17 Questions
Which type of diuretic is Spironolactone classified as?
Potassium-sparing diuretic
What is the primary use of Aldosterone antagonists like Spironolactone in patients with heart failure?
To reduce cardiac remodeling
Which antihypertensive medication is considered teratogenic and should be avoided during pregnancy?
RAAS antagonists
What is the primary goal of using antihypertensive medications?
To prevent long term end-organ damage
In the context of emergency hypertension, which medication is used for better control over the reduction in blood pressure?
Na nitroprusside
What is the standard therapy recommended for pregnant women needing antihypertensive treatment?
Methyldopa
What is a common adverse effect associated with lipid-soluble Beta-Blockers?
Nightmares
Which of the following is a contraindication for Calcium Channel Blockers?
Bradycardia
What effect can Thiazide diuretics have on cardiac output and blood pressure?
Decrease
Which type of Calcium Channel Blockers mainly acts on Voltage gated Ca++ channels in vascular smooth muscles?
Dihydropyridines
What is a common side effect of Thiazide diuretics?
Hypokalemia
Which of the following is a common side effect of calcium channel blockers?
Cold extremities
Which class of beta-blockers is more likely to cross the blood-brain barrier and cause central nervous system side effects?
Lipophilic beta-blockers
Which of the following is a potential adverse effect of diuretic therapy?
Decreased serum potassium levels
A patient with hypertension experiences claudication (cramping pain in the legs during exercise) after starting a calcium channel blocker. What is the most likely explanation for this side effect?
The calcium channel blocker caused increased vasodilation in the legs
A patient with hypertension and heart failure is started on a lipid-soluble beta-blocker. Which of the following is the most likely reason for this choice of medication?
Lipid-soluble beta-blockers are more likely to have cardioprotective effects in heart failure
A patient with hypertension is experiencing cold extremities as a side effect of their calcium channel blocker medication. Which of the following is the most appropriate next step in management?
Switch to a different class of antihypertensive medication
Study Notes
Lifestyle & Risk Factors Modification
- Sedentary life modification: Exercise (brisk walking 30 min/3 times a week)
- Dietary changes: Decrease salt, fats, and increase fruits and vegetables intake
- Habits: No alcohol, no smoking, decrease caffeine, and stress control
Control of Comorbidities
- Manage obesity, diabetes, hyperlipidaemia, hyperuricemia, and atherosclerosis
Pharmacological Treatment
ACE Inhibitors & Angiotensin Receptor Blockers
- Inhibit angiotensin-converting enzyme, decreasing angiotensin II synthesis
- Decrease vasoconstriction, cardiac work, and contractility
- Increase vasodilation, decrease PVR and blood pressure
- Inhibit degradation of bradykinin, increasing vasodilation and decreasing PVR and blood pressure
- Inhibit RAAS, decreasing aldosterone release, salt and water retention, and blood volume
Others
- Aldosterone antagonists (Spironolactone): Blocks aldosterone receptors, decreasing sodium and water retention
- Used in heart failure, reduces cardiac remodeling, and avoids hypokalemia
- Methyldopa: Standard therapy in pregnancy, not causing teratogenicity
- Clonidine and parenteral antihypertensives: Used in emergency hypertension, easily titrated for better control
General Considerations
- Main objective: Control and maintain BP to prevent long-term end-organ damage
- Non-pharmacological treatment is essential in all cases
- Pharmacological treatment aims to decrease BP by 5-15 mmHg gradually
- First-line treatment: ACEIs/ARBs, Thiazide diuretics, or CCBs, depending on patient comorbidities
ADRs of Pharmacological Treatment
- Masking hypoglycemic manifestations in diabetic patients
- Claudication and cold extremities
- Nightmares with lipid-soluble B-Blockers
- Contraindications: Hypertension with bronchial asthma, diabetes, bradycardia, or heart block
Calcium Channel Blockers (CCBs)
- Mechanism: Blocking voltage-gated Ca++ channels in vascular smooth muscles
- Vascular dilatation effect, decreasing PVR and mean BP
- Indications: Hypertension and angina
- ADRs: Hypotension, headache, and ankle edema
- Contraindications: Heart block, bradycardia
- Combination: Can be combined with B-Blockers
Diuretics
- Thiazide diuretics: Block Na/Cl cotransporters in DCT, decreasing salt and water reabsorption
- Moderate ceiling diuretic, decreasing cardiac output and BP
- Main side effect: Hypokalemia
Test your knowledge on diuretics and medications commonly used in patients with heart failure, including their mechanisms of action and potential side effects. This quiz covers topics such as aldosterone antagonists, loop diuretics, and antihypertensives like methyldopa in pregnancy.
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