39 Antihypertensive

Question 1

Is mono therapy or combination therapy used more for hypertension?

Answer 1

Combination therapy–2/3

Question 2

What are the 4 advantages of combined therapy?

Answer 2

1. Different classes with complementary actions.
2. Lower dose
3. Fewer side effects
4. Improved compliance

Question 3

What are the 5 classes of antihypertensive drugs?

Answer 3

1. Diuretics
2. RAS Blockers
3. Ca Channel blockers
   Sympatholytics
   4 Vasodilators

Question 4

What are the targets of antihypersensitivity therapy?

Answer 4

Fluid balance
RAS
central and peripheral SNA
tone of vascular smooth muscle

Question 5

What are three ways the long term use of decreasing vascular resistance is brought about by diuretics?

Answer 5

1. decreased response of VSM to vasoconstrictors
2. Impaired release of NE and Epi
3. Cellular mechanism- decrease in VSM Na and then decrease in Ca

Question 6

Is the diuretic effect reduced by NSAIDS in thiazides?

Answer 6

yes

Question 7

Do thiazides decrease calcium excretion?

Answer 7

Yes…major difference from Loop besides ability to secrete Na

Question 8

What loop agent is not a sulfonamide?

Answer 8

ethacrynic acid

Question 9

Do blood levels of RAS inhibitors correlate with effects? wHy?

Answer 9

1. No
2. • Non Renal RAS
     - ACE/Aldosterone escape

Question 10

What are the angiotensin II actions?

Answer 10

1. Vasoconstriction of peripheral micro vessels
2. Stim thirst and secretion of aldosterone and ADH.
3. Increased SNA activation
4. Cardiac and vascular remodeling
5. Feedback inhibition of renin release

Question 11

Do ACE inhibitors decrease aldosterone?

Answer 11

Yes and increase Na and H2O excretion

Question 12

What do ARBs increase in regards to fluid homeostasis?

Answer 12

Increase Na and H2O

Increase plasma renin and renin activity

Question 13

What type of drug increases plasma renin but not plasma activity?

Answer 13

Renin inhibitors (aliskiren)

Question 14

What are the 2 cardioselective calcium channel blockers?

Answer 14

verapamil and ditiazem

Question 15

What are the 3 VSM selective Ca channel blockers?

Answer 15

nifedipine, nicardipine, amlodipine

Question 16

What 4 sites of actions are there for antihypertensives that act on the SNA?

Answer 16

1. beta adrenergic antagonists
2. alpha adrenergic antagonists
3. inhibitors of peripheral adrenergic transmission
4. central mediated

Question 17

What are beta blockers effects on renin?

Answer 17

decreases secretion

[also decreases central sympathetic outflow, and resets baroreceptors]

Question 18

Why is it good to use a beta blocker or diuretic with alpha 1 blockers?

Answer 18

Because alpha 1 blockers cause fluid retention

Question 19

Does reserpine cause sodium and water retention?

Answer 19

Yes

Question 20

Vasodilators are usually used in combination with what?

Answer 20

diuretics and beta-antagonists

Question 21

What types of vessels are preferred with hydralizine? minoxidil? Nitroprusside? Nitroglycerine?

Answer 21

1. arterioles vs. arteries and veins
2. arterioles vs. veins
3. arteries and veins
4. veins

Question 22

How must epoprostenol be administered?

Answer 22

acute, continuous IV

Question 23

What do we usually combine riociguat with?

Answer 23

ET receptor blockers