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CVS Pharmacology > Drug Therapy Of Hypertension > Flashcards

Drug Therapy Of Hypertension Flashcards

1
Q

Mention causes of drug-induced HTN

A 
Estrogen containing contraceptive pills
NSAIDs
Sympathomimetics
Glucocorticoids 
Liquorice and its derivatives
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2
Q

Enumerate HMOD

A

HF, ISHD, renal failure, retinal artery damage, stroke.

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3
Q

Mention intervention in high normal and grade I HTN

A

High normal. Lifestyle advice. Drug treatment with risk patients esp with CVD
G 1. Life style advice. Drug treatment with low risk patients without HMOD after 3-6 months of lifestyle changes if BP is not controlled. Immediate drug treatment in high risk patient with CVD or HMOD

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4
Q

Mention intervention in grad III and grade IV HTN

A

BOTH
Lifestyle advice
Immediate drug treatment in all patients
Aim for BP control within 3 months

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5
Q

Menyion steps of treatment of uncomplicated HTN

A

1, ACEI+Diuretics/CCB
2, Add diuretics or CCBs
3, add spironolactone, other diuretic, beta or alpha blocker.

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6
Q

When to consider beta blockers in any step of treatment?

A

When there is specific indication for their use as HF, AF, MI angina and pregnant or planning women.

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7
Q

When to consider monotherapy?

A

In low risk patients with grade 1 HTN or very old patients.

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8
Q

Mention steps of treatment of CAD with HTN

A

1, chose two of: ACEI, BB, CCB, diurentics
2, triple combination
3, add spironolactone or alpha blocker

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9
Q

Menyion steps of treatment of HF with HTN

A

1, ACEI + BB + diuretic

2, add spironolactone

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10
Q

Menyion steps of treatment of CKD with HTN

A

1, ACEI + CCB
2, add diuretic
3, add spironolactone

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11
Q

What is the choice of diuretics in HTN?

A

They refer to thiazide or thiazide like drugs. Consider loop diuretics with refractory edema.

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12
Q

When should ACEI be stopped in CKD

A

When SrCr rises more than 30% during treatment.

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13
Q

Mention initial therapy in HTN with
A. AF
B. DM

A

A, ACEI + BB/Non-DHP, anticoagulants should be considered

B, ACEI + CCB/thiazide

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14
Q

BB should not be comibed with …. for fear of …..

A

Non DHP CCB

Marked reduction in HR and AV conduction

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15
Q

Mention precautions of HTN with
A. DM
B COPD

A

A. Avoid dec less than 120/70. SGLT-2 inhibitor help in controlling BP
B. Avoid non selectibe BB, ACEI cause dry cough

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16
Q

Mention steps of treatment of HTN with pregnancy

A

Drugs of choice, methyldopa, labetalol, CCBs

Hypertensive crisis: IV labetalol, nicardipine, MgSO4

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17
Q

Mention precautions of HTN treatment in pregnancy

A

ACEI, ARBs, aliskiren are not recommended during pregnancy

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18
Q

What is the advantage of BB + DHP CCB

A

BB counteract reflex tachycardia induced by DHP CCBs

Have additive antihypertensive effect

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19
Q

What is the advantage if thiazide + BB/ACEI?

A

Thiazides synergize with most antihypertensives by dec volume expansion.
Reduction in antihypertensive effect of diuretics, 2ry to their activation of Renin-Ag system, is counteracted by inhibitory effects of BB, ACEI ir ARBs on the renin-Ag system.

20
Q

…. reset receptors

A

BB

21
Q

Mention indications of thiazide diuretics

A

Elderly, obese and black

Hypertension with osteoporsis and recurrent renal stones.

22
Q

Mention adverse effects of thiazides in antiHTN doses

A
  1. Sulphonamide hypersensitvity, absolute.
  2. Impotence, relative
  3. Sleep disturbance
    Metabolic side effects in higher doses
23
Q

Mention advantages of using LOW dose thiazide

A

Not associated with activation of RAAS system, more effective than higher doses
Not associatef with metabolic side effects

24
Q

Elaborate,

How to choose between loop and thiazide in HTN?

A

Thiazide is used in patient with mild to moderate HTN
Loop is used in:
Patients with fluid overload due to HF or renal disease
Resistant HTN

25
Q

Describe mechanism of action of BB

A
  1. B1-blockade, -ve inotropic and chronotropic, suppression of renin releasr.
  2. B2-blockade, dec sympathetic discharge centrally amd peripherally by dec NE release.
  3. Reset baroreceptors
  4. Some BB are vasodilators
26
Q

Mention advantages & disadvantages of BB in HTN patients

A

Protect from CAD and dec CV mortality
Do not protect against cerebrovascular events
Impair glucose tolerance and inc risk of new onset DM

27
Q

Mention indications of BB with HTN

A

Not used as initial therapy unless there is a specific indication.
Af or AF
Systolic HF
Coronary heart disease (angina pectoris or post-MI)

28
Q

What are the indications of ACEI in HTN

A 
Used as initial therapy in most cases of HTN, CI in pregnancy
Used in
Systolic HF
ISHD
Chronic renal failure with proteinuria
Diabetes mellitus
29
Q

Aliskiren is …..

A

Selective renin inhibitor

30
Q

Describe mechanism of action of CCBs

A

Peripheranl arteriolar VD, dec peripheral resistance
Diuretic action, inc renal blood flow
Dec aldosterone secretion

31
Q

When CCBs are used,….. is preferred.

Why?

A

Long acting DHP

Less reflex tachycardia

32
Q

Mention an indication and a CI of non DHP CCBs

A

I, AF

CI, Hypertension with severe LF dysfunctions

33
Q

CCBs are presferred in HTN with …………….

A

Pregrnancy, peipheral vascular disease, chronic kidney disease, COPD.

34
Q

Mention indications of centrally acting alpha 2 agonists

A
  1. Methyldopa, prrgnancy

2. Cloinidne, HTN emergencies

35
Q

Mention indications of doxazosin

A

Mainly used in essential HTN with BPP

36
Q

GR, Doxazosin is not 2st choice in any type of HTN

A

As it induces postural hypotension, tachycardia and fluid retention thus tolerance.

37
Q

Mention role of direct vasodilators in HTN

A

Hydralazine, 2nd choice in eclampsia if other drugs fail.

Nitroprusside, HTN emergencies

38
Q

Mention CI of thiazide

A

Gout

39
Q

Mention CI of BB and Non DHP

A

Both, bradycardia and AV block
BB, Bronchial astma
NonDHP, Severe LV dysfunctions

40
Q

Mention CI of ACEI and ARBS

A

ARBs, biltaeral renal art stenosis, pregnancy, hyperkalemia

ACEI, all above + history of angioneurotic oedema

41
Q

Define hypertensive urgancy and its managemnet

A

Severe HTN without ckinical evidence of acute HMOD

Managaed by oral drugs with relatively rapid onset of action

42
Q

Define hyoertensive emergency and drugs generally used in its treatment

A

Severe HTN grade 3 with acute HMOD, often life-threatening as HTN encephalopathy.
Nitroprusside, fenoldopam, labetalol, nicardipine.

43
Q

Mention the CI of

  1. Labetalol
  2. Fenoldopam
A
  1. Heary failure

2. Glaucoma

44
Q

Mention drugs used in specific HTN emergencies and their specific indication

A

Esmolol, aortic dissection

NG, ACS

45
Q

What is the next step when tripe comb therapy fails in HTN

A

Add spironolactone, other diuretic or inc dose of other diurectics, alpha or beta blockers.

CVS Pharmacology (6 decks)

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