Hypertension and Anti-Hypertensive Drug Pharmacology

Question 1

What is stage 1 hypertension?

Answer 1

140/90

ABPM - 135/85

Question 2

What is stage 2 hypertension?

Answer 2

160/100

ABPM - 150/95

Question 3

What is severe hypertension?

Answer 3

When either

S is >180
D is >110

Question 4

What would you look for in a history to assess the risk of hypertension in the patient?

Answer 4

Smoking
Family history
Diabetic
Hypercholesterolaemia

Question 5

What would you look for in the examination?

Answer 5

Assess if there is end organ damage

Question 6

How would you look for LVH?

Answer 6

ECG and echocardiograms

Question 7

How would you look for renal failure?

Answer 7

Renal ultrasounds
Estimated GFRs
Proteinuria (urine tests)

Question 8

What is the step 1 treatment for a <55?

Answer 8

ACEI/ARBs

Question 9

What is the step 1 treatment for >55s OR Afro-Caribbean OR of child bearing age?

Answer 9

CCBs

Question 10

Step 2?

Answer 10

Add thiazide type diuretic

Question 11

Step 3?

Answer 11

Add all three in

Question 12

Step 4 if blood K+ is UNDER 4.5mmol/l?

Answer 12

Low dose SPIRONOLACTONE - 25mg/once daily. Can cause hyperkalaemia so careful in patients with a reduced GFR

Question 13

Step 4 if blood K+ is OVER 4.5mmol/l

Answer 13

Use a higher dose thiazide type diuretic

Question 14

Step 5?

Answer 14

Add a beta blocker

Question 15

Step 6?

Answer 15

Use a “less common agent”

Question 16

What is ramipril or perindopril and how do they work?

Answer 16

ACEIs - work by inhibiting ACE converting Angiotensin I to Angiotensin II

Question 17

What does Angiotensin II do?

Answer 17

Makes aldesterone which retains Na+ therefore retaining fluid and increasing BP

Is also a vasoconstricor also increasing BP

Question 18

What else can Angiotensin II do regarding organs?

Answer 18

Causes end organ damage - example is LVH as A2 is a hypertrophic agent

Question 19

What is Conns and why does it produce HT as a symptom?

Answer 19

Excess aldesterone is made - increases BP

Question 20

Contraindications of ACEIs?

Answer 20

Renal artery stenosis
Renal failure
Hyperkalaemia

Question 21

Adverse drug reactions of ACEIs?

Answer 21

Cough main one
1st dose HYPOtension a risk
Renal impairment

Question 22

Drug-drug interactions of ACEIs?

Answer 22

NSAIDS - precipitate acture renal failure

K+ supplements or K+ sparing diuretics - spironolactone

Question 23

Why is using ACEIs when hyperkalaemic bad?

Answer 23

Aldesterone used to remove K+ - if already got too much and you inhibit this removal response messes things up

Question 24

Name some ARBs

Answer 24

Losartan
Valsartan
Candesartan
Irbesartan

(SARTAN)

Question 25

What receptor does ARBs block?

Answer 25

AT1

Question 26

Do ARBS produce a cough?

Answer 26

No

Question 27

What 2 types of CCBs we got?

Answer 27

Vasodilators and Rate limiting

Question 28

Name the rate limiting CCBs.

Answer 28

Verapamil or diltiazem

Question 29

How do the rate limiting CCBs limit the rate?

Answer 29

Block the L type channels - negative inotropic effect Also relax arteries which reduces TPR and CO - reduced myocardial O2 demand

Question 30

Name some vasodilating CCBs

Answer 30

Amlodipine and Felodipine

Question 31

When are vasodilating CCBs used?

Answer 31

In over 55s or women of child bearing age

Question 32

CCBS contraindications?

Answer 32

Rapid vasodilators can precipitate stroke or MI so NEVER use in at risk patients

Question 33

Adverse drug reactions of all CCBs?

Answer 33

Flushing Headache Ankle Oedema

Question 34

Adverse drug reactions of Rate limiting?

Answer 34

Bradycardia and Constipation

Question 35

Name some thiazide type diuretics?

Answer 35

Indapemide

Question 36

How to thiazides Ds work?

Answer 36

Block Na+ reabsorption (antinaurtic) and cause you to pee

Question 37

How long can thiazides take to show antiHT effects?

Answer 37

Weeks

Question 38

Adverse effects of thiazide Ds?

Answer 38

Gout Impotence These not common

Question 39

What are the "less commonly used" agents?

Answer 39

Alpha-1-adrenoreceptor antagonists Centrally acting agents Vasodilators

Question 40

Name a A1-adrenoreceptor antagonist.

Answer 40

Doxazosin

Question 41

How does doxazosin work?

Answer 41

Blocks the receptor and opposes smooth muscle contraction in arteries

Question 42

Adverse drug reactions of doxazosin?

Answer 42

1st dose HYPOtension Dizziness Headache Dry mouth

Question 43

When should doxazosin be used?

Answer 43

Young patients who cannot tolerate other drugs

Question 44

Name a centrally acting agent, how does this drug work?

Answer 44

Methyldopa - alpha-2 receptor agonist causing vasodilation

Question 45

When is methyldopa used?

Answer 45

HT in pregnancy

Question 46

Adverse drug reactions of methyldopa?

Answer 46

Sedation Dry mouth Postural hypotension

Question 47

What is postural hypotension?

Answer 47

Rapid fall of BP when you stand up

Question 48

Name 2 vasodilators?

Answer 48

Hydralazine | Minioxidil