Drug Therapy Of Hypertension

Question 1

Mention causes of drug-induced HTN

Answer 1

Estrogen containing contraceptive pills
NSAIDs
Sympathomimetics
Glucocorticoids 
Liquorice and its derivatives

Question 2

Enumerate HMOD

Answer 2

HF, ISHD, renal failure, retinal artery damage, stroke.

Question 3

Mention intervention in high normal and grade I HTN

Answer 3

High normal. Lifestyle advice. Drug treatment with risk patients esp with CVD
G 1. Life style advice. Drug treatment with low risk patients without HMOD after 3-6 months of lifestyle changes if BP is not controlled. Immediate drug treatment in high risk patient with CVD or HMOD

Question 4

Mention intervention in grad III and grade IV HTN

Answer 4

BOTH
Lifestyle advice
Immediate drug treatment in all patients
Aim for BP control within 3 months

Question 5

Menyion steps of treatment of uncomplicated HTN

Answer 5

1, ACEI+Diuretics/CCB
2, Add diuretics or CCBs
3, add spironolactone, other diuretic, beta or alpha blocker.

Question 6

When to consider beta blockers in any step of treatment?

Answer 6

When there is specific indication for their use as HF, AF, MI angina and pregnant or planning women.

Question 7

When to consider monotherapy?

Answer 7

In low risk patients with grade 1 HTN or very old patients.

Question 8

Mention steps of treatment of CAD with HTN

Answer 8

1, chose two of: ACEI, BB, CCB, diurentics
2, triple combination
3, add spironolactone or alpha blocker

Question 9

Menyion steps of treatment of HF with HTN

Answer 9

1, ACEI + BB + diuretic

2, add spironolactone

Question 10

Menyion steps of treatment of CKD with HTN

Answer 10

1, ACEI + CCB
2, add diuretic
3, add spironolactone

Question 11

What is the choice of diuretics in HTN?

Answer 11

They refer to thiazide or thiazide like drugs. Consider loop diuretics with refractory edema.

Question 12

When should ACEI be stopped in CKD

Answer 12

When SrCr rises more than 30% during treatment.

Question 13

Mention initial therapy in HTN with
A. AF
B. DM

Answer 13

A, ACEI + BB/Non-DHP, anticoagulants should be considered

B, ACEI + CCB/thiazide

Question 14

BB should not be comibed with …. for fear of …..

Answer 14

Non DHP CCB

Marked reduction in HR and AV conduction

Question 15

Mention precautions of HTN with
A. DM
B COPD

Answer 15

A. Avoid dec less than 120/70. SGLT-2 inhibitor help in controlling BP
B. Avoid non selectibe BB, ACEI cause dry cough

Question 16

Mention steps of treatment of HTN with pregnancy

Answer 16

Drugs of choice, methyldopa, labetalol, CCBs

Hypertensive crisis: IV labetalol, nicardipine, MgSO4

Question 17

Mention precautions of HTN treatment in pregnancy

Answer 17

ACEI, ARBs, aliskiren are not recommended during pregnancy

Question 18

What is the advantage of BB + DHP CCB

Answer 18

BB counteract reflex tachycardia induced by DHP CCBs

Have additive antihypertensive effect

Question 19

What is the advantage if thiazide + BB/ACEI?

Answer 19

Thiazides synergize with most antihypertensives by dec volume expansion.
Reduction in antihypertensive effect of diuretics, 2ry to their activation of Renin-Ag system, is counteracted by inhibitory effects of BB, ACEI ir ARBs on the renin-Ag system.

Question 20

…. reset receptors

Answer 20

BB

Question 21

Mention indications of thiazide diuretics

Answer 21

Elderly, obese and black

Hypertension with osteoporsis and recurrent renal stones.

Question 22

Mention adverse effects of thiazides in antiHTN doses

Answer 22

1. Sulphonamide hypersensitvity, absolute.
2. Impotence, relative
3. Sleep disturbance
   Metabolic side effects in higher doses

Question 23

Mention advantages of using LOW dose thiazide

Answer 23

Not associated with activation of RAAS system, more effective than higher doses
Not associatef with metabolic side effects

Question 24

Elaborate,

How to choose between loop and thiazide in HTN?

Answer 24

Thiazide is used in patient with mild to moderate HTN
Loop is used in:
Patients with fluid overload due to HF or renal disease
Resistant HTN

Question 25

Describe mechanism of action of BB

Answer 25

1. B1-blockade, -ve inotropic and chronotropic, suppression of renin releasr. 2. B2-blockade, dec sympathetic discharge centrally amd peripherally by dec NE release. 3. Reset baroreceptors 4. Some BB are vasodilators

Question 26

Mention advantages & disadvantages of BB in HTN patients

Answer 26

Protect from CAD and dec CV mortality Do not protect against cerebrovascular events Impair glucose tolerance and inc risk of new onset DM

Question 27

Mention indications of BB with HTN

Answer 27

Not used as initial therapy unless there is a specific indication. Af or AF Systolic HF Coronary heart disease (angina pectoris or post-MI)

Question 28

What are the indications of ACEI in HTN

Answer 28

``` Used as initial therapy in most cases of HTN, CI in pregnancy Used in Systolic HF ISHD Chronic renal failure with proteinuria Diabetes mellitus ```

Question 29

Aliskiren is .....

Answer 29

Selective renin inhibitor

Question 30

Describe mechanism of action of CCBs

Answer 30

Peripheranl arteriolar VD, dec peripheral resistance Diuretic action, inc renal blood flow Dec aldosterone secretion

Question 31

When CCBs are used,..... is preferred. | Why?

Answer 31

Long acting DHP | Less reflex tachycardia

Question 32

Mention an indication and a CI of non DHP CCBs

Answer 32

I, AF | CI, Hypertension with severe LF dysfunctions

Question 33

CCBs are presferred in HTN with ................

Answer 33

Pregrnancy, peipheral vascular disease, chronic kidney disease, COPD.

Question 34

Mention indications of centrally acting alpha 2 agonists

Answer 34

1. Methyldopa, prrgnancy | 2. Cloinidne, HTN emergencies

Question 35

Mention indications of doxazosin

Answer 35

Mainly used in essential HTN with BPP

Question 36

GR, Doxazosin is not 2st choice in any type of HTN

Answer 36

As it induces postural hypotension, tachycardia and fluid retention thus tolerance.

Question 37

Mention role of direct vasodilators in HTN

Answer 37

Hydralazine, 2nd choice in eclampsia if other drugs fail. | Nitroprusside, HTN emergencies

Question 38

Mention CI of thiazide

Answer 38

Gout

Question 39

Mention CI of BB and Non DHP

Answer 39

Both, bradycardia and AV block BB, Bronchial astma NonDHP, Severe LV dysfunctions

Question 40

Mention CI of ACEI and ARBS

Answer 40

ARBs, biltaeral renal art stenosis, pregnancy, hyperkalemia | ACEI, all above + history of angioneurotic oedema

Question 41

Define hypertensive urgancy and its managemnet

Answer 41

Severe HTN without ckinical evidence of acute HMOD | Managaed by oral drugs with relatively rapid onset of action

Question 42

Define hyoertensive emergency and drugs generally used in its treatment

Answer 42

Severe HTN grade 3 with acute HMOD, often life-threatening as HTN encephalopathy. Nitroprusside, fenoldopam, labetalol, nicardipine.

Question 43

Mention the CI of 1. Labetalol 2. Fenoldopam

Answer 43

1. Heary failure | 2. Glaucoma

Question 44

Mention drugs used in specific HTN emergencies and their specific indication

Answer 44

Esmolol, aortic dissection | NG, ACS

Question 45

What is the next step when tripe comb therapy fails in HTN

Answer 45

Add spironolactone, other diuretic or inc dose of other diurectics, alpha or beta blockers.