Anti-hypertensives

Question 1

ACE Inhibitors Indications?

Answer 1

Hypertension
Post MI (Clinically stable)

Question 2

Contra-indications for ACE inhibitors?

Answer 2

ACE + Aliskerin if eGFR<60ml/min/1.73m2

ACE + Aliskerin (Diabetes)

Question 3

What is aliskerin and why is it contraindicated for use in certain cases with ACE inhibitors?

Answer 3

It is a renin inhibitor

Question 4

What are the common side effects of ACE?

Answer 4

Alopecia
Dry mouth
Dyspnoea
Sleep Disorder
Asthenia
Blurred Vision
Depression
Bronchitis
Confusion
Ileus impotence
Tinnitus
Glossitis
Chest pain
Muscle cramps
Stomatitis

Question 5

Can you abruptly stop ACE inhibitors?

Answer 5

Yes however there are some cases of rebound hypertension

Question 6

Beta blocker indications?

Answer 6

Hypertension

Anxiety

Question 7

Asthma is contraindicated for BB use however if it is well controlled and a BB is deemed necessary which is the appropriate type to use?

Answer 7

Selective Beta Blocker - with caution!

Question 8

What conditions contra-indicate use of both selective and non-selective BBs?

Answer 8

Cardiogenic shock
Hypotension
Marked Bradycardia
Metabolic acidosis
Phaechromocytoma  (apart from specific use with alpha blockers)
Prinzmetal's angina
2nd/3rd degree heart block
Severe peripheral arterial disease
Sick sinus syndrome
Uncontrolled heart failure

Question 9

What type of medication is Propanolol?

Answer 9

Non-selective BB

Question 10

What are the side effects of Propanolol?

Answer 10

Tiredness
Cold extremities
Insomnia
Slow/irregular heartbeat, 
Severely restricted blood flow to fingers and toes (Raynaud's syndrome)
Nightmares or disturbed sleep, 
Shortness of breath

Question 11

Can selective/non-selective beta blockers be stopped abruptly?

Answer 11

Ideally not - definitely not in the case of ischaemic heart disease where sudden cessation can lead to rebound worsening of myocardial ischaemia

Question 12

What type of medication is atenolol?

Answer 12

Selective BB

Question 13

What are the common side effects of Atenolol?

Answer 13

Slower pulse 
Cold hands/feet
Diarrhoea
Nausea
TIred or aching and tired muscles

Question 14

What are the indications for Thiazide diuretics?

Answer 14

Oedema
Hypertension
Congestive heart failure

Question 15

What are the contra-indications for Thiazide diuretics?

Answer 15

Addison's disease
Hypercalcaemia
Hyponatraemia
Refractory Hypokalaemia
Symptomatic Hyperuricaemia

Question 16

What are the side effects of Thiazide Diuretics?

Answer 16

Altered plasma lipid concentrations
Gout
Hypercalcaemia
Hyperglycaemia
Hyperuricaemia
Hypochoraemic alkalosis
Hypokalaemia
Hypomagnesaemia
Hyponatraemia
Metabolic and electrolyte disturbances
Mild GI disturbances
Postural Hypotension

Question 17

Can Thiazide diuretics be stopped abruptly?

Answer 17

If stopped abruptly switch to a low sodium diet due to potential risk of rebound salt and water retention in those with a normal sodium level in their system