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4 Clinical Pharmacology and Intro to Prescribing > 5 Hypertension and Heart Failure > Flashcards

5 Hypertension and Heart Failure Flashcards

1
Q

How is hypertension defined? (NICE guidelines)

A

NICE Hypertension= BP >140/90 mmHg

Elevation in blood pressure that is asssociated with an increase in risk of some harm

Elevated blood pressure that treated will do more good than harm

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2
Q

What are the different types of hypertension? (4)

A
  1. Essential/primary/idiopathic
  2. Secondary (to other pathology eg Pheochromocytoma)
  3. Isolated systolic/diastolic
  4. White coat/clinic (elevation of blood pressure whilst at clinic)
    1. need to be careful to not overdiagnose
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3
Q

Outline the best practice for measuring blood pressure?

A
  1. Patient sat, relaxed, arm supported
  2. Take pressure from both arms
    1. If >15mmHg difference between arms, repeat measurement
    2. Use arm with higher reading
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4
Q

What might be classes as a hypertensive emergency? What are the clinical signs?

A

Hypertensive emergency= BP >180/120 + clinical signs

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5
Q

What BPs are classed as hypertension for:

  • <80 year olds
  • >80 year olds
  • type 1 diabetics
A
  • <80 year olds= 140/90
  • >80 year olds= 150/90
  • type 1 diabetics= 135/85
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6
Q

What are the different stages of hypertension (give BP values)

A
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7
Q

What is defined as prehypertension? What lifestyle changes should be recommended to patients who are prehypertensive?

A

Prehypertension= >120/80 and < 140/90 mmHg

  • Promotion of regular exercise
  • Healthy diet
  • Limit/reduce alcohol intake
  • Smoking cessation
  • Reduce dietary sodium
  • Discourage excessive caffeine consumption
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8
Q

What are the main therapeutic agents for treating primary hyertension? (4)

A
  1. ACE inhibitors (Angiotensin converting enzyme inhibitors)
  2. ARBs (Angiotensin receptor blockers
  3. CCBs (Calcium channel blockers)
  4. Diuretics (eg thiazides)
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9
Q

How do ACE inhibitors aim to reduce blood pressure? (ie what mechanisms)

A

Limit conversion of Angiotensin I to Angiotensin II

Reduce angiotensin II effects:

  • Vasodilation
  • Reduce aldosterone release (increase Na+ and H2O excretion)
  • Reduce ADH (vasopressin) release (increase H2O excretion)
  • Reduce cell growth and proliferation
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10
Q

Can angiotensin II be produced from angiotensin I independently of ACE?

A

Yes- by chymases

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11
Q

Give the names of 2 ACE inhibitors.

A

naproxen= NSAID

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12
Q

Explain why a patient may get a dry cough as a result of taking lisinopril or ramipril.

A
  1. Bradykinin is a substrate for ACE aswell as ACEi.
  2. Use of ACEi potentiates bradykinin
  3. Bradykinin causes vasodilation via NOS/NO and prostacyclin (vasodilator)
  4. Dry cough due to build up of bradykinin
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13
Q

What are some of the contraindications of ACE inhibitors? (5) Who should they not be given to? (3)

A

Contraindications

  1. Hypotension
  2. Dry cough
  3. Hyperkalaemia (low aldosterone)
  4. Renal failure (renal artery stenosis)
  5. AKD

Who should we not give ACE inhibitors to?

  1. Patients w./ CKD
  2. Pregnancy
  3. Breastfeeding
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14
Q

What are some of the important drug interactions with ACEi to note?

A
  1. Drugs that increase K+
  2. NSAIDs
  3. Other antihypertensive agents
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15
Q

Give 2 examples of angiotensin II receptor blockers (ARBs).

A
  1. Candesartan
  2. Losartan
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16
Q

How do ARBs act to reduce BP?

(ARBs= Angiotensin-II blockers= AT1 Receptor blockers)

A

Angiotensin II acts on AT1 and AT2 receptors

Directly target AT1 receptors (more effective at inhibiting Angiotensin II mediated vasoconstriction - chymase production)

17
Q

Why do ARBs not cause a dry cough or angioedema but ACE inhibitors do?

Angioedema is an area of swelling of the lower layer of skin and tissue just under the skin or mucous membranes

A

ARBs have no effect on bradykinin

Less effective in low- renin hypertensives

18
Q

What are some of the contraindications of ARBs inhibitors? (3) Who should they not be given to? (3)

A

Contraindications

  • Hyperkalaemia (low aldosterone)
  • Renal failure (renal artery stenosis)
  • AKD

Who should we not give ACE inhibitors to?

  • Patients w./ CKD
  • Pregnancy
  • Breastfeeding
19
Q

What are some of the important drug interactions with ARBs to note?

A
  1. Drugs that increase K+
  2. NSAIDs
  3. Other antihypertensive agents
20
Q

How do CCBs (calcium channel blockers) work to reduce hypertension?

A

CCBs- target calcium initiated smooth muscle contraction

Different classes (3) interact with different sites on α1 subunit of VOCC

21
Q

Outline the mechanism/site of action of the 3 classes of CCBs which are used to treat hypertension:

  • State the names of drugs in each class
  • State how they work
  • Which class is the first line CCB in hypertension
  • Which drug has selectvity for cerebral vasculature
  • Which drug is use to treat arrythmia and angina
A
22
Q

What are some of the side effects of dihydropyridines and who should it not be given to (contraindications)?

A

Side effects:

Ankle swelling

Flushing

Headaches

Palpitations

Contraindications:

Unstable angina

Severe aortic stenosis

23
Q

What are the 2 important drug interactions to know for the dihydropyridine class of CCBs?

A
  • Amlodipine + simvastatin - increase effect of statin
  • Other antihypertensive agents
24
Q

What are some of the side effects of phenylalkylamines and who should it not be given to (contraindications)?

A

Side effects:

  • Constipation
  • Bradycardia (iv)
  • Heart block
  • Cardiac failure

Contraindications:

  • Poor left ventricular function
  • AV nodal conduction delay
25
Q

What are 3 important drug interactions with phenylalkylamines that we should be aware of?

A
  • β-blockers
  • Other hypertensives
  • Other antiarrythmics
26
Q

Give the name of a thiazide diuretic and a thiazide like diuretic.

A

Thiazide diuretic: bendroflumethiazide

Thiazide like diuretic: indapamide

27
Q

What are some of the side effect of thiazides and what are their 2 important drug interactions?

A

Side effects:

  • Hypokalaemia
  • Hyponatraemia
  • Impaired glucose tolerance
  • Increased cholesterol and triglyceride levels
  • Gout
      • Increased urea and uric acid levels

Interations:

  • NSAIDs
  • Potassium lowering drugs
28
Q

Thiazides are more likely to be chosen to treat hypertension over CCBs if the patient has what sign/symptom?

A

Oedema

29
Q

Why are CCBs used in the first instances to treat hypertension in over 55s and those of black African and Caribbean groups?

A

These populations have low levels of renin in first place- not ideal target system in first instance (RAAS)

30
Q

Why are ACE inhibitors or ARBs the first line treatment for hypertension secondary to type 2 diabetes irrespective of age or ethnicity?

A

ACEis and ARBs have added benefits at kidneys

  • Decrease incidence of diabetic nephropathy and CKD w./proteinuria
    • Dilation of efferent glomerular arteriole
      • Reduced intraglomerular pressure
31
Q

What drugs can be used to treat resistant hypertension (stage 4)? (3) Which of these should be used if blood potassium is >4.5 mmol/l and if blood potassium is <4.5 mmol/l?

A
32
Q

How does spironolactone work? What are its contraindications (2) and what are its important drug interactions to consider?

A

Sprionolactone= aldosterone antoagonist–> stops action of aldosterone at ENaC and also blocks ROMK

​Contraindications:

  1. Hyperkalaemia
  2. Addison’s

Interactions:

  1. Other K+ increasing drugs
  2. ACE inhibitors
  3. ARBs
33
Q

Name 3 β-adrenoreceptor blockers (used to treat hypertension) and explain how beta blockers work to reduce blood pressure.

A
  1. Labetalol (β1, β2 and α1)
    1. Used: preganncy and hypertensive emergencies)
  2. Bisoprolol (β1)
  3. Metoprolol (β1)

How do they work?

  • Block noradrenaline
    • Decrease sympathetic tone
    • Reduce CO
    • Reduce release of renin in kidneys (release= partly regulated by β1- adrenoreceptors)
    • ie REDUCE SYMPATHETIC OUTFLOW
34
Q

With relation to β-blockers give the:

Side effects (5)

Contraindications (4)

Interactions (1)

A

Side effects:

  1. Bronchospasm
  2. Heart block
  3. Raynaud’s
  4. Lethargy
  5. Impotence

Contraindications:

  1. Asthma
  2. COPD
  3. Haemodynamic instability
  4. Hepatic failure

Interactions:

  1. Non-dihydropyridine CCBs
    1. Verapamil
    2. Diltiazem
35
Q

Name 2 α-blocker and describe how they work to treat hypertension. Apart from hypertension what else are they used to treat?

A
  1. Doxazosin
  2. Tamsulosin

How does it work?

  • Selective antagonism- α-1 adrenoreceptors
    • Reduce peripheral vascular resistance

Tamsulosin also used to treat symptoms of BPH

36
Q

State the main contraindications and interactions from α-adrenoreceptor blockers.

A

Contraindications:

  • Postural hypotension

Interactions:

  • Dihydropyridien CCBs- oedema
37
Q

Useful diagram showing neurohormonal response attempting to compensate for hypertension leading to further pathology:

A
38
Q

Identify some drugs used to treat and manage heart failure:

A
39
Q

Outline the approach to the management of heart failure. (Aims and how is this done)

A

4 Clinical Pharmacology and Intro to Prescribing (27 decks)

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