Hypertension

Question 0

2ndry causes of HPT

Answer 0

Endocrine - cushing’s, acromegaly, hyperthyroid
Adrenal - conn’s, adrenal hyperplasia, pheochromocytoma
Renal - diabetic nephropathy, renal artery stenosis
Pregnancy
Neurogenic

Question 1

Long term risks of HPT

Answer 1

Atherosclerosis 
Kidney disease
MI 
Stroke
Retinopathy

Question 2

Drugs that can raise BP

Answer 2

NSAIDS
Oral contraceptives 
Steroids
Liquorice 
vasopressin 
Mono amine oxidase inhibitors 
Sympathomimetics
Carbenoxalone

Question 3

What drug is given in pregnancy induced hypertension

Answer 3

Methyldopa, oral, 250-500mg, 6-8 hourly

Question 4

Contraindications to thiazides diuretic

Answer 4

Gout
Pregnancy
Severe liver failure
Renal failure

Question 5

Absolute contraindications for B-blockers

Answer 5

Asthma

COPD

Question 6

Relative contraindications for B-blockers

Answer 6

Heart failure (except carvedilol)
DM
Peripheral vascular disease
Bradycardia (<50bpm)

Question 7

Contraindications for ACE-inhibitors

Answer 7

Pregnancy
Bilateral renal artery stenosis
Aortic valve stenosis
Hx of angioedema

Question 8

Contraindications for Ca channel blockers

Answer 8

Heart failure
Hypotension
Unstable angina

Question 9

Mechanism of action in thiazides diuretics

Answer 9

Inhibition of sodium and chloride reabsorption in the distal tubules. Potassium is lost secondarily due to increased secretion in the distal tubules.

Question 10

Major A/E of thiazide diuretics

Answer 10

Hypokalaemia 
Hypochloraemic alkalosis
Hyponatraemia 
Hypomagnesaemia 
Hyperuricaemia 
Blood lipoprotein changes
Hypotension 
GIT and hematological disturbances

Question 11

What is a cardio selective B-blocker

Answer 11

Drug with B1 selectivity such as atenolol. Reduces claudication in PVD and may mask hyperglycemia to a lesser degree.

Question 12

Why b-blockers not first line therapy in hypertension

Answer 12

No mortality benefit established
Less protection from stroke
Increased risk of T2DM
Does not reduce BP as much as other agents

Question 13

MOA of B-blockers

Answer 13

Unsure. Reduces CO. Altered baroreceptor reflex.

Depress plasma renin. Decreased release of neurotransmitters eg. NE.

Question 14

Contraindications for B-blockers

Answer 14

Asthma
Severe bronchspasm
2nd/3rd degree AV block
Symptomatic heart failure
Sinus bradycardia
Cardiogenic shock
(Elderly, renal failure)

Question 15

Two NB cardiac conditions in which B-blockers are used

Answer 15

Angina pectoris

Arrhythmias

Question 16

MOA of ACE-inhibitors

Answer 16

Competitive inhibitors of ACE preventing angiotensin ll production. Angiotensin ll is a peripheral vasodilator. Circulating aldosterone is also reduced. Bradykinin, a vasodilator, is also increased.

Question 17

Serious A/E of ACE-inhibitors

Answer 17

Hypotension
Cough
Angioedema
Neutropenia

Question 18

Contraindications for ACE-inhibitors

Answer 18

Renal artery stenosis
Hx of angioedema
Pregnancy
Hyperkaleamia

Question 19

Why ACE-inhibitors good in diabetic nephropathy

Answer 19

Reduce protein loss in urine. Improve diabetic nephropathy through the inhibition of renal MCP-1

Question 20

Names the two types of calcium channel blockers and their different MOA

Answer 20

Dihydropyridines - greatest vasodilatory effect acting on vascular smooth muscle (little nodal effect)
Non-dihydropyridines - depressive effect on SA and AV nodes

Question 21

How does doxazosin work

Answer 21

Blocks post-Junctional alpha1-adrenergic receptors. Causes vasodilation. Do not use in hypertension due to increased CF. Used for peri-operative control in pheochromocytoma

Question 22

How does hydralazine work

Answer 22

Direct action on smooth muscle causing vasodilation. Only use as 4th hypertension Rx in low doses and combo with other drugs.