9.2 - Hypertension and HF treatment Flashcards

1
Q

How do centrally acting agents work? Give an example

A

Work by reducing sympathewtic outflow to reduce BP. e.g. Methyldopa

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2
Q

How do alpha blockers work? ADRs?

A

Antagonism of alpha 1 adrenoreceptors

ADR - postural hypotension, dizziness, headaches and fatigue, oedema

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3
Q

How do thiazide diuretics work? ADRs?

A

Act on NaCl symporter in DCT, reducing water reabsorption and blood volume.

ADR - hypokalaemia, hyperuricaemia, hypercalcaemia, ED

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4
Q

CCB MoA? What are the 3 types? ADRs?

A

Bind to L-type calcium channels and reduce Ca entry. Vasodilates arteries.

3 groups:

  1. Dihydropyridines - tachycardia, sweating, flushing, oedema
  2. Phenylalkylamines - constipation, bradycardia
  3. Benzothiazepines - bradycardia, negative ionotropy.
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5
Q

What are some ADRs to ACEi?

A

dry cough, first dose hypotension, renal failure, hyperkalaemia

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6
Q

What is classified as a hypertensive emergency? How would you treat?

A

>220/120mmHg

Treat with IV sodium nitroprusside which acts as an endogenous nitric oxide.

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7
Q

Which CCB is the preferred?

A

Dihydropyridines

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8
Q

How would you treat mild, moderate, and severe hypertension?

A

Mild - Non pharm therapies

Moderate and severe - Pharm therapies

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9
Q

What is a pheochromocytoma?

A

Adrenal catecholamine secreting tumour

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10
Q

Describe the treatment plan for <55 yo

A

1) ACEi
2) +CCBs
3) +diuretics
4) + alpha blockers, beta blockers, centrally acting drugs, or vasodilators

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11
Q

Describe the treatment plan for a black person or a >55yo

A

1) CCBs
2) +ACEi
3) +diuretics
4) +alpha blockers, beta blockers, centrally acting drugs, or vasodilators

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12
Q

How do direct renin inhibitors work?

A

Bind to renin and prevents cleavage of angiotensinogen to angiotensin I

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13
Q

Define mild, moderate, and severe hypertension

A

Mild - 140-159 s, 90-99 d

Moderate - 160-179 s, 100-109 d

Severe - >180 s, >110 d

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14
Q

What antihypertensive drug is used preferably in pregnancy?

A

Centrally acting agent e.g. methyldopa

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15
Q

What are the 3 types of CCBs?

A

Dihydropyridines, benzothiazepines, phenylakylamines

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16
Q

If patient cannot tolerate ACEi, what is the alternative treatment? Name an example and its ADRs.

A

AG2 receptor blocker

e.g. Losartan. ADR is renal failure, hyperkalaemia

17
Q

How do alpha blockers work?

A

Antagonise alpha 1 adrenoreceptors to reduce TPR

18
Q

What is the MoA of ACEi? ADRs? Give .e.g

A

e.g. - ramipril

MoA - prevent AG2 generation by inhibiting ACE. Also prevents bradykinin degradation. This all reduces effect of RAAS system

ADRs - dry cough, first dose hypotension, renal failure and hyperkalaemia.

19
Q

Name an example ACEi

A

Lisinopril, ramipril

20
Q

How do centrally acting agents work? What drugs does this include? ADRs?

A

Methylodopa - alpha 2 agonist

Clinidine - alpha 2 agonist

All reduce sympathetic outflow to reduce BP

ADRs - tiredness, lethargy, depression

21
Q

Fill in

A
22
Q

Define hypertension. What are the 2 causes of hypertension?

A

>140/90mmHg

Primary - No known cause. 90% of cases

Secondary - known cause.

23
Q

How do direct renin inhibitors work?

A

Bind to renin and prevent cleavage of angiotensinogen to angiotensin 1. Little effect on BP

24
Q

How do beta blockers work?

A

Antagonise beta1 adrenoreceptor, reducing HR and CO. But little effect on BP

25
Q

Define a hypertensive emergency. How would you treat? How does treatment work?

A

>220/120

IV sodium nitroprusside acts as endogenous N2O