Hypertension 2

Question 1

Role of angiotensin II in organ damage

Answer 1

slide 91

Question 2

State the contraindictions of ACE-i ( eg ramipril)

Answer 2

• renal artery stenosis
• renal failure
• hyperkalaemia

Question 3

ADRs of ACE-i

Answer 3

• cough
• first dose hypotension
• tase disturbance
• renal impairment
• angioneurotic oedema

Question 4

Drug-drug interactions of ACE-i

Answer 4

• NSAIDS ( precipitate acute renal failure)
• Potassium supplements (hyperkalaemia)
• Potassium sparing diuretics(hyperkalaemia)

Question 5

State angiotensin II antagonists(ARB)

Answer 5

• Losartan, volsartan, candesartan, irbesartan
• Angiotensin II antagonists block actions of angiotensin II at angiotensin AT1 receptor
• no cough

Question 6

State CCBs

Answer 6

-amlodipine/felodipine(vasodilator), verapamil/diltiazem ( rate limiting)

Question 7

Mechanism of CCBs

Answer 7

• blocks L type calcium channels
• selectively between vascular and cardiac L type channels
• relaxing large and small arteries and reducing peripheral resistance
• reducing CO

Question 8

When are CCBs offered?

Answer 8

• antihypertensive choice for >55yrs or women of child baring age.
• high compliance
• benefit in elderly patient with systolic hypertension

Question 9

Contraindictions of CCBs

Answer 9

• acute MI

- HF, bradycardia ( rate limiting CCBs)

Question 10

ADRs of CCBs

Answer 10

• flushing
• headache
• ankle oedema
• indigestion + reflux oesophagitis

Rate limiting agents also causes

• bradycardia
• constipation

Question 11

State thiazide-type diuretics

Answer 11

-indapamide, chlortalidone

Question 12

Mechanism of thiazide-type diuretics + ARDs

Answer 12

• Urinary excretion of Na+

- uncommon ARDs ( gout and impotence)

Question 13

Less commonly used agents

Answer 13

Alpha-adrenoceptor antagonists
-Doxazosin

Centrally acting agents

• Methyldopa
• Moxonidine (imidazoline agonist)

Vasodilators

• Hydralazine
• Minoxidil

Question 14

Alpha-adrenoceptor antagonists mechanisms and ADRs

Answer 14

Doxazosin

• selrvyibely block post synaptic alpha1-adrenoceptors
• oppose SM contraction in arteries

ADRs

• first dose hypotension
• dizziness
• dry mouth
• headache

Question 15

Centrally acting agents mechanism and ADRs

Answer 15

Methyldopa

• used in hypertension of pregnancy
• converrted to alpha-methynoradrenaline which acts on CNS alpha-adrenoreceptors which decreases entral sympathetic outflow

ADRs

• sedation and drowsiness
• dry mouth/nasal congestion
• orthostatic hypotension

Question 16

Treatment regimes

Answer 16

slide 105

Question 17

Hypertension and pregnancy

Answer 17

• if during, at more risk of developing preeclampsia
• maternal and fetal death possible
• During NORMAL pregnancy, BP falls.Sometimes develops hypertension during pregnancy ( gestational hypertension)
• can be severe from 20wks BP 140/90mmHg and proteinuria > 300mg/24hr = preclampsia

Question 18

Treatment of pregnancy hypertension

Answer 18

Prepregnancy;
-nifedipine MR, methyldopa, atenolol, labetalol

During pregnancy
-add thiazide diuretic and/amlodipine

Preeclampsia
-as above + IV hydralazine, esmolol,labetalol

Question 19

Symptoms of untreated hypertension

Answer 19

Vascular

• aortic dissection
• anuerysm
• peripheral vascular disease

Brain

• stroke
• haemorrhages

Eyes

• papilloedema and retinal haemorrhage ( in malignant hypertension)
• blindness

Kidneys

• kidney failure
• proteinaemia
• uraemia

Heart

• Heart failure (congestive) – breathlessness, fatigue and (ankle) oedema
• Pulmonary oedema – dyspnoea, orthopnoea, haemoptysis, sweating
• MI – (radiating) chest pain, dyspnoea, sweating, feverish
• LVH – dyspnoea, chest pain, palpitations