(2) CV & Renal: Antihypertensives (3.1-3.2)

Question 1

What is the difference in the target of dihydropyridines and non-dihydropyridine calcium channel blockers?

Answer 1

(1) Dihydropyridine: ∝ Smooth muscle
(2) Non-dihydropyridine: ∝ Cardiac muscle

Question 2

Suffix: Dihydropyridines

Answer 2

“-dipine”

(‘-dipine’ = Dihydropyrine)

Question 3

Name the CCB with the strongest cardiac effect

Answer 3

Verapamil

(∴ Verapamil > Diltiazam for angina)

Question 4

Name the CCB which causes both vasodilation and an intermediate cardiac effect

Answer 4

Diltiazem

(Diltiazem = 2 = Affects both smooth muscle and heart)

Question 5

What calcium channel blocker can be used in pregnancy?

Answer 5

Nifedipine

Question 6

Indications (9) : Calcium channel blockers

Answer 6

(1) Hypertension
(2) Malignant hypertension
(3) Hypertension in pregnancy
(4) Raynaud’s
(5) Subarachnoid hemorrhage
(6) Stable angina
(7) Migraine prophylaxis
(8) Prinzmetal angina
(9) Arrhythmia
* (Walk around the room counterclockwise)*

Question 7

Which calcium channel blocker can prevent vasospasm after subarachnoid hemorrhage?

Answer 7

Nimodipine

Question 8

Which CCB is used for migraine prophylaxis?

Answer 8

Verapamil

(Verapamil for Very-Painful-Migraines)

Question 9

Adverse Effects (3) : Dihydropyridines

Answer 9

(1) Lightheadedness and headache
(2) Peripheral edema
(3) Reflex tachycardia

Question 10

Which calcium channel blocker is known to exacerbate myocardial ischemia?

Answer 10

Nifedipine

Question 11

Name 2 distinctive side effects of Verapamil

Answer 11

(1) Constipation
(2) Gingival hypertrophy

Question 12

When should 2 antihypertensive drugs be prescribed?

Answer 12

(1) >20 lbs overweight
(2) BP >20/10 above goal
* (Note the 2s: 20 lbs, >20 systolic, >20/2 diastolic)*

Question 13

Name a first-line diuretic for treating primary hypertension

Answer 13

Hydrochlorothiazide

Question 14

In treating 1° hypertension, which patients are known to respond best to calcium channel blockers?

Answer 14

(1) Blacks
(2) Elderly

Question 15

In which comorbid diseases are ACE inhibitors first-line agents treating 1° hypertension?

Answer 15

(1) Heart failure
(2) Diabetics
(3) MI

Question 16

Define: Hypertensive emergency

Answer 16

End organ damage

PLUS

Systolic > 180 mmHg

OR

Diastolic >120 mmHg

Question 17

What type of adrenergic antagonists are used in hypertensive emergencies?

Answer 17

(1) β1 antagonists
(2) Combined α / β antagonists

Question 18

What are two calcium channel blockers often used in hypertensive emergencies?

Answer 18

(1) Clevidipine
(2) Nicardipine

Question 19

What drug is commonly used in hypertensive emergency in pregnant women?

Answer 19

Hydralazine

(+ Labetalol)

Question 20

How do you prevent reflex tachycardia when administering Hydralazine?

Answer 20

Administer β₁ antagonist

Question 21

What combination of vasodilatory drug therapy is used in patients with heart failure?

Answer 21

Hydralazine + Nitroglycerin

Question 22

Other than hypotension, what is a major possible side effect of Hydralazine?

Answer 22

Drug-induced lupus

Question 23

Which nitrate induces both arteriolar and venous dilation?

Answer 23

Nitroprusside

(Note: sodium cyanide-nitroprusside test is used to diagnose cystinuria)

Question 24

What toxicity is associated with Nitroprusside?

Answer 24

Cyanide poisoning

Question 25

MOA: Fenoldopam

Answer 25

D₁ agonist

• (⇒ Coronary vasodilation ⇒ ↑ O2 delivery)*
• (⇒ Renal vasodilation ⇒ Natriuresis)*