Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

CPT + Prescribing > Hypertension + Heart failure > Flashcards

Hypertension + Heart failure Flashcards

(51 cards)

Start Studying
1
Q

Define blood pressure

A

Force per unit area acting on vessels

Cyclical

MAP = CO X TPR

CO = SV X HR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the role of autocoids in blood pressure regulation?

A

Eg bradykinin, nitric oxide; act on vascular smooth muscle + endothelium

Acute BP maintenance working along with sympathetic NS + RAAS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Describe the relationship between the radius of a vessel and the resistance to flow

A

4th power relationship

Resistance to flow inversely proportional to vessel radius

Vasoconstriction- increased smooth muscle tone thus smaller lumen diameter - increased TPR- increased BP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Describe the pathophysiology and effects of hypertension (particularly on vasculature)

A
  • Vascular remodelling, hypertrophy, thickening
  • Hyperinsulinaemia and hyperglycaemia leading to endothelial dysfunction + ROS formation
  • Downregulation of NO signalling
  • Permanent hypertrophy of vasculature leading to increased TPR + reduced compliance

Increased morbidity + mortality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Give some examples of end organ damage due to hypertension

A
  • Renal disease
  • Peripheral vascular disease
  • Anueurysms
  • Vascular dementia
  • Retinal disease (retinopathy)

Hypertensive heart disease- left ventricular hypertrophy seceondary to increased afterload; dilated heart failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Why is there a greater prevalence of hypertension in men?

A

Women have cardioportective effects pre-menopause from high oestrogen levels

Post-menopause, the risk of hypertension in women catches up to men

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Despite hypertension often persenting asymptomatically, why is it necessary to treat?

A

To slow down/prevent progression of acute coronary syndromes, chronic heart disease, strokes

Reducing CVD risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the NICE guideline for defining hypertension?

A

140/90 mmHg = hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the main types of hypertension and which is most prevalent?

A

Primary/essential/idiopathic- most common

Secondary- phaeochromocytoma, thyroid disease

Pre-hypertensive state

Isolated systolic/diastolic hypertension

White coat/clinic hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Describe the best practice for a clinical diagnosis of hypertension

A

Sitting, relaxed, arm supported

If there is a >15 mmHg difference between both arms, repeat measure + use arm with higher reading

ABPM/HBPM for white coat syndrome patients

CVD risk + end organ damage assessed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

When may emergency treatment be required for hypertension ie what is considered a hypertensive emergency?

A

BP > 180/120 mmHg

+

Clinical signs eg papilloedema, retinal haemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the target BP for someone <80 yrs of age and for someone with T2DM? (ie at what BP should treatment be initiated?)

A

140/90

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the target BP for someone >80 yrs of age? (ie at what BP should treatment be initiated?)

A

150/90

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the target BP for someone with T1DM?

A

135/85 (lower if experiencing severe T1DM complications)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Define stage 1 hypertension

A

STAGE 1:

Clinic BP 140/90- 159/99

ABPM/HBPM 135/85 - 149/94

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Define stage 2 hypertension

A

Clinic BP 160/100 - <180/120

ABPM/HBPM:

150/95 or higher

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Define stage 3 (severe/resistant) hypertension

A

Clinic systolic <180

OR

Clinic diastolic > 120 mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Define the BP ranges for pre-hypertension and give some lifestyle modifications to reduce CVD risk

A

>120/80 + <140/90 mmHg

Lifestyle advice

Reduced dietary sodium intake

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

List the main therapeutic agents used for primary hypertension

A
  • ACE inhibitors
  • Angiotensin (AT1) receptor blockers- ARBs
  • Calcium channel blockers- CCBs
  • Diuretics- thiazide, thiazide like

Targetting RAAS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Where is ACE found and what does it do?

A

Luminal surface of capillary endothelial cells, predominantly in LUNGS

Catalyses conversion of angiotensin 1 to POTENT VASOCONSTRICTOR angiotensin 2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

In the presence of ACE inhibitors, how else can angiotensin 2 be produced from angiotensin 1?

Study These Flashcards
A

Via chymases; angiotensin 2 production independent of ACE

22
Q

Give 2 examples of ACE inhibitors

Study These Flashcards
A
  • Ramipril
  • Lisinopril
23
Q

Give some side effects of ACE inhibitors

Study These Flashcards
A

Hypotension

Dry cough

Hyperkalaemia (low aldosterone)

Renal failure; renal artery stenosis where efferent arteriole constriction is required

Angioedema

24
Q

Give 2 examples of Angiotensin 2 receptor antagonists

Study These Flashcards
A
  • Candesartan
  • Losartan
25
Describe the action of CCBs
Target calcium initiated smooth muscle contraction Interact with different sites on alpha 1 sub-unit of VOCC Have a selectivity for vascular smooth muscle or the myocardium (pacing cells)
26
Classify the calcium channel blockers into 3 types
* Dihydropyridines - used for hypertension * Non-dihydropyridine: phenylalkylamines + benzothiazapines
27
Which type of CCBs are selective for peripheral vasculature?
Dihydropyridines Little inotropic/chronotropic effects; little effect on myocardium/pacing cells of heart 1st line CCBs for hypertension
28
Which type of CCBs are selective for the myocardium + pacing cells of heart?
Non-digydropyridines; phenylalkylamines Depresses SA + AV nodal conduction, negative inotropy (reduced force of contraction of heart)
29
Which type of CCBs are selective to the myocardium and the vasculature?
Benzothiazapines (non-dihydropyridines)
30
Give 3 examples of CCBs
* **Amlodipine** * **Nifedipine** * **Nimodipine (cerebral vasculature selectivity; sub-arachnoid haemorrhage)**
31
Give some side effects of the dihydropyridine class of CCBs (used for hypertension)
Ankle swelling Flushing Headache (vasodilation) PALPITATIONS; REFLEX/COMPENSATORY TACHYCARDIA - thus contraindication with unstable angina, severe aortic stenosis
32
Describe the drug interaction between amlodipine (CCB) and simvastatin
Amlodipine increases the effect of simvastatin, thus need to lower the dose of statins if taken with amlodipine Also contraindications with other anti-hypertensives (eg hypotension)
33
What is the main use of phenylalkylamines and how do they work?
Class 4 anti-arrhythmic (angina, hypertension) Prolongs action potential + effective refractory period Negative inotropic + chronotropic effects
34
Give an example of a phenylalkylamine
## Footnote **Verapamil**
35
Give an example of a benzothiazapine
## Footnote **Diltiazem**
36
Give 2 examples of thiazide diuretics
**Bendroflumethiazide** **Indapamide**
37
What is the mechanism of action of thiazide diuretics? Used for oedema
Inhibit Na+/Cl- co-transporter in DCT, thus increased Na+ and H20 EXCRETED
38
Give some side effects and contraindications of thiazide diuretics
* Hypokalaemia * Hyponatraemia * Hyperuricaemia * Arrhythmia (K+ disturbances) * Raised glucose * Raised cholestrol + triglyceride levels Thus, contraindicated in hypokalaemia, hyponatraemia, gout, NSAIDS, K+ lowering drugs
39
What is the 1st line medication for primary hypertension in patients with diabetes or those \<55yrs age + not black?
ACE inhibitor or ARB Then, add CCB, thiazide-like diuretic later if needed
40
What is the 1st line medication for primary hypertension in a patient \>55yrs age or black origin?
CCB; as they have low renin levels thus no point targetting RAAS Then add ACEi/ARB, thiazide-like diuretic later if needed (step 3 for all pt's = ACEi OR ARB + CCB + thiazide-like diuretic)
41
Why are ACE inhibitors always 1st line for primary hypertension in patients with diabetes? - regardless of their age/ethnicity
2 pronged approach ACEi/ARB reduced risk of diabetic nephropathy + CKD with proteinuria due to dilation of efferent glomerular arteriole; Reduced peripheral vascular resistance- reduced BP + DILATION of efferent glomerular arteriole-- REDUCED INTRAGLOMERULAR PRESSURE- beneficial for T2DM
42
What medication can be added at step 4 for resistant hypertension and what are some of its contraindications?
* Spironolactone; aldosterone/mineralocorticoid receptor antagonist * Contraindicated in hyperkalaemia, Addison's * Not with other drugs increasing K+ levels, ACEi's, ARBs-- monitoring needed If patient is hyperkalaemic, consider adding SYMPATHETIC BLOCKERS- alpha/beta blockers, instead of spironolactone
43
Give 3 examples of B-adrenoceptor blockers
* **Labetalol** * **Bisoprolol** * **Metoprolol**
44
Describe the mechanism of action of B-adrenoceptor blockers
Decrease sympathetic tone by blocking noradrenaline Reducing myocardial contractility, thus decreasing CO
45
Give an example of an alpha-adrenoceptor blocker
**Doxazosin**
46
Describe the mechanism of action of alpha-adrenoceptor blockers
Selective antaagonist of alpha-1 adrenoceptors Reduce peripheral vascular resistance, thus lower BP (May lead to postural hypotension- dizziness, syncope, headache, fatigue) Contraindicated in pre-existing postural hypotension, dihydropyridine CCBs- oedema)
47
List some factors which can vary the cardiac output
* Preload (filling pressure); LVEDP- sarcomere length - Starling's curve * Afterload- load ventricle has to pump against * Contractility * Heart rate
48
Give some symptoms of heart failure
* Reduced exercise tolerance * Dyspnoea * Fatigue * Oedema- swelling; peripheral, pulmonary
49
List some mangement options for heart failure; heart failure with reduced ejection fraction (\<45%)
* Diuretics (congestive symptoms + fluid retention); furosemide- loop diuretic * B-blockers; bisoprolol * ACEi's; ramipril, lisinopril * Mineralocorticoid receptor antagonists; spironolactone * Angiotensin receptor blockers (ARBs); candesartan, losartan AIM: reduce preload, reduce sympathetic stimulation, reduce blood volume-- reduce workload on heart
50
Why do you want to reduce sympathetic stimulation in heart failure by giving B-blockers?
To slow down heart rate and allow more time for contraction of the heart- with aim of increasing CO
51
What is the usual type of heart failure?
LV systolic dysfunction; reduced LV ejection fraction \<45%

CPT + Prescribing (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions