Anti-Hypertensives

Question 1

1st line drugs

Answer 1

A: ACE inhibitor
B: beta blockers
C: calcium channel blockers
D: diuretics

Question 2

2nd line drugs

Answer 2

Hydralazine
Mineralocorticoid receptor antagonists
Alpha blockers (Prazosin etc)

Question 3

Examples of ACE inhibitors

Answer 3

Captopril
Enalapril
Lisinopril

Question 4

ACE inhibitors ADR

Answer 4

Severe hypotension
Acute renal failure
Hyperkalemia
Angioedema
Dry cough (bradykinin, substance P)
Contraindicated in pregnancy

Question 5

ACE Inhibitors Uses

Answer 5

Hypertension
Cardiac failure
After MI

Question 6

What does Ag II Type 1 (AT1) blockers block

Answer 6

Block interaction between Ag II & its receptor (AT1)

Question 7

Ang II Type 1 blockers ADR

Answer 7

Dry cough
Contraindicated in pregnancy

Question 8

Which 2 drugs should not be used together

Answer 8

ACE inhibitors & AT1 blockers
Can worsen side effects & lower efficacy

Question 9

Examples of AT1 receptor blocker

Answer 9

Losartan
Valsartan

Question 10

Examples of beta blockers

Answer 10

Non-selective: Carvedilol, Propranolol
Cardioselective: Bisoprolol, Metoprolol XL, Atenolol
Mixed (3rd gen): Nebivolol

Question 11

Beta blockers ADR

Answer 11

Bradycardia
Clinical depression
Hypotension
Asthma
Bronchoconstriction
AV nodal block

Question 12

Beta blockers uses

Answer 12

Hypertension
Cardiac Failure
Following MI
Abnormal heart rhythm
Anxiety disorders

Question 13

Which diuretics to use to lower BP

Answer 13

Thiazides

Question 14

Calcium channel blockers names

Answer 14

Non-DHP: Verapamil, Diltiazem
DHP: Nifedipine

Question 15

Difference between DHP vs Non-DHP CCB

Answer 15

DHP - greater effect on cardiac depression
Non-DHP - greater effect on vasodilation

Both equally as effective at reducing cardiac contractility

Question 16

Non-DHP calcium channel blocker MOA (Verapamil, Diltiazem)

Answer 16

Decrease SA/AV conduction, decrease supraventricular & re-entry tachycardia

Question 17

Uses of non-DHP calcium channel blocker (Verapamil, Diltiazem)

Answer 17

Anti-arrhythmia

Question 18

DHP calcium channel blocker MOA (Nifedipine, Amlodipine)

Answer 18

Decrease myocardial contractility: decrease oxygen requirement, decrease CO –> decrease BP

Decrease vascular smooth muscle tone –> decrease BP

Question 19

DHP calcium channel blocker (Nifedipine, Amlodipine) ADR

Answer 19

Cardiac depression: bradycardia, AV block, heart failure

Question 20

DHP calcium channel blocker (Nifedipine, Amlodipine) Uses

Answer 20

Anti-angina
Anti-hypertension

Question 21

Prazosin MOA

Answer 21

Lower vessel tone (dilation), lower peripheral resistance, lower BP

Question 22

Prazosin PK

Answer 22

Reach peak concentration in 2.5h
t/12: 7h
Extensively bound to plasma protein
M in liver
E in feces & bile

Question 23

Prazosin ADR

Answer 23

(can use in patients with renal impairment)
Reflex tachycardia/palpitations, orthostatic hypotension
Depression, urinary frequency, flushing

Question 24

Hydralazine MOA

Answer 24

Direct arteriole vasodilator
Inhibit IP3-induced calcium release from smooth muscle cells sarcoplasmic reticulum
Lower peripheral resistance, compensatory relase of NE/E, increase venous return & CO

Question 25

Hydralazine PK

Answer 25

IV: onset 5-30min, duration 2-6h
Oral: onset 20-30min, duration 2-4h
Reach peak plasma concentration in 2.5h
t1/2: 7h

Question 26

Hydralazine Uses

Answer 26

Oral: HFrEF
Essential hypertension (when 1st line medications unsuitable/inadequate)

IV: Acute onset, severe peripartum/post partum hypertension (>15min)

Question 27

Hydralazine ADR

Answer 27

Baroreflex associated sympathetic activation: flushing, hypotension, tachycardia
Hydralazine-induced lupus syndrome (HILS): arthralgia, myalgia, serositis, fever
Contraindicated: coronary artery disease (stimulates sympathetic nervous system, increase CO & O2 demand, myocardial ischaemia)