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CPT > Hypertension + Antihypertensives > Flashcards

Hypertension + Antihypertensives Flashcards

1
Q

Equations to work out mean arterial pressure

A

DBP + PP/3
or
CO x TPR

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2
Q

Blood pressure regulation mechanisms

A
  • autonomic sympathetic activity
  • RAAS system
  • autacoids e.g. bradykinin, nitric oxide
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3
Q

Response of sympathetic activity in decrease in BP

A
  • activation of B1 adrenoreceptors on heart > increase CO
  • activation of a1 adrenoreceptors on smooth muscle > vasoconstriction > increased venous return + peripheral resistance
  • activation of B1 adrenoreceptors on kidneys > renin release > RAAS
  • increase in BP
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4
Q

Response of RAAS in a decrease in BP

A
  • drop in renal blood flow
  • renin released
  • angiotensinogen > AngI > AngII > increased peripheral resistance
  • increased aldosterone > increased Na+ + H2O retention > increased blood volume > increase CO
  • increased ADH > water reabsorption > increased blood volume
  • increase in BP
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5
Q

Stages of hypertension

A
  • stage 1: >140/90mmHg
  • stage 2: >160/100mHg
  • stage 3 > 180 systolic or >110 diastolic

Increase in 20 systolic + 10 diastolic each time

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6
Q

What is target blood pressure for <80 years old?

A

<140/90mmHg

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7
Q

Range for pre hypertension

A

120/80mmHg - 140/90mmHg

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8
Q

What advice should be given to pre hypertensive patients?

A
  • promote regular exercise + healthy diet
  • reduce stress + promote relaxation
  • discourage excessive caffeine consumption
  • smoking cessation
  • reduce sodium intake
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9
Q

What classifications of drugs are used to treat primary hypertension?

A
  • ACE inhibitors ACEi
  • angiotensin recpetor blockers ARB
  • calcium channel blockers CCB
  • diuretics - thiazide + thiazide like
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10
Q

How do ACEi help hypertension?

A
  • limit conversion of angiotensin I > angiotensin II but inhibiting circulating + tissue ACE
  • reduction in AngII activity:
    -vasodilation
    -reduction in alsoderone release
    -reduced ADH release
  • lower BP
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11
Q

What is target blood pressure for >80 years old?

A

<150/90mmHg

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12
Q

What is desired blood pressure?

A

120/80mmHg

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13
Q

Adverse effects of ACEi

A
  • dry cough (bradykinin accumulation)
  • hypotension
  • hyperkalaemia (lower aldosterone > ^ [K+])
  • worsen renal failure
  • angioedema
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14
Q

Contradictions of ACEi

A

Renal artery stenosis
AKD
Pregnancy
Idiopathic angiodema

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15
Q

Why is dry cough a possible side effect of ACEi?

A
  • ACE also converts bradykinin into peptide fragments
  • accumulation of bradykinin can cause dry cough
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16
Q

Suffix for ACEi

A

-pril

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17
Q

Suffix for angiotensin II receptor antagonists

A

-sartan

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18
Q

Adverse effects of ARBs

A
  • hypotension
  • hyperkalaemia (low aldosterone > ^ [K+])
  • worse renal failure
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19
Q

What are possible side effects of ACEi that are not an issue with ARBs?

A

Dry cough
Angioedema
No effect on bradykinin

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20
Q

Contraindications of ARBs

A

Renal artery stenosis
AKD
Pregnancy

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21
Q

Important drug interactions with ACEi +ARBs

A
  • potassium sparing drugs
  • NSAIDs
  • other hypertensives
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22
Q

How do angiotensin II receptor antagonists work?

A
  • AngII blockers
  • bind to AT1 receptors
  • limit action of angiotensin II
  • lower BP
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23
Q

Why do ACEi and ARBs precipitate hyperkalaemia?

A

Lower aldosterone
Causes increase in [K+]

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24
Q

Types of calcium channel blockers

A
  • Dihydropyridines
  • Non-dihydropyridines - Phenylalkamines + benzothiazapines
25
Q

Suffix of dihydropyridine class of CCBs

A

-ipine

26
Q

Adverse effects of dihydropyridine class CCBs

A
  • ankle swelling
  • flushing
  • headaches
  • palpitations (due to compensatory tachycardia)
27
Q

Contraindications of dihydropyridines class CCBs

A

Unstable angina
Severe aortic stenosis
Cardiogenic shock

28
Q

Action of dihydropyridine class CCBs

A
  • selective for peripheral vasculature
  • inhibits Ca2+ influx to vascular smooth muscles
  • causes vasodilation
  • decreases peripheral vascular resistance + cardiac workload
29
Q

Action of phenylalkamines

A

Depress SA node
Slows Av conduction
Negative inotropy

30
Q

Example of Phenylalkylamine

A

Verapamil

31
Q

Uses of verapamil

A

Arrhythmias
Angina
Hypertension

32
Q

Adverse effects of phenylalkyalamines

A
  • Constipation
  • Bradycardia
  • Heart block
  • Cardiac failure
33
Q

Contraindications of phenylalkylamines

A

Poor LV function
AV nodal conduction delay

34
Q

Important drug interactions of dihydropyridine class CCBs

A

Amlodipine with simvastatin

35
Q

Important drug interactions of verapamil

A

B blockers
Other antihypertensives or antiarrhymtics

36
Q

Examples of thiazide + thiazide like diuretics

A

Bendroflumethiazide
Indapamide

37
Q

Adverse effects of thiazide + thiazide like diuretics

A
  • Hypokalaemia
  • Hyponatraemia
  • Gout
  • Arrhythmias
  • increase glucose
38
Q

Contraindications of thiazide + thiazide like diuretics

A

Hypokalaemia
Hyponatraemia
Gout

39
Q

How do thiazide + thiazide like diuretics work?

A
  • Inhibit Na+/Cl- co transporter in DCT
  • Reduced Na+ + H2O reabsorption
40
Q

Important drug interactions with thiazide + thiazide like diuretics

A

NSAIDs
v K+ drugs e.g loop diuretics

41
Q

Treatment of resistant hypertension

A
  • spironolactone: aldosterone receptor antagonist if blood K+ <4.5mmol/l
    OR
  • a/B blockers: if blood K+ >4.5mmol/l
42
Q

Contraindications of spironolactone

A

Hyperkalaemia
Addison’s

43
Q

Suffix of B adrenoreceptors blockers

A

-olol

44
Q

How can you use the names of beta blockers to know what receptor they act on?

A

A-N β1
O-Z β1 and β2
Not “olol” ending α and β

45
Q

Suffix of a adrenoreceptors blockers

A

-osin

46
Q

What is the target BP for pregnant women?

A

135/85mmHg

47
Q

What is first line treatment of gestational hypertension?

A

Labetalol hydrochloride

48
Q

What is the mechanism of action of lebtalol hydrochloride?

A

Beta blocker
- Blocks B1 receptors in heart > vasodilation > decrease vascular resistance

49
Q

Order of treating hypertension in patients with(out) type 2 diabetes, <55 or not black

A

1- ACEi or ARBs
2- ACEi or ARB + thiazide diuretic or CCB
3- ACEi or ARB + thiazide diuretics + CCB
4- add spironolactone (blood K+ <4.5mmol/l) or a/B blocker (blood K+ >4.5mmol/l)

50
Q

Order of treating hypertension in patients without type 2 diabetes, >55 or black

A

1- CCB
2- CCBs + ACEi or ARB or thiazide diuretics
3- ACEi or ARBs + CCB + thiazide diuretics
4- add spironolactone (blood K+ <4.5mmol/l) or a/B blocker (blood K+ >4.5mmol/l)

51
Q

What is first line treatment for hypertension is type 2 diabetes?

A

ACEi or ARBs

52
Q

Examples of ACEi

A

Lisinopril
Ramipril

53
Q

Examples of ARBs

A

Candesartan
Losartan

54
Q

Examples of dihydropyridine CCBs

A

Amlodipine
Nimodipine

55
Q

Examples of benzothiazapines

A

Diltiazem

56
Q

Examples of B adrenoceptors blockers

A

Labetalol
Bisoprolol
Metoprolol

57
Q

Examples of a adrenoceptor blockers

A

Doxazosin

58
Q

Why can spironolactone cause gynaecomastia?

A

It has anti-androgenic effects > reduces action of male hormones > imbalance with oestrogen > breast tissue development

59
Q

Where aldosterone released from?

A

Zona glomerulosa in adrenal cortex

CPT (28 decks)

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