anti-hypertensive drugs

Question 1

Name 3 ACE 1 inhibitors

Answer 1

Lisinopril
Captopril
Enalapril

Question 2

ACE 1 inhibitors MOA

Answer 2

1. decrease ang 2 -> dec vasoconstriction and aldersterone
2. prevent bradykinin inactivation

Question 3

ACE 1 inhibitor clinical uses

Answer 3

1. hypertension
2. cardiac failure
3. following myocardial infarction
4. renal insufficiency

Question 4

ACE 1 inhibitor adverse effects

Answer 4

1. severe hypotension
2. acute renal failure
3. hyperkaelemia
4. angioedema and dry cough (induced by bradykinin and substance P inflammatory consequences)
5. contraindicated in pregnant woman

Question 5

Name some Ang II type 1 (AT1) blockers

Answer 5

1. valsartan
2. losartan
3. candesartan

-SARTANS

Question 6

AT1 blockers MOA

Answer 6

AT1 receptor antagonists, prevent Ang II from binding to AT1r

Question 7

AT1 blockers adverse effect

Answer 7

similar to ace1 inhibitors just less dry cough

Question 8

Beta blockers MOA

Answer 8

block B1 receptors
- no adenylyl cyclase to convert ATP into cAMP -> cAMP cannot activate PKA, hence Ca2+ channels
- block calcium induced calcium release (calcium released from sacrolemma induced by calcium entering via channels)
-> decrease contractility

Question 9

Can we give non selective beta blockers to someone with asthma?

Answer 9

NO
drug will block b1 and 2 adrenoreceptors => prevent stimulation of heart but also prevent bronchodilation

Question 10

Name some beta blockers

Answer 10

1. carvediolol (non selecetive)
2. bisoprolol (cardioselective)
3. metoprolol XL (^)
4. Nebivolol (mixed)

ALL APPROVED FOR CARDIAC FAILURE

Question 11

Beta blockers clinical use

Answer 11

1. hypertension
2. cardiac failure
3. following myocardial infarction
4. arrhythmia
5. anxiety disorders

Question 12

Beta blockers adverse effects

Answer 12

1. hypotension
2. bradycardia
3. AV nodal block
4. CNS: depression
5. bronchoconstriction

Question 13

diuretics : thiazides clinical uses

Answer 13

1. hypertension
2. congestive heart failure
3. nephrolithiasis
4. nephrogenic diabetes due to idiopathic hypercalciuria

Question 14

thiazides AE

Answer 14

1. hypokalaemic: metabolic alkalosis (increased K+ and H+ excretion at intercalated cells of CD)
2. hyponatraemia (decreased sodium reabosrption)
3. hyperuricaemia (increased urate reabsorption at PCT) => GOUT
4. hyperglycaemia
5. hyperlipidaemia
6. hypercalcaemia (enhanced reabsorption of ca2+ at PCT)

Question 15

2nd line anti-hypertensives

Answer 15

1. hydralazine (heart failure)
2. mineralcorticoid receptor antagonists (used for heart failure)
3. alpha adrenergic antagonist

Question 16

alpha adrenergic antagonist MOA

Answer 16

prevents alpha 1 vasoconstrction, reduces vessel tone, reduces peripheral vascular resistance, BP dec

Question 17

alpha adrenergic antagonist adverse effect

Answer 17

SAFE for renal impaired
1. reflex tachycardia
2. urinary incontinence

Question 18

Name the classes of first line antihypertensives

Answer 18

1. ACE1 inhibitors
2. AT1 blockers
3. beta blockers
4. calcium channel blockers DHPs
5. diuretics: thiazides

Question 19

Name 2 calcium channel blockers that are DHPs

Answer 19

1. nifedipine
2. amlodipine

Question 20

DHPs MOA for antihypertension

Answer 20

• dec intracellular calcium concetration
• myosin LC relaxes
• decrease vascular smooth muscle tone, dec BP

Question 21

DHPs adverse effect

Answer 21

1. hypotension
2. heart failure
3. myocardial infarction

Question 22

DHPs clinical use

Answer 22

1. HTN
2. stable angina (amlodipine)
3. reduce risk of MI and stroke (amlodipine)

Question 23

thiazide MOA

Answer 23

• location: DCT
• DCT: impermeable to water, permeable to salt

Question 24

Name 2 thiazides

Answer 24

1. hydrochlrothiazide
2. indapamide