Hypertention

Question 1

How can you calculate mean arterial bloood pressure?

Answer 1

Q/3 DBP + 2/3SBP

Question 2

What are the target blood pressures for different groups?

Answer 2

140/90 under 80’s and type 2 diabetics
150/90 over 80 years old
135/85 type 1 diabetics

Question 3

What are the stages of hypertension

Answer 3

Stage 1 = 140/90-159/99

Stage 2=160/100-180120

Stage 3=180+/120+

Question 4

What drugs can be used to treat hypertension

Answer 4

Ace inhibitors
Angiotensin receptor blockers
Calcium channel blockers
Diuretics

Question 5

What is the action of angiotensin 2?

Answer 5

Angiotensin 2 acts on AT1 receptors to cause these
Increases sympathetic activity = vasoconstriction
Increases Na+ and water retention in kidneys = increased blood volume
Increased aldosterone secretion from adrenal gland which also increased sodium and water retention increasing blood volume.
Increased arterial vasoconstriction
Increased ADH secretion from the pituitary gland leading to increased Water from the kidney.

Question 6

For Ramipril give

Class
Uses
Side effects
Others in class
Drug-drug interactions

Answer 6

Class; ACEi
Uses heart failure and (low renin)hypertension
Others in class : lisimopril
Side effects: dry cough from bradykinin build up), Hypotension, hyperkalaemia (as losing Na+ exchanged for K+), cause or worsted renal failure (decreased blood flow to kidneys), angioedma (more common and Afro-Caribbean patients)
Drug-drug interaction: NSAIDSs, other anti hypertensives.

Question 7

Losartan

Class
Uses
Side effects
Others in class
Drug-drug interactions

Answer 7

Angiotensin 2 receptor antagonistClass

Uses: hypertension , heart failure
Side effects: hypotension, hyperkalaemia (low aldosterone high Na+ loss exchanged for K+), cause or worsen renal failure.
Others in class: candesartan
Drug-drug interactions: K+ raising drugs and NSAIDs

Other info: no effect on bradykinin so no dry cough. Chymases can produce angiotensin 2 further down pathway ARBs block this so more effective at inhibiting vasoconstriction.

Question 8

Amlodipine

Class
Uses
Side effects
Others in class
Drug-drug interactions

Answer 8

Class: calcium channel blocker - dihydropyridine
Mechaism: blocks voltage gated calcium channel stopping influx of calcium which stops smooth muscle contraction in peripheral vasculature. Vasodilation leads to reduced BP.
Uses: hypertension
Side effects: ankle swelling, flushing and headaches from the vasodilation. Palpitations from compensatory tachycardia.
Others in class: nimodipine, nifedipine
Drug-drug interactions: amlodipine and simvastatin

Question 9

Verapamil

Class
Mechaism
Uses
Side effects
Others in class
Drug-drug interactions

Answer 9

Class: non-dihydropyridine , phenylalkyamines 
Uses: class 4 antiarrythmic , angina and hypertention
Mechanism: depresses SA node and slows AV conduction, negative inotropy , reduces HR reduces BP
Side effects: constipation, bradycardia, heart block and cardiac failure.
Others in class
Drug-drug interactions: b-blockers other antihypertensives and antiarrythmics

Question 10

Bendroflumethiazide 
Class
Uses
Mechaism
Side effects
Others in class
Drug-drug interactions

Answer 10

Class: thiazides like diuretics
Uses: hypertension
Mechanism: inhints Na+/Cl- co-transporter in distal convoluted tubule reducing Na+ and water retention reducing blood volume and pressure.
Side effects: hyperkalaemia, huponatraemia (short term), hyperuricemia (gout), arrhythmias, high glucose, high cholesterol
Others in class: indapmide
Drug-drug interactions : NSAIDs, loop diuretics and other K+ lowering drugs.

Question 11

What drugs and pprogression is used in treating hypertension for people with type 2 diabetes? Or who are under 55 not black or diabetic

Answer 11

1. ACEi/ARB
2. Add thiazides like durietic
3. Add CCB

Question 12

What drugs and progression is used in black African or African- Caribbean patients?
Or over 55

Answer 12

1. CCB
2. Add ACEi or ARB or thiazide like diuretic
3. Both ACEi/ARB or add thiazide depending on which did first.

Question 13

What do you use to treat resistant hypertention?

Answer 13

Spironolactone

Question 14

For spironolactone

Class
Uses
Mechaism
Side effects
Others in class
Drug-drug interactions

Answer 14

Class: aldosterone receptor antagonist
Uses: resistant hypertention
Mechanism: blocks aldosterone which reduces Na+ and water retention and vasoconstriction.
Side effects: hyperkalaemia and gynaecomastia
Others in class:
Drug-drug interactions : labetalol which reduces sympathetic outflow

Question 15

Bisoprolol

Class
Uses
Mechaism
Side effects
Others in class
Drug-drug interactions

Answer 15

Class: b-adrenoceptor blockers
Uses: hypertension
Mechanism: decrease vasoconstriction by blocking noradrenaline and reduce myocardial contraction resulting in reduced CO
Side effects: bronchospasms, heart block, Raynauds, lethargy, impotence
Others in class: labetalol, metoprolol
Drug-drug interactions: non-dihydropyridine CCBs , verapamil and diltiazem

Question 16

Doxazosin

Class
Mechanism 
Uses
Side effects
Others in class
Drug-drug interactions

Answer 16

Class: alpha adrenoceptors blockers 
Mechanism : reduce peripheral vasoconstriction 
Uses: 
Side effects
Others in class
Drug-drug interactions