9.2 - Hypertension and HF treatment

Question 1

How do centrally acting agents work? Give an example

Answer 1

Work by reducing sympathewtic outflow to reduce BP. e.g. Methyldopa

Question 2

How do alpha blockers work? ADRs?

Answer 2

Antagonism of alpha 1 adrenoreceptors

ADR - postural hypotension, dizziness, headaches and fatigue, oedema

Question 3

How do thiazide diuretics work? ADRs?

Answer 3

Act on NaCl symporter in DCT, reducing water reabsorption and blood volume.

ADR - hypokalaemia, hyperuricaemia, hypercalcaemia, ED

Question 4

CCB MoA? What are the 3 types? ADRs?

Answer 4

Bind to L-type calcium channels and reduce Ca entry. Vasodilates arteries.

3 groups:

1. Dihydropyridines - tachycardia, sweating, flushing, oedema
2. Phenylalkylamines - constipation, bradycardia
3. Benzothiazepines - bradycardia, negative ionotropy.

Question 5

What are some ADRs to ACEi?

Answer 5

dry cough, first dose hypotension, renal failure, hyperkalaemia

Question 6

What is classified as a hypertensive emergency? How would you treat?

Answer 6

>220/120mmHg

Treat with IV sodium nitroprusside which acts as an endogenous nitric oxide.

Question 7

Which CCB is the preferred?

Answer 7

Dihydropyridines

Question 8

How would you treat mild, moderate, and severe hypertension?

Answer 8

Mild - Non pharm therapies

Moderate and severe - Pharm therapies

Question 9

What is a pheochromocytoma?

Answer 9

Adrenal catecholamine secreting tumour

Question 10

Describe the treatment plan for <55 yo

Answer 10

1) ACEi
2) +CCBs
3) +diuretics
4) + alpha blockers, beta blockers, centrally acting drugs, or vasodilators

Question 11

Describe the treatment plan for a black person or a >55yo

Answer 11

1) CCBs
2) +ACEi
3) +diuretics
4) +alpha blockers, beta blockers, centrally acting drugs, or vasodilators

Question 12

How do direct renin inhibitors work?

Answer 12

Bind to renin and prevents cleavage of angiotensinogen to angiotensin I

Question 13

Define mild, moderate, and severe hypertension

Answer 13

Mild - 140-159 s, 90-99 d

Moderate - 160-179 s, 100-109 d

Severe - >180 s, >110 d

Question 14

What antihypertensive drug is used preferably in pregnancy?

Answer 14

Centrally acting agent e.g. methyldopa

Question 15

What are the 3 types of CCBs?

Answer 15

Dihydropyridines, benzothiazepines, phenylakylamines

Question 16

If patient cannot tolerate ACEi, what is the alternative treatment? Name an example and its ADRs.

Answer 16

AG2 receptor blocker

e.g. Losartan. ADR is renal failure, hyperkalaemia

Question 17

How do alpha blockers work?

Answer 17

Antagonise alpha 1 adrenoreceptors to reduce TPR

Question 18

What is the MoA of ACEi? ADRs? Give .e.g

Answer 18

e.g. - ramipril

MoA - prevent AG2 generation by inhibiting ACE. Also prevents bradykinin degradation. This all reduces effect of RAAS system

ADRs - dry cough, first dose hypotension, renal failure and hyperkalaemia.

Question 19

Name an example ACEi

Answer 19

Lisinopril, ramipril

Question 20

How do centrally acting agents work? What drugs does this include? ADRs?

Answer 20

Methylodopa - alpha 2 agonist

Clinidine - alpha 2 agonist

All reduce sympathetic outflow to reduce BP

ADRs - tiredness, lethargy, depression

Question 21

Fill in

Answer 21

Question 22

Define hypertension. What are the 2 causes of hypertension?

Answer 22

>140/90mmHg

Primary - No known cause. 90% of cases

Secondary - known cause.

Question 23

How do direct renin inhibitors work?

Answer 23

Bind to renin and prevent cleavage of angiotensinogen to angiotensin 1. Little effect on BP

Question 24

How do beta blockers work?

Answer 24

Antagonise beta1 adrenoreceptor, reducing HR and CO. But little effect on BP

Question 25

Define a hypertensive emergency. How would you treat? How does treatment work?

Answer 25

>220/120

IV sodium nitroprusside acts as endogenous N2O