3 - Hypertension

Question 1

What is essential hypertension?

Answer 1

Hypertension of unknown cause. Aka: Primary hypertension

Question 2

What type of hypertension leads to medical emergency?

Answer 2

Malignant hypertension - accelerated hypertension causing damage to vessels in end organs (brain, heart, kidney and eyes).

Question 3

What is orthostatic hypotension?

Answer 3

Hypotension on assuming upright posture. Aka: Postural hypertension

Question 4

Hypertension can lead to increased incidence of what?

Answer 4

Renal failure, coronary disease, cardiac failure and stroke.

Question 5

What is a sign of hypertension?

Answer 5

Elevated blood pressure

Question 6

The drugs that lowers blood pressure may promote salt and water retention, by diminishing renal perfusion and by (increasing/decreasing) the secretion of renin and aldosterone.

Answer 6

The drugs that lowers blood pressure may promote salt and water retention, by diminishing renal perfusion and by INCREASING the secretion of renin and aldosterone.

Question 7

What drugs commonly produce sedation?

Answer 7

1. NE synthesis inhibitors
2. Transmitter depleting agents
3. Sympathetic tone agents
4. Beta-blockers

Question 8

What drugs can contribute to lassitude (lack of energy)?

Answer 8

1. Alpha-blockers (Prazosin)
2. Peripheral NE depleting agents (guanethidine)
3. Vasodilators

Question 9

What are some of the early side effects of all antihypertensive agents (as well as drug-induced hypotension)?

Answer 9

Dizziness, headache, drowsiness and palpitations.

Question 10

T/F Have to balance risks of toxicity from drug treatment vs risk of not treating

Answer 10

True

Question 11

Can different classes of anti-htn drugs be used together?

Answer 11

Yes, used for additive effects. They can be used to keep down excessive control ozone regulatory mechanism and to limit side effects and toxic effects.

ex: The tendency of beta-blockers to increase peripheral resistance by blocking beta2 receptors in skeletal muscles is counteracted by the action of vasodilator, and the tendency of a vasodilator to cause a reflex increase in cardiac output is counteracted by a beta-blocker. The combination of hydrazine with propranolol and a diuretic has achieved wide acceptance.

Question 12

What are the HTN agents of choice for patients with advanced renal disease?

Answer 12

Vasodilators - they keep renal perfusion most nearly adequate after lowering blood pressure.

Question 13

Few women will tolerate __________ because of hypertrichosis (abnormal hair growth).

Answer 13

Few women will tolerate MINOXIDIL because of hypertrichosis (abnormal hair growth).

Question 14

Impotence is commonly associated with what drugs?

Answer 14

1. Alpha-Methyl DOPA
2. Clonidine
3. Reserpine
4. Gunethidine

(Prazosin produced far fewer difficulties)

Question 15

What 2 drugs are widely used in hypertensive emergencies (ex: acute dissection of aorta requires a rapid decrease in blood pressure, and pulse pressure without increasing cardiac output)?

Answer 15

1. Intravenous trimethaphan

2. Propranolol

Question 16

What 4 drugs are used with great caution during a hypertensive emergency due to their tendency to increase cardiac output?

Answer 16

1. Hydrazaline
2. Nitroprusside
3. Diazoxide
4. Fenoldopam

Question 17

What is the action of diuretics in general?

Answer 17

Lower blood pressure by reduction of blood volume and by a direct vascular effect

Question 18

What is the first line drug therapy used for hypertension?

Answer 18

Diuretics and beta-blockers

Question 19

T/F - The maximal antihypertensive effect of thiazides is achieved with doses less than those required for maximal diuretic effect.

Answer 19

True

Question 20

What is the action of thiazides?

Answer 20

Lower blood pressure, initially by increasing sodium and water excretion, decreases extracellular volume, resulting in a decrease in cardiac output and renal blood flow

Question 21

T/F - Thiazides are okay to use in patients with inadequate kidney function.

Answer 21

False - Thiazides should not be used in patients with inadequate kidney function.

Question 22

What is spironolactone?

Answer 22

Aldosterone antagonist that is a potassium sparing diuretic used along with thiazides.

Question 23

What does SARA stand for? Give an example.

Answer 23

Selective aldosterone receptor antagonist - Ex: Eplerenone

Question 24

__________ has a lower incidence of endocrine related side effects due to its reduced affinity for other steroid receptors.

Answer 24

Eplerenone

Question 25

______________ is the side effect of eplerenone therapy especially in patients with renal insufficiency, and those with diabetes mellitus.

Answer 25

Hyperkalemia

Question 26

_____________ are ineffective as antihypertensives, but act promptly in patients who have poor renal function. They cause decreased renal vascular resistance and increased renal blood flood.

Answer 26

LOOP DIURETICS are ineffective as antihypertensives, but act promptly in patients who have poor renal function. They cause decreased renal vascular resistance and increased renal blood flood.

Question 27

What are beta adrenergic blocking agents used for?

Answer 27

Treatment of arrhythmias, angina pectoris and as a first line therapy for hypertension