 2 Sem 2 CPT > 4.2 Hypertension and Heart Failure > Flashcards

4.2 Hypertension and Heart Failure Flashcards

(52 cards)

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1
Q

What is the consequence of higher blood pressure causing increased arterial thickening?

A

Smooth muscle cell hypertrophy

Accumulation of vascular matrix

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2
Q

What BP defines hypertension?

A

140/90mmHg

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3
Q

What is primary/essential hypertension?

A

High BP without any single evident cause

90% patients

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4
Q

What is secondary hypertension?

A

High BP with a discrete, identifiable underlying cause

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5
Q

What is grade 1 hypertension?

A

140/90

Mild

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6
Q

What is grade 2 hypertension?

A

160/100

Moderate

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7
Q

What is grade 3 hypertension?

A

180/110

Severe

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8
Q

Lifestyle therapy for hypertension

A 
Patient education 
Maintain normal body weight (BMI 20-25)
Reduce salt intake <6g/day
Limit alcohol 
Exercise
Fruit and veg 
Eat less fat
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9
Q

What is the first line pharmacological therapy for hypertension?

A

ACE inhibitor/Angiotensin receptor blocker
Calcium channel blocker
Diuretics

A C D

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10
Q

How do ACE inhibitors work?

A

Prevent generation of AngII
Potentiates action of bradykinin

Less vasoconstriction, less aldosterone release so less salt and water retention, less sympathetic activity

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11
Q

Name some ACE inhibitors

A

lisinopril

ramipril

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12
Q

What is the main side effect of ACE inhibitors? Why?

A

Dry cough

Bradykinin accumulates in the lung causing irritation

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13
Q

What are some important but less common side effects of ACE inhibitors?

A

Angio-oedema
Renal failure incl renal artery stenosis
Hyperkalaemia

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14
Q

Name two angiotensin receptor blockers

A

Losartan

Candesartan

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15
Q

How do angiotensin receptor blockers work?

A

Bind to angiotensin AT1 receptor (blocking effects of AngII)

Inhibits vasoconstriction and aldosterone stimulation caused by AngII

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16
Q

What is the difference between angiotensin receptor blockers and ACE inhibitors in terms of side effects?

A

No effect on bradykinin

Well tolerated with few side effects because doesn’t cause a cough

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17
Q

What are some important side effects of angiotensin receptor blockers?

A

Renal failure

Hyperkalaemia

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18
Q

How do calcium channel blockers work?

A

Bind to specific alpha subunit of L-type calcium channel

Reduces cellular calcium entry

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19
Q

What are the three main groups of calcium channel blockers?

A

Dihydropyridines - nifedipine, amlodipine
Benzotthiazepines - diltiazem
Phenylalkylamines - verapamil

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20
Q

What do calcium channel blockers do?

A

Vasodilate peripheral, coronary and pulmonary arteries

No significant effect on veins

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21
Q

What does verapamil do?

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A

Depresses SAN and slows AV conduction

22
Q

What are some properties of calcium channel blockers dihydropyridines? e.g. amlodipine

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A

Good oral absorption
Protein bound >90%
Metabolised by the liver
Few have active metabolites

23
Q

What are some side effects of dihydropyridines?

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A

Sympathetic nervous system activation leading to tachycardia and palpitations
Flushing, sweating, throbbing headache
Oedema e.g. ankle swelling
Gingival hyperplasia

24
Q

What are some properties of phenylalkylamines? e.g. verapamil

Study These Flashcards
A

Impedes calcium transport across the myocardial and vascular smooth muscle cell membrane
Class IV prolongs AP and RP
Peripheral vasodilation
Reduction in cardiac preload and myocardial contractility

25
Adverse effects of phenylalkylamines?
Constipation Bradycardia Reduce myocrdial contractility as negative inotrope which can worsen HF
26
What are some properties of benzothiazepines? e.g. diltiazem
Impedes calcium transport across myocardial and vascular SM cell membrane Prolonges AP and RP Peripheral vasodilation and reduction in preload and contractility
27
Adverse effects of benzothiazepines
Bradycardia | Less negative inotropic effect than verapamil
28
Would you give diltiazem or verapamil to a patient with angina or heart failure?
Diltiazem | Less negative inotropic effect
29
What do thiazides/thiazide like diuretics do?
Reduce distal tubular sodium reabsorption
30
What is the mechanism of blood pressure reduction when using thiazides?
Complex Initial blood volume decrease Later TPR falls
31
What does the dose-blood pressure response curve look like for thiazides?
Flat
32
What are some adverse effects of thiazides?
``` Hypokalaemia Increased urea/uric acid Impaired glucose tolerance Increased cholesterol an TG Activates RAAS ``` Dirty drug
33
Name an alpha blocker
Doxazosin
34
Name some properties of alpha blockers
Selective antagonists at post synaptic a1 adrenoceptors Antagonise the contractile effects of NA on vascular SM = reduce peripheral vascular resistance
35
What are some adverse effects of alpha blockers?
Postural hypotension (more effect in upright position) Headache and fatigue Oedema
36
Why are beta blockers useful for high blood pressure?
Reduce HR and CO | Inhibit renin release (less RAAS)
37
What are some adverse effects of beta blockers?
``` Lethargy, impaired concentration Reduced exercise tolerance Bradycardia Raynauds Impaired glucose tolerance ```
38
What is a contraindication for beta blockers?
Asthma | But is safe for COPD
39
What is aliskiren?
Direct renin inhibitor
40
What does aliskiren do?
Binds to a pocket in renin which blocks the cleavage of angiotensinogen to Ang I (Prevents breakdown of angiotensinogen)
41
How does aliskiren work to lower BP?
Reduces plasma renin activity Vasodilatory BP reduction
42
How do centrally acting agents lower blood pressure? | methyldopa, clonidine, moxonidine
Reduce sympathetic output
43
When is methldopa commonly used?
To treat hypertension in pregnancy
44
Name some side effects on centrally acting agents to lower BP? Why do they cause these effects?
Tiredness/lethargy Depression Because work in the brain
45
What is a contraindication for thiazides?
Gout
46
What is a contraindication for ACE inhibitors and ARBs?
Pregnancy | Renovascular hypertension
47
What is the aetiology of HF?
Ischaemic Heart Disease Hypertension Cardiomyopathies (alcohol, chemo, iron overload) Valve disease
48
What is prognosis after MI related to?
Inversely related to amount of LV damage/dysfunction
49
What lifestyle modifications can be made to manage HF?
Reduce salt Decrease alcohol Increase aerobic exercise Decrease BP
50
What drugs could be prescribed to treat HF?
``` ACE inhibitor/ARB Beta blocker Spironolactone Ivabradine (Funny channel receptor causing bradycardia) Sacubitril (increases natriuresis) ``` nitratesm digoxin, inotropes, phosphodiesterase inhibitors)
51
What are the physiological effects of beta blockers?
``` Reduce HR Reduce BP due to reduced CO Reduces myocardial O2 demand Reduced mobilisation of glycogen Negate unwanted effects of catecholamines ```
52
Why must you be careful with giving b blockers in HF?
The failing myocardium may be dependent on HR

Yr 2 Sem 2 CPT (9 decks)

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