Anti-hypertensive Drugs

Question 1

What are the 4 causes of secondary hypertension?

Answer 1

Pheochromocytoma, hyperaldosteronism, preeclampsia, renal stenosis.

Question 2

What are the 4 classes of drugs commonly used to treat hypertension?

Answer 2

Diuretics, Beta blockers, Angiotensin Converting Enzyme Inhibitors, Angiotensin receptor blockers.

Question 3

How do Thiazide diuretics reduce hypertension?

Answer 3

They increase the excretion of Na and H2O in the DCT.

Question 4

True or false: Thiazide diuretics are the first line therapy for hypertension.

Answer 4

True. They are effective, safe, and cost effective.

Question 5

What are the common adverse effects of Thiazide diuretics?

Answer 5

Muscle weakness/fatigue, K loss, Hyperglycemia, Hyperlipidemia.

Question 6

What is the normal K level?

Answer 6

4 mEq/L

Question 7

True or false: Loop diuretics re more effect for curing serious fluid retention rather than BP.

Answer 7

True. Loop diuretics are used in fluid overload states, such as congestive failure.

Question 8

What are the three angiotensin converting enzyme inhibitors?

Answer 8

Captopril, Enalapril, Lisinopril.

Question 9

True or false: Captopril, Enalapril, and Lisinopril are used as a mono therapy for stage 1,2, and 3 hypertension.

Answer 9

True.

Question 10

True or false. ACEI’s are used in combination with a thiazide diuretic, Ca channel blocker, or Beta blocker for stage 4 hypertension.

Answer 10

True.

Question 11

What do ACEI’s prevent?

Answer 11

The conversion of angiotensin 1 to angiotensin 2.

Question 12

True or false: Renin-angiotensin system inhibitors may cause renal damage in the fetus.

Answer 12

True. Contraindicated use with pregnancy.

Question 13

What are the common side effects of ACEI’s?

Answer 13

Dry cough, hyperkalemia, first dose effect, loss of taste.

Question 14

True or false: ACEI’s may increase fetal mortality during the third trimester of pregnancy.

Answer 14

True.

Question 15

What are the angiotensin II receptor blockers?

Answer 15

Losartan, Valsartan, Telmisartan, Irbesartan. Eprosartan mesylate, Candesartan cilexitil, Olmesartan medoxomil.

Question 16

There are two types of angiotensin II receptors. Which one mediates most of the effects of angiotensin II?

Answer 16

AT1.

Question 17

True or false: AT2 is highly expressed in fetal and diseased tissues, but is silent in adult tissues.

Answer 17

True.

Question 18

What are the major adverse effects of angiotensin II receptor blockers?

Answer 18

Dizziness.

Question 19

What are the Beta adrenergic blockers?

Answer 19

Propanolol, Atenolol, Labetalol, Metoprolol, Nadolol, Timolol.

Question 20

What is the action of beta blockers?

Answer 20

They compete for binding site of norepineprhine and epinephrine.

Question 21

What do Prazosin and Terazosin block?

Answer 21

Alpha 1 adrenergic receptors.

Question 22

Beta blockers are the only drugs that act by decreasing cardiac output.

Answer 22

True.

Question 23

Which receptor do Beta blockers act on in the heart?

Answer 23

B1 receptor.

Question 24

Which receptor do beta blockers act on in the peripheral circulation and bronchi?

Answer 24

B2 receptor.

Question 25

True or false, Beta blockers are used as a mono therapy for stage 1 and 2 hypertension.

Answer 25

True.

Question 26

What are the common problems associated with beta blockers?

Answer 26

Fatigue, bradycardia, myocardial depression, asthma, increase in plasma cholesterol, diabetics, impotence.

Question 27

What are the 2 alpha adrenergic blockers?

Answer 27

Prazosin, Terazosin

Question 28

True or false: Alpha adrenergic blockers are used as a mono therapy for stage 1 hypertension.

Answer 28

True.

Question 29

True or false: Alpha adrenergic blockers are combined with diuretics to treat stage 2 hypertension.

Answer 29

True.

Question 30

True or false: Alpha adrenergic blockers are used for malignant prostatic hypertrophy.

Answer 30

False. Used for BENIGN prostatic hypertrophy.

Question 31

What are the adverse effects of alpha blockers?

Answer 31

First dose effect, edema, orthostatic hypotension, nasal stuffiness, delayed ejaculation, tachycardia, dizziness, headache, incontinence.

Question 32

What are the two classes of Ca channel blockers?

Answer 32

Dihydropyridines and non-dihydropyridines.

Question 33

What is Nifedipine?

Answer 33

A dihydropyridine Ca channel blocker.

Question 34

What are Verapamil and Diltiazem?

Answer 34

Non-dihydropyridine Ca channel blockers.

Question 35

True or false: Ca channel blockers are used as mono therapy for stage 1 hypertension only.

Answer 35

False. Used as mono therapy for stage 1,2 and 3 hypertension.

Question 36

True or false: Dihydropyridines have a greater effect on vascular smooth muscle.

Answer 36

True.

Question 37

True or false: Non-dihyropyridines have a greater effect on the heart.

Answer 37

True.

Question 38

What are the effects of dihydropyridines on BP and HR?

Answer 38

Decrease BP, Increase HR.

Question 39

What are the effects of non-dihydropyridines on BP and HR?

Answer 39

Decrease BP, Decrease HR, and Decrease contractility.

Question 40

What are the adverse effects of dihydropyridines?

Answer 40

Headache, digital dysethesia, tachycardia, ankle edema.

Question 41

What are the adverse effects of non-dihydropyridines?

Answer 41

Bradycardia, myocardial depression, constipation.

Question 42

True or false: Short duration nifedipine may aggravate myocardial ischemia.

Answer 42

True.

Question 43

What is Aliskiren?

Answer 43

A renin inhibitor.

Question 44

What is the action of Aliskiren?

Answer 44

Binds to renin and prevents angiotensinogen conversion to angiotensin 1.

Question 45

What are the two centrally acting anti-hypertensive agents?

Answer 45

Clonidine and Methyldopa.

Question 46

What place in therapy do centrally acting anti-hypertensive drugs have?

Answer 46

They are used in combination with diuretics to treat ALL stages of hypertension.

Question 47

What are the adverse effects of Methyldopa?

Answer 47

Decreased liver function, mental lassitude, impaired concentration.

Question 48

What are the adverse effects of Clonidine and Methlydopa?

Answer 48

Sedation, dry mouth, bradycardia, constipation, sexual disfunction, fluid retention, postural hypotension, mental depression.

Question 49

How long does it take for the full therapeutic effects of Reserpine to develop?

Answer 49

2-3 weeks.

Question 50

True or false: Reserpine can cause psychic depression.

Answer 50

True.

Question 51

What is Guanethidine?

Answer 51

A rarely used agent to treat severe hypertension.

Question 52

True or false: The therapeutic effectiveness of Guanethidine is preceded by a brief period of hypertension.

Answer 52

True.

Question 53

What are hydralazine and minoxidil?

Answer 53

Vasodilators.

Question 54

True or false: Minoxidil is used to grow hair.

Answer 54

True.

Question 55

What is the use for vasodilators?

Answer 55

They are used with diuretics and Beta blockers for treating hypertension no controlled with other drugs.

Question 56

What is the action of hydralazine?

Answer 56

It interferes with the availability of calcium.

Question 57

What is the action of minoxidil?

Answer 57

It opens K channels.

Question 58

What are the common side effects of vasodilators?

Answer 58

Na and water retention, Tachycardia, Increased myocardial work.

Question 59

What are side effects specific to minoxidil?

Answer 59

Hypertricosis and hair growth.

Question 60

What are side effects specific to hydralazine?

Answer 60

Rheumatoid state that may process to SLE.

Question 61

What are the 2 drugs used in hypertensive emergencies?

Answer 61

Diazoxide and Trimethaphan.

Question 62

What are the actions of diazoxide?

Answer 62

Arterial vasodilator; Opens K channels.

Question 63

How is diazoxide administered?

Answer 63

IV

Question 64

What are the contraindications of diazoxide?

Answer 64

Angina pectoris, myocardial infarction, dissecting aneurism, pulmonary edema, and diabetes.

Question 65

What is the action of Trimethaphan?

Answer 65

Ganglion blocking agent; Arterial and venous vasodilator

Question 66

How is Trimethaphan administered?

Answer 66

IV

Question 67