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Systems 2: Cardiovascular > Hypertension Therapy > Flashcards

Hypertension Therapy Flashcards

1
Q

How is true hypertension diagnosed?

A
  • ABPM - HBPM (home)
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2
Q

How is risk of hypertension assessed?

A
  • Previous MI, stroke, IHD - Smoker - Diabetes - Hypercholesterolaemia - Family history (familial HCRM) - Physical exam
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3
Q

What would you do to assess the end organ damage of the heart?

A
  • ECG - Echocardiogram
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4
Q

What would you do to assess the end organ damage of the kidneys?

A
  • Proteinuria - Renal ultrasound - Renal function (glomerular filtration)
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5
Q

How would the cause of the hypertension be tested?

A

Screen for common causes such as endocrine or renal artery stenosis

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6
Q

What does LVH stand for?

A

Left ventricular hypertrophy

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7
Q

What does the ECG show?

A

Left ventricular hypertrophy can be seen by the inversion of the t wave

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8
Q

After you have calculated the patients risk what should you next do?

A

Choose a target BP to reduce to

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9
Q

At what assign-score risk should treatment for CVD be given?

A

15-20%

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10
Q

How do we treat hypertension?

A
  • Slow stepped approach
  • Low doses of multiple drugs
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11
Q

Why are low doses of multiple hypertensives given?

A

Reduce side effects

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12
Q

What class are young people given when deciding hypertension therapy?

A

A (high renin)

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13
Q

What drugs are given for people with high renin?

A

ACE inhibitors

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14
Q

What class are elderly people put into for hypertension therapy?

A

C and D (low renin)

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15
Q

What drugs are used to treat C and D classes?

A

C - calcium channel blocker

D - thiazide - type diuretic

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16
Q

When should treatment of stage 1 hypertension of someone under the age of 80 be given?

A

If they have any of the following

  • Organ damage
  • CVD
  • Renal disease
  • Diabetes
  • CVD risk of greater than 20%
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17
Q

Why is a thiazide-like diuretic sometimes offered in place of a calcium channel blocker?

A
  • Intolerence
  • Evidence or high risk of heart failure
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18
Q

What is added to the treatment of hypertension if CCB doesn’t reach intended BP?

A
  • Thiazide-type diuretic such as clortalidone/indapamide
  • ACEI
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19
Q
A
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20
Q

If desired BP isn’t reached after CCB and additions what is done?

A
  • CCB
  • ACEI
  • Diuretic

All given at the same time

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21
Q

If all three drugs together what should be done?

A
  • Further diuretic therapy with low dose spironolactone if K levels low
  • Consider higher dose thiazide-like diuretic
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22
Q

What are examples of ACE inhibitors?

A
  • RAMIPRIL
  • Perindopril
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23
Q

What are the contraindictions of ACEI?

A
  • Renal artery stenosis
  • Renal failure
  • Hyperkalaemia
24
Q

What are the adverse drug reactions of ACEI?

A
  • Cough
  • First dose hypotension
  • Taste disturbance
  • Renal impairment
  • Angioneurotic oedema (rapid swelling of the dermis)
25
Q

What are the drug-drug interactions with ACEI?

A
  • NSAIDs - acute renal failure
  • Potassium supps - hyperkaelemia
  • Potassium sparing diuretics - hyperkalaemia
26
Q

What are ARB’s?

A

Angiotensin II antagonists

27
Q

What is the advantage of ARB’s over ACEI?

A

No cough

28
Q

What are the two common vasodilator calcium channel blockers?

A
  • Amlodipine
  • Felodipine
29
Q

What are the 2 common rate limiting CCB?

A
  • Verapamil
  • Diltiazem
30
Q

How do CCB’s work?

A
  • Blocking L-type calcium channels
  • Can be selective between vascular and cardiac L type channels
  • Relaxes large and small arteris (TPR down)
  • Reduces CO
31
Q

What are the CCB’s contraindictions?

A
  • Acute MI
  • Heart failure, bradycardia
32
Q

What are the adverse drug reactions of CCB’s?

A
  • Flushing
  • Headache
  • Ankle oedema
  • Ingestion and reflux oesophagitis
33
Q

What can rate limiting agents (CCB’s) also cause?

A
  • Bradycardia
  • Constipation
34
Q

Diagram showing CCB’s action

A

Notice how reducing calcium level will reduce contraction level

35
Q

What are the 2 common thiazide type diuretics?

A
  • Indapamide
  • Clortalidone
36
Q

Where do Thiazides work on in the nephron?

A

Distal tube

37
Q

How do thiazide type diuretics work?

A
  • Block reabsorption of sodium
  • Enhance loss of sodium through urine
38
Q

What are less commonly used antihypertensives?

A
  • Alpha adrenoreceptor antagonists - Doxazosin
  • Centrally acting agents - methyldopa, moxonidine
  • Vasodilators - hyrdalazine, minoxidil
39
Q

What is the mechanism of action of doxazosin?

A
  • Block post synaptic alpha 1 adrenoreceptors
  • Stop vascular smooth muscle contraction in arteries
40
Q
A
41
Q

What is the main use of methyldopa to treat hypertension?

A

In pregnancy

42
Q

What does methyldopa do?

A

Acts on alpha receptors in the CNS to decrease sympathetic innervation

43
Q

Take a patient at 55 years, this is your course of action

A

If over 55years of age

•Start CCB

–No or incomplete effect

•Add Thiazide-type diuretic

–Incomplete effect

•Add ACE inhibitor

–Still incomplete effect

•Add Beta-blocker

–Still incomplete effect

•Add one of the less commonly used agents

44
Q
A
45
Q

This is the course of action for a young hypertensive

A
  • Start ACEI
  • If female of child bearing age CCB or Beta Blocker
  • No or incomplete effect
  • Add Thiazide type diuretic

–Incomplete effect

•Add Calcium channel blocker

–Still incomplete effect

•Add Beta-blocker

–Still incomplete effect

•Add one of the less commonly used agents

46
Q

What is the treatment for gestational hypertension?

A
  • NO ACEI OR ARB
  • Pre pregnancy - use nifedipine, methyldopa, atenolol, labetalol
  • During pregnancy - add thiazide diuretic
47
Q

What is the prevelence of childhood pre hypertension?

A

3-10%

48
Q

What is typical end organ damage associated with childhood hypertension?

A
  • LVH
  • Decreased vascular response
  • Increased carotid artery medial thickness
  • Low GFR
  • Increased atheroma deposits
  • Reduced cognitive scores
49
Q

What are the common causes of hypertension in newborn infants?

A
  • Renal artery thrombosis
  • Renal artery stenosis
  • Congenital renal malformations
  • Coarctication
50
Q

What are the common causes of hypertension in infants?

A
  • Renal parenchymal disease
  • Coarctication
  • Renal artery stenosis
51
Q
A
52
Q

Why is there an increase in primary childhood hypertension?

A
  • Obesity
  • Lack of exercise

Both very high at the moment

53
Q

What is accelerated hypertension?

A

An increase in blood pressure (180/110) resulting in organ damage and retinal changes

54
Q

What is malignant hypertension?

A

Cases where papilloedema (stage 4) fundal changes are present (optical disc swelling caused by increased cranial pressure)

55
Q

What is accelerated hypertension associated with?

A
  • Existing hypertension diagnosis
  • Poor BP control
  • POOR REACTION TO MEDICATION
56
Q

WHAT NOT TO DO WITH HYPERTENSIVE PATIENTS

A
  • Do not reduce BP suddenly and excessively.
  • Do not use sublingual medication.
  • Do not use rapidly acting nifedipine or ACEI.
  • Do not use intermittent as required therapy, oral or IV.
  • Do not use IV hydralazine

–5-20 minute lag before producing an erratic response

•Do not use sodium nitroprusside

–(coronary steal syndrome and increased intracranial pressure, cyanide toxicity)

57
Q
A

Systems 2: Cardiovascular (19 decks)

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