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Flashcards in Hypertention & ACEi Deck (42):
1

Target BP for those under 80

Clinic:
140/90 mmHg
135/85mmHg

2

Target BP for those with CV disease/high risk

What conditions are included in this?

130/80
Artherosclerotic CV disease, diabetes in presence of kidney, eye or cerebrovascular disease

3

How long is a new antihypertensive used for to establish response

4 weeks

4

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

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

Treatment steps for patient under 55

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

6

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

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

7

Who should get low dose aspirin

Only those with establish pec CV disease

8

Target BP for over 80 years

150/90

9

Target BP for patients with diabetes

140/80

10

In T1DM hypertension usually indicates ....

Diabetic nephropathy

11

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

Proteinuria

12

Choices for treating hypertension in pregnancy

Labetalol
Mehthyldopa
MR nifedipine

13

Target of BP for pregnancy
- uncomplicated hypertension
- target organ damage

150/100
140/90

14

Risk factors for developing preeclampsia 5

Hypertension
CKD
diabetes
Autoimmune disease
Hypertension in previous pregnancy

15

Women at risk of preeclampsia should take... From when...

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

Risks of reducing BP to fast during hypertensive crisis

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

17

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

alpha blockers such as phenocybenzaine and phentolamine

18

what classes of drugs are doxazoxcin and prazosin

alpha blockers (and vasodilators)

19

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

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

20

when is methyl dopa used as an antihypertensive

pregnancy
(it is a centrally acting antihypertensive)

21

why is clonidine not often used

centrally acting antihypertensive but causes rebound hypertension on withdrawl

22

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

alpha blockers for BPH

23

when starting ACEi what electrolyte discturbance should first be addressed

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

24

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

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

furosemide 80mg OD

25

ACEi have a role in managing what side effect of diabetes

nephropathy

26

why should ACEi not be given with NSAIDs

increased risk of renal damage

27

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

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

28

what to change ACEi to if patient experiences dry cough?

why does this help?

ARB

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

29

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

increased risk of hyperkalaemia, hypotension and renal impairment

30

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

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

31

what should you do with ACEi pt develops altered LFTs

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

32

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

bedtime

33

what is aliskiren?

renin inhibitor

34

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

thiazide like diuretic

35

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

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

36

mode of action of sildenafil

vasodilator

37

mode of action of iloprost

vasodilator

38

mode of action of doxasosin

alpha blocker

39

mode of action of methyldopa

centrally acting

40

mode of action of guanethidine monosulfate

adrenergic neurone blocker

41

mode of action of aliskiren

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

42

how fast do ACEi reduce BP

2 hours