Drugs used for treatment of Hypertension 5

Question 1

List the adverse effects for methyldopa

Answer 1

Adverse effects: hypotension, drowsiness, diarrhoea, impotence,
hypersensitivity reactions

Question 2

Write down the stepwise treatment of hypertension
7 steps

Answer 2

1. Lifestyle
   modification
2. Add 1st agent:
   hydrochlorothiazide
   (HCTZ)
3. Add 2nd agent:
   Enalapril OR
   amlodipine
   4.Increase dose of 2nd
   agent
   5.Add 3rd agent:
   Enalapril OR
   amlodipine
   6.Increase dose of 3rd
   agent
4. Increase dose of
   HCTZ AND add
   spironolactone

Question 3

Drugs for Angina

Answer 3

Beta-blocker
OR
Long-acting calcium channel blocker

Question 4

Medicine for prior MI

Answer 4

Beta-blocker
AND
ACE-inhibitor

Question 5

Medicine for heart failure

Answer 5

ACE-inhibitor
AND
Carvedilol, oral
OR
Spironolactone, oral
For significant volume overload:
Loop diuretic

Question 6

Medicine for left ventricular hypertrophy (confirmed by ECG)

Answer 6

ACE inhibitors

Question 7

Medicine for stroke: secondary prevention

Answer 7

Hydrochlorothiazide, oral
AND
ACE-inhibitor

Question 8

Medicinefor Diabetes type 1 and 2 with/without evidence of microalbuminuria/proteinuria

Answer 8

ACE-inhibitor, usually in combination with diuretic

Question 9

Medicine for chronic kidney disease

Answer 9

ACE-inhibitor, usually in combination with diuretic

Question 10

Medicine for isolated systolic hypertension

Answer 10

Hydrochlorothiazide, oral
OR
Long-acting calcium channel blocker

Question 11

Explain the beta blocker mechanisms in hypertension

Answer 11

• Block β1 receptors in heart
• ↓ HR and force of contraction → ↓ cardiac output → ↓ BP
• Block β1 receptors in juxtaglomerular cells of the kidney
• ↓ renin release → ↓ RAAS activation → ↓ BP

Question 12

explain how is doxazosin in hypertesion used

Answer 12

Consider 4th / 5th line for use in hypertension, if BPH is a co-morbidity.

Question 13

explain the alpha blocker mechanisms in hypertension

Answer 13

• Problems associated with the use of α1 receptor antagonists:
• Orthostatic hypotension
• Reflex sympathetic stimulation
• ↑ HR, contractility, and circulating NA levels leads to ↑
  myocardial O2 requirements
• Activation of RAAS and fluid retention

Question 14

Antagonisms of alpha 1 receptors causes what

Answer 14

Vasodilation-decreased in PVR-decrease in BP

Question 15

List the hypertension special classes

Answer 15

• Pregnancy-induced hypertension
• Asymptomatic severe hypertension (SBP ≥180mmHg and/or DBP ≥110mmHg)
• Hypertensive urgency (SBP >180mmHg and/or DBP >110mmHg)
• Stroke

Question 16

Symptoms for Hypertensive urgency

Answer 16

headache, shortness of breath (SOB), oedema without neurological or cardiac
complications

Question 17

Explain the treatment for hypertensive urgency and goal fot treatment

Answer 17

• Commence treatment with amlodipine AND furosemide/hydrochlorothiazide if renal insufficiency or
  pulmonary congestion
• Goal of treatment: lower DBP to 100mmHg over 24-48 hours
• Refer to hospital

Question 18

explain about stroke related to BP

Answer 18

Stroke
* BP often elevated
* Do not treat BP, refer

Question 19

List drugs for hypertensive emergency

Answer 19

Medicine treatment
* Amlodipine, oral, 10 mg immediately as a single dose.
* If pulmonary oedema:
* Furosemide, IV, 40 mg as a single dose

Question 20

explain the hypertensive emergency

Answer 20

markedly elevated BP: systolic BP > 180 mmHg and/or a diastolic BP > 130 mmHg
A hypertensive emergency is life threatening and needs immediate referral to
hospital

Question 21

Hypertensive emergency is associated with which symtoms?

Answer 21

• unstable angina/chest pain
• neurological signs, e.g. severe headache, visual disturbances, confusion, coma or seizures
• pulmonary oedema
• renal failure