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Flashcards in Deck 3 Deck (34)
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1

Q. What blood pressure is clinically suspected hypertension (HTN) ?

A. BP 140/90 mmHg or higher

2

Q. Which chronic heart pattern is hypertension closest linked to?

A. Atrial fibrillation – chaotic heart pattern, predisposed to blood clotting and embolism (independent stroke risk)

3

Q. In the NICE HTN guidelines what is first line treatment for: A) Pt under 55 years B) Pt over 55 years or Afro-Caribbean? Give an example for each

A. ACE inhibitor (prevents angiotensin I to II) or low-cost angiotensin II receptor blocker (prevents angiotensin II from acting)
ACE inhibitor: e.g. Ramipril, enalapril, perindopril, trandolapril
ARB: e.g. candesartan, valsartan, telmisartan, losartan, irbesartan

B. Calcium-channel blocker
e.g. Amlodipine, nifedipine, diltiazem, felodipine, lacidipine, verapamil

4

Q. In the NICE HTN guidelines what is second line treatment?

A. Add in calcium channel blocker (centrally acting – sympathetic NS)

5

Q. In the NICE HTN guidelines what is third line treatment?

A. Add a thiazide-like diuretic

6

Q. Why are afro-caribbeans and over 55 year olds treated with CCBs initially?

A. They are less likely to be affected by RAAS/renal hypertension than the younger population so calcium channels are targeted initially

7

Q. What conditions are ACE inhibitors used to treat?

A. HTN, HF, diabetic nephropathy

8

Q. Name two ACE inhibitors

A. Ramipril, enalapril, perindopril, trandolapril

9

Q. Which two reactions do angiotensin II blockers inhibit?

A. Angiotensin to angiotensin II
B. Bradykinin to inactive peptides (reduced bradykinin breakdown = cough in some pts)

10

Q. Name 4 adverse effects of ACE inhibitors

A. Cough (dry, chronic)– 10% of patients
B. Rash (common adverse effect)
C. Anaphylactoid reactions

11

Q. Which patients are contraindicated?
ACE-I

A. Pregnancy – teratogenic

12

Q. What conditions are angiotensin II receptor blockers used to treat?

A. HTN, diabetic nephropathy, HF (when ACE-I contracindicated)

13

Q. Name two angiotensin II receptor blockers

A. Candesartan, valsartan, telmisartan, losartan, irbesartan

14

Q. Which receptors to angiotensin II receptor blockers block?

A. Blocks AT-1 receptors

15

Q. What mechanism do angiotensin II receptor blockers reduce?

A. Blocks angiotensin II from activating AT-1 receptors: (which usually increases BP, stimulates release of aldosterone etc)

16

Q. Name 4 adverse effects of angiotensin II receptor blockers (generally well tolerated)

A. Symptomatic hypotension (especially volume deplete patients)
B. Hyperkalaemia - increased K conservation
C. Potential for renal dysfunction
D. Rash – allergy related
E. Angio-oedema – allergy related
F. Contraindicated in pregnancy
G. Generally, very well tolerated

17

Q. Which patients are contraindicated?
A2RB

A. Contraindicated in pregnancy

18

Q. What conditions are CCBs used to treat?

A. Hypertension, Ischaemic heart disease (IHD) – angina, Arrhythmia (tachycardia)

19

Q. Name two CCBs

A. Amlodipine, nifedipine, diltiazem, felodipine, lacidipine, verapamil

20

Q. How do CCBs affect calcium channels?

A. L-type calcium channel blockers (causes channel to close)

21

Q. What are the three main classes of CCB? Describe the action of each class

A. Dihydropyridines: nifedipine, amlodipine, felodipine, lacidipine
a. Preferentially affect vascular smooth muscle – vasodilators – lower BP
b. Peripheral arterial vasodilators
c. (most clinically relevant)
B. Phenylalkylamines: verapamil
a. Acts differently - Main effects on the heart
b. Negatively chronotropic, negatively inotropic (reduces HR and contractility of heart)
C. Benzothiazepines: diltiazem
a. Intermediate heart/peripheral vascular effects (reduces HR and contractility of heart and acts as a vaspodilator)

22

Q. Name a drug from each class of CCBs

A. Dihydropyridines: nifedipine, amlodipine, felodipine, lacidipine
B. Phenylalkylamines: verapamil
C. Benzothiazepines: diltiazem

23

Q. Name 4 adverse effects of CCBs

1. Due to peripheral vasodilatation (mainly dihydropyridines)
Flushing
Headache
Oedema – swelling, typically ankles (gravity)
Palpitations – relax tachycardia due to vasodilation
2. Due to negatively chronotropic effects (mainly verapamil/diltiazem)
Bradycardia
Atrioventricular block – impulse blockage, often in pts with prev weak conduction
3. Due to negatively inotropic effects (mainly verapamil)
Worsening of cardiac failure
4. Verapamil causes constipation – smooth muscle of intestines - calcium

24

Q. What conditions are BBs used to treat?

Ischaemic heart disease (IHD) – angina, Heart failure, Arrhythmia, Hypertension

25

Q. Name two BBs

bisoprolol, carvedilol, propranolol, metoprolol, atenolol, nadolol

26

Q. Which nervous system do BB affect?

Sympathetic

27

Q. Describe the action of B1/2/3 receptors

A. Beta 1: increase HR (+ve chronotropic), conduction velocity, stroke volume
Increase renin secretion from juxtaglomerular cells of kidney, increase ghrelin secretion from the stomach



B. Beta 2: smooth muscle relaxation (symp) (bronchi, GI tract to decrease motility), vasodilation of blood vessels (skeletal), lipolysis in adipose tissue



C. Beta 3: lipolysis in adipose tissue

28

Q. Which BBs are B-1 selective? Which are B1/B2 (nonselective)

A. B-1 selective: Metoprolol, bisoprolol

B. Combined: Atenolol


C. B1/B2: Propanolol, nadolol, carvedilol

Selectivity (relative rather than absolute) The term “cardioselective” is often used to imply β-1 selectivity. This is a misnomer since up to 40% of cardiac β-adrenoceptors are β-2 .

29

1. Q. Name 4 adverse effects of BB blockers

Main adverse effects:
(effects on cerebral)
1. Fatigue
2. Headache
3. Sleep disturbance/nightmares

(due to blocking of adrenaline…)
4. Bradycardia
5. Hypotension
6. Cold peripheries
7. Erectile dysfunction

Worsening of:
8. Asthma (may be severe) or COPD
9. PVD – Claudication or Raynaud’s
10. Heart failure – if given in standard dose or acutely

30

Q. Which patients are contraindicated?

Asthmatics (PVD, HF