Antihypertensive Drugs

Question 1

Types of hypertension?

Answer 1

1. Mild HTN(150/100)-
   Thaizide (hydrochlorothiazide)
   Beta blockers (atenolol, metoprolol)
2. Moderate HTN (thiazides+beta blocker or ace inhibitors (perindopril)
3. Severe HTN- 3 drugs may be combined
   A. Ccb (amlodipine)
   B. Ace inhibitors or arb ( telmisartan)
   C. High ceiling diuretic ( furosemide)
4. Hypertensive emergency
   Sodium nitroprusside infusion
   Glyceryl trinitrate infusion
5. HTN during pregnancy- alpha methyldopa

Question 2

Pharmacological basis of use of Diuretics?

Answer 2

1. Thiazides diuretics + potassium sparing diuretic (spironolactone)

Are the drug of choice in treatment of uncomplicated HTN in low doses 25mg/day
Used in elderly patients

MOA: decreases bp by excreting water and electrolyte ( moderate potency)

2. High ceiling (loop) diuretic
   Not used for treatment of HTN
   USED TO TREAT HTN WITH EDEMA

MOA: removing salt $ water ( potent action)

Question 3

What types of people is diuretics suitable for?

Answer 3

Elderly patients
Isolated systolic HTN
Obese with fluid overload
Low cost therapy

Question 4

What type of people are diuretics not suitable for?

Answer 4

GOUT

Pple with ^ lipids

Hypertension during pregnancy

Question 5

Pharmacological basis use of adrenergic blockers (sympathetic depressants)?

Answer 5

1. Alpha adrenergic blockers(prazosin)
   Dilate vessels, decrease total peripheral resistance in arteries, decreases venous return and cardiac output
2. Beta blockers(atenolol, metoprolol)
3. Apla$beta labetolol

Question 6

Beta 1 blockers?

Answer 6

Atenolol, metoprolol.
Mild hypertensives

MOA: decrease bp, heart rate, cardiac outputs

Advantages: no salt and water retention
Low side effects 
Lost cost
Once a day
Cardio-protective

Question 7

Beta blockers is sutiable for?

Answer 7

Young patient 
Tachycardia or anxiety
Thin-built patient 
Pregnancy
Migraine+hypertension 
Low cost therapy

Question 8

Avoid no selective beta blocker in?

Answer 8

Bradycardia 
Conduction defects
Diabetic 
Asthma or lung Disease 
Severe heart failure 
Peripheral vascular disease 
Abnormal lipid profile
Prinzmetals angina (1/3 of the vessel is blocked)

Question 9

Pharmacological basis of use of ccb( amlodipine)

Answer 9

Advantages 
First line antihypertensive
Minimal fluid retention 
Quick onset of action
Once a day
Mono therapy is effective (50%)

Question 10

Which ccb drug should not be used with b blockers ?

Answer 10

Verapamil $ diltiazem

Causes cardiac depression-cardiac arrest$ death

Question 11

Which ccb drugs should not be used for HTN?

Answer 11

Verapamil

Question 12

Ccb is sutiable for ?

Answer 12

Elderly
Isolated systolic HTN
asthma/COPD patient
Peripheral vascular disease
Pregnant hypertensives (but methyldopa is the drug of choice)
Diabetics (but ACE is the drug of choice)

Question 13

Ccb should be avoided in?

Answer 13

Myocardial inadequacy
Chf 
Conduction defects
Sick sinus syndrome 
Patients receiving b blocker should avoid verapamil and diltiazem
IHD
Post-mi
Prostrate enlargement
Gastric reflex disease (GERD)

Question 14

Pharmacological basis of use of ace inhibitors?

Answer 14

First drug of choice in all grade of HTN

Controls no in 50%

Improve renal blood flow ( decreases nephropathy)

Question 15

Pharmacological basis of use of ARB?

Answer 15

Similar to ace 
As effective as ace
Posses all advantages of ace plus
It is free of side effect
Usually superior to ace

MOA: act by blocking angiotensin (AT1) receptor

Question 16

ACE/AT1 blocker is suitable for?

Answer 16

Diabetic nephropathy
Young patients 
Patient with cardiac enlargement 
Gout
Peripheral vascular disease 
Dyslipedaemic patients

Question 17

ACE/AT1 should be avoided in?

Answer 17

Pregnancy
Hyperkalemia
Pre-existing dry cough 
Bilateral renal artery stenosis 
Single kidney artery stenosis

Question 18

Non-pharmacological treatment of HTN?

Answer 18

Salt- restrictions 
Potassium intake (citrus fruits)
Beetroot
Avoid smoking
Avoid alcohol 
Mild exercise
Mental relaxation