Question
Ms. X, 50 year attended outpatient’s department with H/o giddiness and headache. Her blood pressure recording was 160/96 mm Hg. Diagnosis was essential hypertension (
- (a) Name four drug groups with two examples which can be given for this patient. ( 4 mark(s)
- (b) Write the mechanism of action, two uses and two adverse effects of any two of the above drug groups. ( 6 mark(s)
- (c) Enumerate four drugs which can be given for hypertension in pregnancy. ( 2 mark(s)
- (d) Briefly describe management of hypertensive emergency. 3 mark(s)
Answer
a) Four drug groups, two examples each
| Group | Examples |
|---|---|
| Diuretics | Hydrochlorothiazide, Furosemide |
| ACE inhibitors | Enalapril, Ramipril |
| Calcium channel blockers | Amlodipine, Verapamil |
| Beta-blockers | Atenolol, Metoprolol |
b) Mechanism, uses, adverse effects of two groups
ACE inhibitors: Mechanism — block angiotensin-converting enzyme, reducing angiotensin II formation, lowering peripheral resistance and aldosterone-driven fluid retention. Uses — hypertension, heart failure. Adverse effects — dry cough, hyperkalemia.
Calcium channel blockers: Mechanism — block L-type voltage-gated Ca²⁺ channels in vascular smooth muscle, causing arteriolar vasodilation. Uses — hypertension, angina. Adverse effects — ankle edema, flushing.
c) Drugs for hypertension in pregnancy Methyldopa, Labetalol, Nifedipine, Hydralazine.
d) Management of hypertensive emergency
- Rapid but controlled BP reduction (avoiding overly rapid falls that risk cerebral/coronary hypoperfusion) — target roughly 25% reduction in mean arterial pressure over the first hour, not full normalization immediately.
- IV Sodium nitroprusside or Labetalol — titratable, rapid-onset agents allowing minute-to-minute control.
- IV Glyceryl trinitrate — particularly where cardiac ischemia/pulmonary edema coexists.
- Continuous BP and end-organ monitoring throughout treatment; identify and address the underlying precipitant.