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Phase II - Pharmacology > 17. Cardiology - Antihypertensives > Flashcards

17. Cardiology - Antihypertensives Flashcards

1
Q

What is the definition of hypertension?

A

Sustained systolic BP of 140mmHg or greater or sustained diastolic BP of 90mmHg or greater.

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2
Q

What is hypertension an important risk factor for?

A

Heart disease, stroke, chronic kidney disease, and heart failure.

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3
Q

What are the classes of drug that can be used to treat hypertension?

A

Angiotensin II receptor blockers, renin inhibitors, ACE inhibitors, diuretics, B-blockers, calcium channel blockers, a-blockers, others.

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4
Q

What is the naming rule of ARBs? Give an example.

A

Ends in -sartan. E.g. candasartan or losartan.

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5
Q

Give an example of a renin inhibitor?

A

Aliskiren.

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6
Q

What is the naming rule of ACE inhibitors? Give an example.

A

Ends in -pril. E.g. lisinopril, ramipril.

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7
Q

What is the naming rule for loop diuretics? Give an example.

A

Ends in -ide. E.g. bumetanide, furosemide.

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8
Q

What is the naming rule of thiazide diuretics? Give an example.

A

Ends in -thiazide. E.g. bendroflumethiazide.

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9
Q

Give an example of a potassium sparing drug.

A

Amiloride, spironolactone.

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10
Q

Give an example of a thiazide-like diuretic.

A

Indapamide.

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11
Q

What is the naming rule of B-blockers? Give an example.

A

Ends in -lol. E.g. acebutolol, atenolol, bisoprolol, propanolol, sotalol.

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12
Q

What is the naming rule of calcium channel blockers? Give an example.

A

Ends in -dipine (mostly). E.g. amlodipine, diltiazem, verapamil.

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13
Q

What is the naming rule of a-blockers? Give an example.

A

Ends in -zosin. E.g. doxazosin.

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14
Q

What are the lifestyle and health factors disposing people to hypertension?

A

Race, age, diabetes, obesity, disability, stressful lifestyle, high intake of sodium, smoking.

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15
Q

What are the two main control mechanisms of blood pressure?

A

Baroreflexes and RAAS.

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16
Q

Briefly explain how the SANS responds to reduced BP.

A

Increase activity; activate B1 adrenoceptors on heart –> increased CO; activate a1 in smooth muscle –> increased venous return and peripheral resistance; activation of B1 in kidneys –> increase renin.

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17
Q

Briefly explain how the RAAS responds to reduced BP.

A

Reduced renal blood flow –> reduced GFR –> Na+ and water retention –> increased blood volume –> increased CO; increased renin –> increased ATII -> increased aldosterone –> increased blood volume and CO.

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18
Q

What are the goals of antihypertensive treatment?

A

Reduce cardiovascular and renal morbidity and mortality.

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19
Q

What is the most common cause of failed antihypertensive therapy and why?

A

Non-compliance. The goal is long term reduction in risks rather than symptomatic relief, the patient may be more impacted by negative side effects of the drugs rather than the long term benefit.

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20
Q

Which diuretic should be used in initial management of hypertension?

A

Thiazide.

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21
Q

Which diuretic should be given to a hypertensive patient with inadequate kidney function?

A

Loop diuretics.

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22
Q

What are the ADRs of thiazides?

A

Hypokalaemia, hyperuricaemia, hyperglycaemia.

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23
Q

Which channel do thiazides act on and where?

A

Na+Cl- symporter in distal convoluted tubules.

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24
Q

Which channel do loop diuretics act on and where?

A

Na+-K+-2Cl- symporter (NKCC2) in thick ascending limb of the loop of Henle.

25
Q

What are the ADRs of loop diuretics?

A

Hypokalaemia, calciuria.

26
Q

Which channel do potassium sparing diuretics act on and where?

A

Epithelial Na+ channel (ENaC) in late distal and collecting ducts.

27
Q

What is another benefit of aldosterone antagonists as well as their diuretic effect?

A

Diminishes cardiac remodelling in heart failure.

28
Q

What is the mechanism of action of B-blockers?

A

Decrease CO, reduce SANS outflow, inhibit renin.

29
Q

Where does propranolol act?

A

On B1 and B2 receptors.

30
Q

What are the benefits of selective B1 blockers over non selective B blockers?

A

Increase production of NO - a vasodilator. Nonselective B blockers can’t be used in patients with asthma as they can act on B2 and stop bronchodilation.

31
Q

What are the common ADRs of B blockers?

A

Bradycardia, hypotension, fatigue, lethargy, insomnia, decreased libido.

32
Q

What are the complications of abrupt withdrawal of B blockers?

A

Induced angina, MI, sudden death if IHD.

33
Q

What is the mechanism of action of ACE-inhibitors?

A

Reduce peripheral vascular resistance by blocking ACE which cleaves angiotensin I to II (potent vasoconstrictor). This also means bradykinin (potent vasodilator) isn’t broken down and there is more nitric oxide production.

34
Q

What are the common ADRs of ACE-inhibitors?

A

Dry cough, fever, rash, altered taste, hypotension, hyperkalaemia.

35
Q

What should be given alongside ACE-inhibitors to prevent a serious ADR?

A

Potassium-sparing diuretics or potassium supplements.

36
Q

What is the mechanism of action of calcium channel blockers?

A

They block L type Ca2+ channels in the heart and smooth muscle of vasculature, and therefore the inward movement of calcium so muscle relaxes.

37
Q

What are the ADRs of calcium channel blockers?

A

1st degree AV block and constipation, negative inotropic and chronotropic, dizziness, headache, fatigue, peripheral oedema.

38
Q

What is the mechanism of action of a-blockers?

A

Decrease peripheral vascular resistance and lower arterial blood pressure by causing relaxation of both arterial and venous smooth muscle.

39
Q

What is an ADR of a-blockers?

A

Salt and water retention.

40
Q

What is another use of a-blockers aside from as an anti-hypertensive?

A

Treatment of benign prostatic hyperplasia.

41
Q

What is mechanism of action of clonidine?

A

Act centrally as an a2-agonist to inhibit sympathetic vasomotor centres and decrease sympathetic outflow to periphery.

42
Q

What are the ADRs of clonidine?

A

Sedation, dry mouth, constipation.

43
Q

What is the mechanism of action of methyldopa?

A

A2-agonist converted centrally to diminish adrenergic outflow from CNS.

44
Q

What are the ADRs of methyldopa?

A

Sedation and drowsiness.

45
Q

What is a hypertensive emergency?

A

Life-threatening situation with severe elevations in BP (systolic >180mmHg or diastolic >120mmHg) with evidence of impending or progressive target organ damage.

46
Q

Which medications are used in a hypertensive emergency?

A

Calcium channel blockers, nitric oxide vasodilators, adrenergic receptor antagonists, hydralazine (vasodilator), fenoldopam (dopamine agonist).

47
Q

What is resistant hypertension?

A

BP that remains elevated despite administration of a three-drug regimen including a diuretic.

48
Q

What is the most common cause of resistant hypertension?

A

Poor compliance.

49
Q 
Of the following, which is most likely to cause a 45 year old man to have a persistent dry cough?
A. enalapril
B. losartan
C. nifedipine
D. prazosin
E. propranolol
A

A. enalapril - ACE-inhibitor so prevents breakdown of bradykinin –> cough.

50
Q 
Which may cause reflex tachycardia and/or postural hypotension on initial administration? 
A. atenolol
B. hydrochlorothiazide
C. metoprolol
D. prazosin
E. verapamil
A

D. prazosin - blocks a1-receptors.

51
Q 
Which can precipitate a hypertensive crisis following abrupt cessation of therapy?
A. clonidine
B. diltiazem
C. enalapril
D. losartan
E. hydrochlorothiazide
A

A. clonidine - increased SANS with abrupt stopping after prolonged administration.

52
Q 
A 48-year-old patient has had his hypertension managed for the past 5 years with a thiazide diuretic. The last 3 months, his diastolic pressure has increased, so he's since been prescribed an additional anti-hypertensive agent. He complains of being unable to achieve an erection and being less fit than before. What is the likely additional medication?
A. Captopril
B. Losartan
C. Metoprolol
D. Minoxidil
E. Nifedipine
A

C. Metoprolol - side effect of B blockers.

53
Q 
A 40-year-old male has just been diagnosed with hypertension with readings of 163/102mmHg and 165/100mmHg. He has diabetes that is well controlled with oral hypoglycaemics. Which is the best initial treatment for his hypertension?
A. Felodipine
B. Furosemide
C. Lisinopril
D. Lisinopril and hydrochlorothiazide
E. Metoprolol
A

D. Lisinopril and hydrochlorothiazide - systolic BP is more than 20mmHg above goal so needs two treatments. Diabetes gives him an indication for ACE-i or ARB use.

54
Q 
A 60yo white female hasn't reached her BP goal within 1 months of starting lisinopril. Which would be inappropriate in this situation?
A. Increase dose of lisinopril
B. Add a diuretic
C. Add a calcium channel blocker
D. Add an ARB medication
A

D. Add an ARB medication - ARB and ACE-i should not be given together as it increases risk of ADRs.

55
Q 
3 months into treatment, a patient has hyperkalaemia. Which is most likely responsible for this?
A. Chlorthalidone
B. Clonidine
C. Furosemide
D. Losartan
E. Nifedipine
A

D. Losartan - ARBs can increase serum potassium.

56
Q 
Which of the following is most likely to cause peripheral oedema?
A. Atenolol
B. Clonidine
C. Felodipine
D. Hydralazine
E. Prazosin
A

C. Felodipine - common side effect of calcium channel blockers.

57
Q 
Which is the appropriate choice for hypertension treatment during pregnancy?
A. Aliskiren
B. Fosinopril
C. Hydralazine
D. Valsartan
A

C. Hydralazine - all the others are contraindicated due to potential for harm to fetus.

58
Q 
A 50yo male has newly diagnosed hypertension. He needs two drugs for initial treatment and has comorbidities including diabetes and chronic hepatitis C with moderate liver impairment. Which should be prescribed with a thiazide diuretic?
A. Lisinopril
B. Spironolactone
C. Fosinopril
D. Furosemide
E. Hydralazine
A

A. Lisinopril - diabetes means he should have an ACE-i or ARB. Most ACE-i need hepatic conversion to active metabolites so a non-pro-drug should be given.

Phase II - Pharmacology (7 decks)

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