Hypertension 2/2

Question 1

outline the ant-hypertensive drugs safe to use in pregnancy

Answer 1

1) Labetalol - 100 mg twice a day.
2) Methyldopa - 250 mg 2–3 times a day.
3) M/R nifedipine (unlicensed) depends on the brand used.

Question 2

1) how would you manage pregnant women with chronic hypertension already receiving treatment treatment?
2) What is the target BP for patients with uncomplicated hypertension in pregnancy?
3) what is the target for women with target organ damage due to hypertension and in women with chronic hypertension who have given birth?

Answer 2

1) Drug therapy should be reviewed
2) <150/100mm/Hg
3) <140/90mmHg is advised

Question 3

how long following pregnancy should it take for anti-hypertensive treatment to be reviewed?

Answer 3

Long term hypertensive treatment should be reviewed 2 weeks the birth

Question 4

How should women who took methyldopa during pregnancy be managed following the birth of their child?

Answer 4

Discontinue methyldopa and restart original hypertensive medication within 2 days of birth

Question 5

what is Pre-eclampsia?

Answer 5

A combination of hypertension

and proteinuria in pregnancy. Typically occurs after 20 weeks

Question 6

list the high risk factors for Pre-eclampsia?

Answer 6

1) CKD
2) Diabetes
3) Autoimmune disease
4) Chronic hypertension
5) Hypertension during previous pregnancy
↳ ( moderate risk factors include: 1st pregnancy, >40y, pregnancy interval >10y, BMI >35kg/m2, multiple pregnancy or family history)

Question 7

what medication is given to patients at high risk of developing pre-eclampsia and from when should they start/stop taking it?

Answer 7

1) Aspirin 75mg od (unicensed)
2) From 12 weeks till the birth of the baby
↳ (those with TWO moderate risk factors also started on same treatment)

Question 8

what is the initial treatment for women with pre-eclampsia or gestational hypertension who present with a BP of >150/100mmHg?

Answer 8

1) Oral labetalol to reach target BP of <150mmHg systolic and 80-100mmHg diastolic.
2) Alternatives : methyldopa, M/R nifedipine

Question 9

in women with pre-eclampsia where birth is considered likely within 7 days IM betamethasone is recommended. What is the purpose of giving this drug?

Answer 9

Recommended for fetal lung maturation

Question 10

1) Define hypertensive urgency

2) How should it be treated?

Answer 10

1) Severe hypertension WITHOUT damage to target organs (>180/110mmHg)
2) Reduce BP gradually over 24-48h with oral anti-hypertensive such as labetalol or CCB (amlodipine or felodipine)

Question 11

1) Define hypertensive emergency

2) How should a hypertensive emergency be treated?

Answer 11

1) Severe hypertension WITH acute damage to target organs
2) IV anti-hypertensive, reduce BP by 20-25% over first few mins or within 2 hours. following drugs could be considered : sodium nitroprusside, labetalol, GTN,hydralazine, esmalol, ect.

Question 12

what is phaeochromoctoma?

what drugs are used to manage this condition

Answer 12

1) Rare, usually benign tumor that develops in an adrenal gland.
2) Alpha blockers are used in short term management. Once alpha blockade is established, tachycardia can be controlled by cardio-selective B-Blocker
↳ Phenoxybenzamine (peripheral vasodialator) is a powerful alpha-blocker which is effective- but has many SE (e.g. avoid contact with skin- contact sensitisation)

Question 13

The use of labetalol in pregnancy is not known to be harmful, except possibly in first trimester. If labetalol is used close to delivery, what should infants be monitored for signs of?

Answer 13

Alpha-blockade (as well as beta blockade)

Question 14

what are the monitoring requirements for labetolol?

Answer 14

liver damage - severe hepathocellular damage reported. laboratory testing needed at first symptom of liver dysfunction (or if jaundice), if any evidence of damage discontinue.

Question 15

1) shock is a medical emergency associated with high mortality. list 3 causes of shock
2) why should shock be treated promptly?

Answer 15

1) Hemorrhage, sepsis, myocardial insufficiency

2) Due to profound hypotension which leads to tissue hypoxia and organ failure

Question 16

outline how is shock managed?

Answer 16

1) Identify and correct underlying cause
2) Volume replacement is essential to correct the hypovolaemia associated with sepsis an hemorrhage
3) Cardiac output may be improved by the use of sympathomimetic inotropes such as adrenaline/epinephrine, dobutamine or dopamine.
↳( Use of sympathomimetics and vasoconstrictors to be done in intensive care with invasive haemodynamic monotoring)

Question 17

1) when would noradrenaline/norepinephrine (vasconstrictors) be considered in septic shock?
2) why would this not be appropriate in cardiogenic shock?

Answer 17

1) When fluid replacement and inotropic support fail to maintain blood pressure
2) In cardiogenic shock, peripheral resistance is frequently high and to raise it further may worsen myocardial performance and exacerbate tissue ischemia (also avoid volume replacement)

Question 18

1) Vasoconstrictor sympathomimetics act on alpha-adrenergic receptors to raise BP. list 3 vasoconstrictor sympathomimetics
2) Discuss the danger of using vasoconstrictors

Answer 18

1) Noradrenaline/norepinephrine, phenylephrine, midodrine

2) Although they raise BP, they can reduce perfusion of vital organs such as the kidneys

Question 19

Name an inotropic sympathomimetic

Answer 19

Dopamine - used in cardiogenic shock in infarction or cardiac surgery
(its a cardiac stimulant which acts on β1-receptors in cardiac muscle, and increases contractility with little effect on rate)