Anti-hypertensives 2

Question 0

What is ambulatory BP monitoring (ABPM) ?

Answer 0

Device worn during waking hours and BP measure every 30 mins

Question 1

What is white coat hypertension ?

Answer 1

Having BP recorded can cause it to rise

Question 2

What is home BP monitoring (HBPM) ?

Answer 2

2 readings, 1 min apart taking in the morning and evening for a week

Question 3

What is stage 1 hypertension?

Answer 3

BP > or equal to 140/90 and subsequent ABPM/HBPM > or equal to 135/85

Question 4

What is stage 2 hypertension ?

Answer 4

BP > or equal to 160/100 and subsequent ABPM/HBPM > or equal to 150/95

Question 5

What is severe hypertension ?

Answer 5

> equal to 180 systolic or > or equal to 110 diastolic

Treatment occurs immediately

Question 6

What happens if patient has a stage 1 but no end organ damage ?

Answer 6

<40 yes
- check for secondary causes and none then they have to undergo life style changes and if they have secondary causes they are given drugs
40-80yrs
- lifestyle changes

Question 7

What is defined as end organ damage ?

Answer 7

Heart- hypertropy- checked using an ECG
Kidney - renal function - urine/blood tests
Eye- papillodema, retinal haemorrhage

Question 8

What happens to a patient with stage 1 and end organ damage ?

Answer 8

Investigate end organ damage to try and treat hypertension

Question 9

What happens to a patient diagnosed with stage 2 ?

Answer 9

Once confirmed by ABPM then it is treated with drugs

Question 10

What happens to a patient with stage 3 ?

Answer 10

Treatment is started immediately with no ABPM/HBPM

If there are signs of papillodema or retinal haemorrhage then they are referee to special care on same day

Question 11

What are the lifestyle changes advised ?

Answer 11

Lose weight 
Reduce salt intake 
Stop smoking 
Reduce alcohol consumption 
Reduce total fat consumption 
Increase exercise 
Increase fruit and veg

Question 12

What drugs are often administered to young Caucasians ?

Answer 12

ACE inhibitors or at-1 antagonist

Question 13

What drugs are usually given to Afro-caribeans and patients older than 55?

Answer 13

Thiazides and calcium antagonist

Question 14

What are the additional pharmacological options for patients with sever hypertension ?

Answer 14

Minoxidil
Hydralazine
Sodium nitroprusside

Question 15

What drugs can be used in pregnancy for pre-existing hypertension or pre-eclampsia ?

Answer 15

Methyl dopa - reduce sympathetic outflow at medulla
Beta-blockers - only in 3rd trimester
Hydralazine in crisis

Question 16

How do you measure pulmonary pressure ?

Answer 16

Right side of the heart is catheterised - very invasive so it’s rarely done

Question 17

What is an indication of pulmonary hypertension ?

Answer 17

Regurgitation from right ventricle to right atrium detected by a stethoscope
Pulmonary emboli is often a common feature so anticoagulants are often taken

Question 18

What drugs are used to treat pulmonary hypertension ?

Answer 18

Sildenafil - phosphdiesterase inhibitor
Bosentan - et-a antagonist
Epoprostenol- prostacyclin
Illoprost - synthetic prosyacylin analogue

Question 19

How does sildenafil treat pulmonary hypertension?

Answer 19

Inhibits phosphdiesterase 5 which breaks down cGMP to GTP so it increases cGMP increasing relaxation

Question 20

How does bosentan treat pulmonary hypertension ?

Answer 20

Blockers et-a and b receptors so it promotes vasodilation

Question 21

How does prosyacylin and its analogues treat pulmonary hypertension ?

Answer 21

Epoprosterol- prosyacylin 
- increases cAMP which increases vasodilation 
- inhibits platelet aggregation 
- provide symptomatic relief in exercise
Illoprost 
Synthetic

Question 22

What are the adverse effects of anti-hypertensive ?

Answer 22

Flushing
Headache
Dizziness

Question 23

What conditions can each of these drugs not be used in ?

• captopril
• candesartan
• bendrofluemethiazide
• propranolol
• bosentan

Answer 23

Captopril - pregnancy 
Candesartan - pregnancy or breast feeding
Bendrofluemethiazide - hyponatraemia 
Propranolol- agh,as 
Bosentan- pregnancy and breat St feeding