Hypertension

Question 1

Indication to start anti-hypertensive medication

Answer 1

140/90mmHg +
    End organ damage
    Renal disease
    CVS risk >20% next 10 years
    Diabetes
    Established CVS
or 160/100mmHg

Question 2

Diuretics

Answer 2

Thiazide loop, K+ sparing
(Down) ECF volume so vascular resistance lower
Hypokalemia, hyperglycemia, hyperlipidemia, hyperuricemia, azotemia

Question 3

B-blockers

Answer 3

Propanolol, metoprolol, atenolol, timolol, carvedilol
(Down) cardiac contractility + renin release
Bronchospasm (IF ASTHMA), bradycardia, CHF exacerbation, impotence, fatigue, depression

Question 4

ACEi

Answer 4

Captopril, enalapril, fosinopril
Block aldosterone –> reduce peripheral resistance –> reduce salt/water retention
Cough, angioedema, rashes, leukopenia, hyperkalemia

Question 5

ARBs (angiotensin II receptor blocker)

Answer 5

Losartan, valsartan, irbesartan
Block aldosterone effects, reduce peripheral resistance and salt/water retention
Rashes, leukopenia, hyperkalemia (NO COUGH)

Question 6

CCBs

Answer 6

Dihydropyridines (amlodipine, felodipine, nifedipine) AND non-dihydropyridines (diltiazem, verapamil)
(Down) smooth muscle tone and cause vasodilation
Dihydropyridines (headache, flushing, peiripheral edema)
Non-dihydropyridines (down contractility)

Question 7

Vasodilators

Answer 7

Hydralazine, minoxidil
(Down) peripheral resistance by artery dilation
Hydralazine (headache, lupus-like syndrome)
Minoxidil (orthostasis, hirsutism)

Question 8

Alpha 1- adrenergic blockers

Answer 8

Prazosin, terazosin, phenoxybenzamine
Blcok norepinephrine on vascular smooth muscle –> vasodilation
Orthostatic hypotension

Question 9

Centrally acting adrenergic agonists

Answer 9

Methyldopa, clonidine
X central alpha 2 adrenergic receptors –> X sympathetic nervous system
Somnolence, orthostatic hypotension, impotence, rebound HTN.

Question 10

contraindication: asthma/COPD

Answer 10

beta blockers

Question 11

contraindication: bradycardia, 2nd or 3rd degree atrioventricular block

Answer 11

beta blockers

CCB non dihydropyridines (diltiazem, verapamil)

Question 12

contraindication: heart failure

Answer 12

CCB (especially diltiazem and verapamil)

Question 13

contraindication: gout

Answer 13

thiazide

Question 14

favourable: CKD w micro/macro albuminuria

Answer 14

ACEi or sartans

Question 15

favourable: Heart failure

Answer 15

ACEi or sartans
Bblockers (carvedilol, controlled release metoprolol, bisoprolol, nebivolol)
Thiazide diuretics

Question 16

favourable: post MI

Answer 16

Bblockers

ACEi or sartans

Question 17

favourable: angina

Answer 17

Bblockers
CCB
ACEi

Question 18

AF

Answer 18

ACEi or sartans
rate control (non dihydropyridines, CCB, BB)

Question 19

Xxx Bblocker + CCB (verapamil/diltiazem - non dihydropyridines)

Answer 19

Heart block

Question 20

Xxx ACEi + ARB

Answer 20

decrease renal function (although proteinuria improves)

Question 21

Major drug classes to treat hypertension

Answer 21

angiotensin converting enzyme inhibitors/ angiotensin II receptor blockers, CCB, thiazide, beta blockers

Question 22

Which medication to use NICE guidelines

Answer 22

Initial:
   <55 ACEi or ARB
   >55 or black  CCB
Then:
   ACEi/ARB + CCB
After:
   ACEi/ARB + CCB + thiazide
3 drugs = resistant
   low dose spironolactone (25mg D) if K+ <4.5mmol/L

Question 23

Renin-Angiotensin-Aldosterone pathway

Answer 23

https://www.youtube.com/watch?v=PDE2qdS2ZvY

Handwritten tutorials