Hypertension and heart failure

Question 1

what is the equation for BP?

Answer 1

COTPR or HRSV*TPR

Question 2

How does diabetes cause high blood pressure ?

Answer 2

endothelial dysfunction and increase in ROS = Medial hypertrophy of vessels

Question 3

what is Nice definition of stage 1 hypertension ?
stage 2 ?
severe ?

Answer 3

BP higher than 140/90
ABP = 135/85
stage 2 = 160/100
ABP = 150/95
severe = 180 / 110

Question 4

What is the primary cause of hypertension ?

Answer 4

Idiopathic (Essential)

Question 5

how do you take a BP ?

Answer 5

patient is sat down relaxed and arm supported

repeat on both arms if >20 difference repeat on higher arm

Question 6

What is prehypertensions and how is it normally treated ?

Answer 6

elevated BP below stage 1 with no end organ damage.

Lifesyle changes

Question 7

What are the 3 main types of anti-HT agents ?

Answer 7

ACE inhibitors /Ang Receptors (ARBs)
Calcium Channel blockers
Diuretics

Question 8

where is ACE found ? where does ANG 2 work on ?

Answer 8

Luminal surface of capillary endothelial cells in the lungs

AT1 and AT2

Question 9

What receptor is most potent for ANG2 and what are the effects?

Answer 9

AT1,

Vasoconstriction , Aldosterone release, ADH release and vascular muscle cell growth

Question 10

Name 2 Ace inhibitors

Answer 10

Captopril, Ramipril , Enalapril and lasinopril

Question 11

Why are ARBs used sometimes of ACE-i ?

Answer 11

ANG 2

Question 12

what are the main side effects of ACE-i?

Answer 12

dry cough (BK build up), Angioedema , renal failure and Hyperkalaemia

Question 13

What are the effects of Bradykinin on the body ?

Answer 13

Dry cough and vasodilation via NO and PGI2

Question 14

what are the side effects of ARBs and what do they target ?

Answer 14

Renal failure and hyperkalaemia , no BK = no dry cough

AT1 receptors

Question 15

what are the ways ANG2 is made ?

Answer 15

RAAS system

Chymase production

Question 16

name 2 ARBs

Answer 16

Iosartan
Candesartan
eprosartan
irbesartan

Question 17

what class of CCBs target VSMCs?

Answer 17

Dihydropyridines

Question 18

What class of CCBs target Cardiac myocytes ?

Answer 18

Phenylalkyamines and benzothazapines , non dihydropyridines

Question 19

what class of CCBs sits in the middle ?

Answer 19

benzothiazapines

Question 20

When would you use CCBs over ACE-i in first line treatment ?

Answer 20

low renin hypertensives

Question 21

name 2 dihyropryridines

Answer 21

Amlodipine , nifedipine and nicardipine

Question 22

what are properties of Dihydropyridines ?

Answer 22

Good oral absorption
protein bound
metabolised by liver

Question 23

what are the side effects of dihyropyridines ?

Answer 23

Tachycardia - sympathetic activation 
palpitations 
Flushing, sweating , headaches
oedema
reaction with simvastatins

Question 24

what is the MOA of Phenylalkylamines ? what is the overall effect?

Answer 24

impeded calcium transport across myocardial membrane
prolongs the AP and refractory period
negative chronotrophic and inotropic
Used in angina and arrthymia

Question 25

side effects of phenylalkylamines

Answer 25

bradycarida , constipation and worsen HF

Question 26

name a phenylalklamine

Answer 26

verapamil

Question 27

Name a benzothiazapine ? what is a good for ?

Answer 27

diltiazem and angina

Question 28

why do afro-carbianen or >55 a years old patients go straight to CCBs or Diuretics?

Answer 28

low renin activity

Question 29

what is the MOA of Thiazides ?

Answer 29

Inhibit Na+ reabsorption in DCT

Question 30

What are the side effects of thiazides ?

Answer 30

Hypokalaemia , increased Urea levels, glucose intolerence , hyperlipidemia, activates RAAS

Question 31

Name 1 thiazide

Answer 31

bendroflumethiazide | indapamide

Question 32

what can be used in hypertensive emergencies ?

Answer 32

Nitriates e.g. SNP | Labetalol - beta blocker, Good in pregnancy

Question 33

name a A1 Blocker and its side effects

Answer 33

doxazosin postural hypotension headache and fatigue oedema

Question 34

name a beta blocker and its side effects

Answer 34

bisoprolol bronchoconstriction mask tacycardia Raynaud's - cold hands

Question 35

what are the main causes of acute HF ?

Answer 35

Haemorrhagic shock, cariogenic shock (MI) or septic shock

Question 36

what do we mean by self perpetuating cycle of HF?

Answer 36

Decresed CO leads to more vasoconstriction via RAAS lead to increased afterload and preload = worsening HF

Question 37

What is the management of HF?

Answer 37

Diuretics- treat symptoms , treat underlying condition | ACEi and beta blockers . similar to HT.

Question 38

what is digoxin used for ?

Answer 38

an adjunct therapy of HF - only patients with Sinus rhythm | used in AF

Question 39

What is ivabradine ?

Answer 39

If current blocker = slows HR

Question 40

What is sacubitril ?

Answer 40

potentiates ANP and BNP = Loss in BP