4.3 - Antihypertensive Drugs

Question 1

What are the anti-hypertensive drugs?

Answer 1

A: Angiotensin Converting Enzyme (ACE) Inhibitors + AngII Receptor blockers
B: B blockers
C: Calcium channel blockers
D: Diuretics
E: Etcetera (vasodilators)

Question 2

What are ACE inhibitors used to treat?

Answer 2

HTN + Chronic HF
–> reduce activity of RAS system by inhibiting the formation of AngII

Question 3

What are the effects of decreased AngII?

Answer 3

Less vasoconstriction

Less aldosterone
–> Less K+ secretion
–> Less Na+ and water retention

Question 4

ACE is necessary for metabolizing bradykinin, what does this mean for some patients?

Answer 4

Bradykinin builds up in blood
–> some patients get a dry cough and must stop taking medication

Question 5

What are the physiological effects of ACE inhibitors?

Answer 5

Decreased AngII
–> Decreased Na+ / water retention
–> Decreased secretion of K+
–> Vasodilation
^ Decreased blood pressure (afterload)

–> Reduced vascular and cardiac remodeling

Question 6

What are the Angiotensin converting enzyme inhibitors?

Answer 6

Ramipril, perindopril, enalapril, captopril

Question 7

What are the adverse effects of ACE inhibitors

Answer 7

–> Hypotension
–> Dry cough, especially with captopril
–> Angioedema
–> Risk of hyperkalemia

Question 8

What is angioedema?

Answer 8

Swelling of the face associated with use of ACE inhibitors

Question 9

What are the AngII receptors blockers?

Answer 9

Losartan, irbesartan, valsartan

Question 10

What are the osmotic diuretics?

Answer 10

Mannitol

Question 11

What are the classes of natriuretics?

Answer 11

Carbonic Anhydrase inhibitors
–> acetazolamide

Loop Diuretics
Thiazides
K sparing

Question 12

What transporter does a loop diuretic act on? Name a loop diuretic.

Answer 12

Furosemide
–> blocks Na/K/Cl transporter in ascending limb of loop of the nephron

Question 13

What are the adverse effects of loop diuretics like furosemide?

Answer 13

–> Volume depletion
–> Hypotension
–> Hypo K, Mg, and Ca
–> Increase in uric acid and plasma lipids
–> Ototoxicity (esp when used in combination w aminoglycosides)

Question 14

Which diuretic would you not prescribe to someone with gout?

Answer 14

Loop diuretic + thiazides
–> Adverse effects include increase in uric acid

Question 15

Which diuretics would you not prescribe to someone with kidney stones?

Answer 15

Loop diuretics
–> Adverse effects include calcium secretion (so more will be passing through the kidneys, and might combine with oxalate to crystalize)

A better option would be a thiazide or thiazide-like.

Question 16

Which cotransporter do thiazide and thiazide like drugs act on?

Answer 16

A Na/Cl cotransporter in the distal convoluted tubule

Question 17

Name a thiazide drug

Answer 17

Hydrochlorothiazide

Question 18

Name the thiazide like drugs

Answer 18

Indapamide, chlorthalidone

Question 19

What are the adverse effects of thiazides/thiazide-like drugs?

Answer 19

–> Hypo Na, K
–> Hypotension
—> Increase in uric acid, glucose, and lipids

Question 20

Which diuretics would you not prescribe to someone with dyslipidemia?

Answer 20

Loop diuretics + thiazides
–> adverse effects include increase in plasma lipids

Question 21

What kind of diuretic would you not prescribe to someone with diabetes or who is prediabetic?

Answer 21

Thiazide
–> Adverse effects include increase in BGL

Question 22

What are the potassium-sparing diuretics?

Answer 22

Spironolactone and eplerenone

Question 23

What is another name for potassium-sparing drugs? Why?

Answer 23

Mineralocorticoid receptor antagonists
–> aldosterone receptor antagonists (inhibits NaCl secretion in distal convoluted tubule)

Question 24

What are the adverse effects of eplerenone?

Answer 24

hyperkalemia

Question 25

What are the adverse effects of spironolactone, in addition to hyperkalemia?

Answer 25

Has anti-androgen effect
–> Gynecomastia, menstrual irregularities, decreased libido

Question 26

What are the arterial vasodilators? What are they used for? What are some precautions to using them?

Answer 26

Hydralazine, minoxidil
–> Used to treat hypertensive emrgencies / refractory
–> tend to increase heart rate and retention of Na and water, so used in combo with B-blockers and diuretics

Question 27

What are the mixed (venous and arterial) vasodilators? What are they used for? What is a precaution with using them?

Answer 27

Sodium Nitroprusside
–> Used in hypertensive emergencies; rapid onset
–> Beware of cyanide poisoning

Question 28

What are the a1 antagonists? What are they used for? What are their adverse effects?

Answer 28

Prazosin, terazosin, doxazosin
–> Reduce peripheral vasoconstriction

Used to treat HTN and BPH

Adverse effects
–> Orthostatic hypotension w reflex tachycardia
–> Na + water retentions
–> Fatigue

Question 29

What adrenergic antagonist is used to treat hypertension is pregnant individuals? What is its mechanisms of action?

Answer 29

Labetalol
–> Inhibits alpha 1, beta 1, and beta 2 adrenergic receptors

Question 30

What are some issues associated adherence strategies regarding antihypertensives?

Answer 30

–> There are no initial symptoms of the diease, but there are adverse effects of the medication
–> Long term treatment, longer dosing intervals helps with adherence
–> Often involves many drugs

Question 31

What is the first line treatment for HTN?

Answer 31

Thiazides, ACEIs, ARBs, CCBs, B-blockers.

Question 32

What adrenergic drug stimulates negative feedback on NA release, resulting in vasodilation? What is it used to treat? What are its adverse effects?

Answer 32

Clonidine
–> A2 agonist

Used to treat RfHTN

Adverse effects: sedation, dry mouth, depression

Question 33

What noradrenaline synthesis inhibitor is used to treat HTN in pregnant women?

Answer 33

a-methyldopa, which is transformed into a-methyl-NA and stimulates a2 receptors.