Anti-hypertensive drugs

Question 1

Name examples of ACEi. Describe MOA.

Answer 1

RAMIPRIL, LISINOPRIL

Inhibit ACE in lungs, preventing conversion of angiotensin I to angiotensin II. Results in vasodilation, decreased aldosterone production and decreased SNS activation.

Question 2

Suggest ADRs of ACEi.

Answer 2

1. dry cough - increased bradykinin
2. hyperkalaemia
3. angioedema
4. AKI - prevent vasoconstriction of efferent arteriole by AngII (auto-regulatory mechanism to maintain GFR)

Question 3

Name 3 indications for ACEi

Answer 3

1. HTN
2. diabetic nephropathy
3. secondary prevention of IHD

Question 4

Name possible contra-indications for ACEi

Answer 4

1. pregnancy and breast-feeding
2. renal artery stenosis
3. aortic stenosis
4. hereditary angio-oedema
5. hyper-sensitivity

Question 5

what must be monitored when a pt takes ACEi?

Answer 5

UandEs - before initiation and after dose changes

Question 6

Name examples of CCB. What is MOA?

Answer 6

AMLODIPINE, NIFEDIPINE

Inhibit calcium transport across myocardial and vascular smooth muscle cells… vasodilation of peripheral, coronary and pulmonary arteries.

Question 7

Give examples of CCB ADRs.

Answer 7

1. peripheral oedema
2. headaches
3. dizziness
4. flushing
5. tachycardia and palpitations
6. gingival hyperplasia (rare)

Question 8

Name examples of thiazide-like diuretics. What is MOA?

Answer 8

INDAPAMIDE, CHLORTALIDONE

Inhibit Na/Cl symporter in DCT… decreased Na and H2O reabsorption.
At lower doses, vasodilatory effect is prominentl; at higher doses, diuretic effect becomes more apparent.

Question 9

Suggest ADRs for thiazide-like diuretics.

Answer 9

1. postural hypotension
2. hyponatraemia, hypokalaemia and hypercalaemia
3. hyperuricaemia and gout
4. impotence
5. impaired glucose tolerance
6. hypochloraemic alkalosis

Rare

7. pancreatitis
8. photosensitive rash
9. agranulocytosis, aplastic anaemia, leucopenia