Term
|
Definition
decrease sodium ion reabsorption
increase urine volume |
|
|
Term
| Is endothelium-1 a vasoconstrictor? |
|
Definition
|
|
Term
| What effects does captopril have? |
|
Definition
|
|
Term
| What effects does spironolactone have? |
|
Definition
antagonist at the aldosterone receptor
increases synthesis of sodium channels which boosts reabsorption of sodium |
|
|
Term
| What effects does amlodipine have? |
|
Definition
| blacks voltage gated calcium channels |
|
|
Term
| What effects does b blockers have have? |
|
Definition
| blocks vasodilation effects |
|
|
Term
| What is produced by the action of COX enzymes? |
|
Definition
|
|
Term
| What is textbook physiological blood pressure? |
|
Definition
|
|
Term
| What is white coat hypertension? |
|
Definition
increased blood pressure due to blood pressure recording
therefore several readings are taken, sometimes outside of clinic |
|
|
Term
| What is ambulatory blood pressure monitoring? |
|
Definition
device worn during waking hours
BP measured every 30 min |
|
|
Term
| What is home blood pressure monitoring? |
|
Definition
2 readings 1 min apart
morning and evening for 7 days |
|
|
Term
| Describe stage 1 hypertension |
|
Definition
S=140-159 or D=90-99
>140/90 |
|
|
Term
| Describe stage 2 hypertension |
|
Definition
S=160-179 or D=100-109
> 160/100 |
|
|
Term
| Describe stage 3 hypertension |
|
Definition
S=180-219 or D=110-119
> 180/110 |
|
|
Term
| What is the action taken in stage 1 |
|
Definition
| Confirm over 1-2 weeks then treat. |
|
|
Term
| What is the action taken in stage 2 |
|
Definition
| Confirm over 3-12 weeks then treat. If patient has complications e.g. diabetes then treat earlier. |
|
|
Term
| What is the action taken in stage 3 |
|
Definition
Confirm over 12 weeks and treat if there are complications. Life-style change, if there are no complications.
Only treat if hypertension persists.
Got to allow for complications... |
|
|
Term
| When is severe hypertension and what actions are taken |
|
Definition
>220/120 or accelerated/malignant.
Immediate treatment required. |
|
|
Term
|
Definition
| Target = S<140, D<90 (lower if there is established underlying disease). |
|
|
Term
| How is treatment initiated in stage 1 hypertension? |
|
Definition
1. assess for any end organ damage
2. age |
|
|
Term
| How is end organ damage assessed? |
|
Definition
heart - hypertrophy (ECG)
kidney - renal function limited (urine/blood test)
eye - papilloedema, retinal haemorrhage |
|
|
Term
| What happens if you have stage 1 and >20% CV risk? |
|
Definition
|
|
Term
| If a patient has no end-organ damage and is 40-80 years of age, what happens? |
|
Definition
lifestyle advice:
- Stop smoking.
- Lose weight.
- Reduce alcohol consumption.
- Reduce dietary salt.
- Reduce total and saturated fat intake.
- Increase fruit and vegetable intake.
- Increase exercise. |
|
|
Term
| If a patient has no end-organ damage and is below 40 years of age, what happens? |
|
Definition
| check for secondary cause, if there is one, treat it. If there isn't, follow lifestyle advice. |
|
|
Term
| How is treatment initiated in stage 2 hypertension? |
|
Definition
> 160/100 confirmed home readings
treat hypertension |
|
|
Term
| How is treatment initiated in stage 3 hypertension? |
|
Definition
> 180/110
1. immediately start antihypertensive drug treatment, without waiting for ABPM or HBPM
2. immediately refer person to specialist care the same day if they show signs of papilloedema and/or retinal haemorrhage (accelerated hypertension) |
|
|
Term
38 year old male
152/90mmHg
overweight
drinks 30 units a week |
|
Definition
arrange for home measurement of BP
if there is > 135/85 check for end organ damage and secondary causes
if none , suggest lifestyle changes |
|
|
Term
| Give an example and identifier of diuretics |
|
Definition
bendroflumethiazide
'thiazide' |
|
|
Term
| Give an example of aldosterone antagonist |
|
Definition
|
|
Term
| Give an example and identifier of ACE inhibitor |
|
Definition
|
|
Term
| Give an example and identifier of AT1 blocker |
|
Definition
|
|
Term
| Give an example and identifier of ca channel blocker |
|
Definition
|
|
Term
| Give an example of k channel blocker |
|
Definition
|
|
Term
| Give an example and identifier of alphal blocker |
|
Definition
|
|
Term
| Give an example and identifier of beta blocker |
|
Definition
|
|
Term
| Give an example of a nitrate |
|
Definition
|
|
Term
| What does systemic hypertension treatment depend on? |
|
Definition
| age and ethnic background |
|
|
Term
| How are young caucasians treated? |
|
Definition
ACE inhibitor or AT1 anatgonist
(perhaps beta-blocker if other not tolerated) |
|
|
Term
| How are Afro-Caribbeans and >55 years olds treated? |
|
Definition
| Thiazide or Ca2+-receptor antagonist. |
|
|
Term
| Discuss Combination Therapy and Progressive Therapy |
|
Definition
Even for ‘standard hypertension’, a single antihypertensive drug is often not sufficient. When this is the case, combination therapy is used. For example:
ACE inhibitor or AT1 antagonist with thiazide or Ca2+-channel antagonist.
If this is inadequate,
Thiazide and Ca2+-channel antagonist.
Then may add,
α(1)-blocker, spironolactone, another diuretic or a β-blocker.
Additional pharmacological options for very severe hypertension include diazoxide, hydralazine, sodium nitroprusside and/or minoxidil. |
|
|
Term
| Why is combination therapy used? |
|
Definition
| Combination therapy is used because one drug may have its effects more or less balanced by the baroreceptor reflex, which would detect the vasodilatory effects of the drugs used, and act to reverse the drop in MAP thus exacerbating the hypertension. |
|
|
Term
| Describe the acute treatment for very severe hypertension |
|
Definition
1. minoxidil, diazoxide (K channel openers)
2. hydrazine (K channel opener, inhibits SR Ca release and NO production)
3. sodium nitroprusside (NO donor)
used with e.g. beta-blocker to inhibitor reflex tachycardia |
|
|
Term
| Does hypertension arise in pregnancy? |
|
Definition
| either pre-existing or occurs in 3rd trimester (pre-eclampsia) |
|
|
Term
|
Definition
| a medical condition characterised by high blood pressure and high urine protein content in pregnant women. Pre-eclampsia leads to eclampsia: the life-threatening occurrence of seizures during pregnancy |
|
|
Term
| What is prescribed for pre-existing hypertension (pre-eclampsia)? |
|
Definition
methyldopa
acts as an alpha-2 agonist in medulla to reduce sympathetic outflow |
|
|
Term
| What would be used in hypertensive crisis in pregnancy? |
|
Definition
| • Labetolol or hydralazine is used in hypertensive crises. |
|
|
Term
| What other drugs are used in pregnancy hypertension? |
|
Definition
β-blockers are used in third trimester.
Nifedipine: a dihydropyridine Ca2+-channel blocker that primarily blocks L-type Ca2+-channels. |
|
|
Term
| How is pulmonary hypertension identified? |
|
Definition
| Difficult to measure pulmonary pressure – only severe cases identified – but regurgitation from right ventricle to right atrium is an indicator. |
|
|
Term
| What is a common feature of pulmonary hypertension? therefore, how is it treated? |
|
Definition
pulmonary emboli
anticoagulants |
|
|
Term
| What is pulmonary hypertension usually due to? |
|
Definition
| an underlying disease which must be addressed by therapy |
|
|
Term
| Which drugs are used to treat pulmonary hypertension? |
|
Definition
sildenafil
bosentan
epeprostenol
iloprost |
|
|
Term
|
Definition
sildenafil - 'fil'
phospodiesterase 5 inhibor (PDE5 inhibitor)
PDE5 breaks down cGMP to GMP
given orally |
|
|
Term
|
Definition
non-selective endothelium 1 receptor antagonist 'entan'
blocks ETA and ETB receptors
because of the potent vasoconstrictive effects of ET1, receptor blockade promotes vasodilation
given orally |
|
|
Term
|
Definition
prostacyclin
causes vasodilation through increased cAMP production
inhibits platelet aggregation
provides symptomatic relief and increases exercise tolerance
not orally bioavailable |
|
|
Term
| How is epoprostenol given |
|
Definition
i.v. long term via central venous catheter
inhalation (to limit systemic hypotension) |
|
|
Term
|
Definition
synthetic prostacyclin anologue
given by inhalation |
|
|
Term
| Adverse effects of captopril |
|
Definition
renal impairement
dry cough |
|
|
Term
| Adverse effects of minoxidil |
|
Definition
|
|
Term
| Adverse effects of propranolol |
|
Definition
|
|
Term
| Which drugs cannot be used in pregnant women? |
|
Definition
| captopril, candesartan and bosentan |
|
|
Term
| Which drugs cannot be used in breastfeeding women? |
|
Definition
|
|
