Paper I — 2023 January (Supplementary) (2019 Scheme) — Q6
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Paper I
2023 January (Supplementary) (2019 Scheme) · 100 marks · 180 min
Question
(
(a) Frusemide.
( 4 mark(s)
(b) Write the pharmacological management of Stage II Hypertension. 4 mark(s)
Q68 marksShort Essays
Answer
a) Furosemide
A high-efficacy loop diuretic. MOA: inhibits the Na⁺-K⁺-2Cl⁻ (NKCC2) cotransporter in the thick ascending limb of the loop of Henle, blocking reabsorption of Na⁺, K⁺, and Cl⁻, producing marked natriuresis and diuresis. Uses: acute pulmonary edema/heart failure, edema of cardiac/hepatic/renal origin, hypertensive emergencies (adjunct), hyperkalemia/hypercalcemia. Adverse effects: hypokalemia, hyponatremia, hypochloremic metabolic alkalosis, ototoxicity, hyperuricemia, hypovolemia/hypotension.
b) Pharmacological management of Stage II hypertension
Stage II hypertension (markedly elevated BP) is generally unlikely to be controlled by monotherapy, so combination therapy is typically started from the outset rather than titrating one drug first:
Two-drug combination, commonly an ACE inhibitor/ARB + Calcium channel blocker, or ACE inhibitor/ARB + Thiazide diuretic — combining agents with complementary mechanisms achieves greater BP reduction with fewer dose-related adverse effects than pushing a single agent to its maximum dose.
If BP remains uncontrolled, a third agent (typically the remaining class from the combination above) is added.
Beta-blockers are added for specific compelling indications (post-MI, heart failure, arrhythmia) rather than as routine first-line agents.
Ongoing monitoring of renal function/electrolytes, and lifestyle modification (salt restriction, weight management, physical activity) alongside pharmacotherapy.
