Hypertention & ACEi Flashcards Preview

2 Cardiovascular > Hypertention & ACEi > Flashcards

Flashcards in Hypertention & ACEi Deck (42)
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1
Q

Target BP for those under 80

A

Clinic:
140/90 mmHg
135/85mmHg

2
Q

Target BP for those with CV disease/high risk

What conditions are included in this?

A

130/80

Artherosclerotic CV disease, diabetes in presence of kidney, eye or cerebrovascular disease

3
Q

How long is a new antihypertensive used for to establish response

A

4 weeks

4
Q

Define stage 1 hypertension and when should you treat?
Stage 2?
Severe?

A

Stage 1 - 140/90mmHg - treat those under 80 who have target-organ damage, CV disease, renal disease , diabetes, 10 year risk over 20%
If under 40 and no target organ damage refer.

Stage 2 - 160/100 - treat all
Severe - 180/110 - treat promptly

5
Q

Treatment steps for patient under 55

A
ACEi ( if not tolerated ARB or BB)
CCB
thiazide like diuretic
Spironolactone and specialist referral
Alpha blocker
6
Q

Treatments steps for over 55, or black people of any age

A

CCB ( or if evidence of HF try thiazide like diuretic)
ACEi
Then as with under 55

7
Q

Who should get low dose aspirin

A

Only those with establish pec CV disease

8
Q

Target BP for over 80 years

A

150/90

9
Q

Target BP for patients with diabetes

A

140/80

10
Q

In T1DM hypertension usually indicates ….

A

Diabetic nephropathy

11
Q

ACEi should be considered for all patients with …… (Sign of renal disease)

A

Proteinuria

12
Q

Choices for treating hypertension in pregnancy

A

Labetalol
Mehthyldopa
MR nifedipine

13
Q

Target of BP for pregnancy

  • uncomplicated hypertension
  • target organ damage
A

150/100

140/90

14
Q

Risk factors for developing preeclampsia 5

A
Hypertension
CKD
diabetes
Autoimmune disease
Hypertension in previous pregnancy
15
Q

Women at risk of preeclampsia should take… From when…

A

Aspirin low dose - from week 12 to term

Also applies for those over 40, over 10 years since last pregnancy, BMI over 35, multiple pregnancy, FH

16
Q

Risks of reducing BP to fast during hypertensive crisis

A

Reduced organ percussion leading to cerebral infraction, blindness, deterioration in renal function, myocardial ischaemia

17
Q

what class of drugs may be used to treat phaechromocytoma (tumour of the adrenal gland releasing noadrenaline)

A

alpha blockers such as phenocybenzaine and phentolamine

18
Q

what classes of drugs are doxazoxcin and prazosin

A

alpha blockers (and vasodilators)

19
Q

what class of drug is hydralazine and why do we not often use it

A

alphablocker

used as an adjunt in hypertensive treatment but causes tachycardia and fluid retention when used alon

20
Q

when is methyl dopa used as an antihypertensive

A

pregnancy

it is a centrally acting antihypertensive

21
Q

why is clonidine not often used

A

centrally acting antihypertensive but causes rebound hypertension on withdrawl

22
Q

what is the mode of action of alfuzosin, terazocin and tamsulosin
what are they used for

A

alpha blockers for BPH

23
Q

when starting ACEi what electrolyte discturbance should first be addressed

A

-stop K supplements and K sparing diuretics as ACEi may cause hyperkalaemia

24
Q

what is a caution when introducing an ACEi to a patient already taking a high dose of loop diuretic in HF?
what is classed as high dose

A

profound first dose hypertension
(temporary withdrawl of the loop may reduce risk but conversely cause pulmonary oedema)

furosemide 80mg OD

25
Q

ACEi have a role in managing what side effect of diabetes

A

nephropathy

26
Q

why should ACEi not be given with NSAIDs

A

increased risk of renal damage

27
Q

what renal condition should we never used ACEi/ARB in?

A

renal artery stenosis {bilateral or severe unilateral} (ACEi would reduce glomerular filtration causing failure)
- also caution ACEi in peripheral vascular disease

28
Q

what to change ACEi to if patient experiences dry cough?

why does this help?

A

ARB

they don’t inhibit breakdown of bradykinin (bradykinin causes the cough(

29
Q

why should you not use more than one drug affecting the renin angiotensin system

A

increased risk of hyperkalaemia, hypotension and renal impairment

30
Q

why should afro-carribean pt not receive ACEi? (2)

A

less likely to respond (as likely to have low rennin hypertension)
more likely to develop angioedema

31
Q

what should you do with ACEi pt develops altered LFTs

A

stop ACEi - reports of cholestatic jaundice, hepatitis, hepatic necrosis etc.

32
Q

what time of day should the first dose of ACEi be given

A

bedtime

33
Q

what is aliskiren?

A

renin inhibitor

34
Q

if someone has HF what antihypertensive are we thinking about first line

A

thiazide like diuretic

35
Q

if a pt has a STEMI how fast should there BP be reduced

A

reduce over period of 2 mins to 2 hours by 20-25%

36
Q

mode of action of sildenafil

A

vasodilator

37
Q

mode of action of iloprost

A

vasodilator

38
Q

mode of action of doxasosin

A

alpha blocker

39
Q

mode of action of methyldopa

A

centrally acting

40
Q

mode of action of guanethidine monosulfate

A

adrenergic neurone blocker

41
Q

mode of action of aliskiren

A

renin inhibitor (so probs dont give with ACE/ARBs!)

42
Q

how fast do ACEi reduce BP

A

2 hours