Anti- hypertensives and heart failure drugs

Question 1

Name 2 ACE inhibitors

Answer 1

Ramipril and Lisinopril

Question 2

What is the mode of action for losartan and candesartan?

Answer 2

Angiotensin receptor blockers

Question 3

What are the 3 classifications of calcium channel blockers?

Answer 3

Dihydropryidines, phenylalkamines, benzothiazepines

Question 4

Name one dihydropyridine calcium channel blocker

Answer 4

Amlodipine, nifedipine

Question 5

Name one phenylalkamine calcium channel blocker?

Answer 5

Verapamil

Question 6

Name one benzothiazepine calcium channel blocker

Answer 6

dilitazem

Question 7

What type of diuretic is most commonly used in hypertension? name one example of one

Answer 7

Thiazides- eg bendroflumethiazide, indapamide

Question 8

How does doxazosin work to reduce BP?

Answer 8

Theyre alpha adrenoreceptor blockers

Question 9

How does aliskiren work to reduce BP?

Answer 9

Renin inhibitor

Question 10

How does hydralazine work to reduce BP?

Answer 10

Stimulates NO release and Inhibits ca2+ release from SER so vasodilates

Question 11

Which diuretics are commonly combined to reduce BP but keep glucose and K+ stable?

Answer 11

A thiazide diuretic and amiloride (K+ sparing diuretic)

Question 12

What drugs are used to treat phaeochromocytoma?

Answer 12

phenoxybenzamine (non competative alpha blocker) and phentolamine (competative alpha blocker)

Question 13

What drugs are used to treat hypertensive emergencies?

Answer 13

Sodium Nitroprusside- mimic NO to cause vasodilation

Question 14

Above what BP is classed as mild, moderate and severe hypertension?

Answer 14

Grade 1 (mild) = >140/90
Grade 2 (moderate)= >160/100
grade 3 (severe)= > 180/110

Question 15

What 4 lifestyle interventions can help reduce BP?

Answer 15

• Normal BMI
• Reduce salt intake to <6g/ pday
• limit alcohol consumption
• aeorbic exersize for >30 mins per day
• > 5 portions fruit and veg
• reduce fat intake

Question 16

List 3 side effects of ACEi like lisinopril and ramipril? (think about effect on kidneys)

Answer 16

• dry cough, N+V, dizziness
• Angio- odema (puffy face)
• renal failure (as inhibits efferent arteriole constriction)
• Hyperkalaemia (inhibits aldosterone, less K+ secretion at collecting ducts

Question 17

List 3 side effects of losartan/ candesartan (angiotensin receptor blockers)

Answer 17

• No cough
• GI upset, dizziness, muscle cramps
• Still renal failure + hyperkalamia

Question 18

Describe side effects of calcium channel blockers

Answer 18

• bradycardia (tachycardia w/ amlodipine)
• constipation (particularly verapamil)
• headache
• palpitations
• flushings
• sweating
• odema

Question 19

List 3 side effects of thiazides

Answer 19

• hypokalaemia
• Gout
• hyperglycaemia (impaired glucose tolerance)
• increased TAG and LDLs
• activates RAAS, so usually given with ACEi

Question 20

list 3 side effects of doxazosin (alpha receptor blocker)

Answer 20

• postural hypotension (have more effect when standing upright)
• headaches, fatigue, odema
• safer in renal disease

Question 21

Describe the NICE guidlines on deciding on drug treatment

Answer 21

<55 1st line= ACE i or ARB
>55 or black 1st line= Calcium channel blocker
2nd line for both= add ACEi/ARB + CCB together
3rd line= add thiazide diuretic as well as ACEi & CCB
4th line= add further diuretic or alpha or beta blocker

Question 22

List 3 endocrine causes of secondary hypertension

Answer 22

Conns syndrome (hyperaldosteronism)
Adrenal hyperplasia
Cushings syndrome
Phaechromocytoma
Acromegaly 
Thyroid disease

Question 23

List 1 renal causes of secondary hypertension

Answer 23

Renovascular hypertension
Diabetic renal disease
Renal artery stenosis

Question 24

List the 4 principles of treating heart failure

Answer 24

• correct cause
• non pharmacological
• pharmacological
• manage complications/ co morbidities/ risk factors

Question 25

What benefit do diuretics have in heart failure?

Answer 25

reduce odema

Question 26

What benefit do B blockers, ACEi and ARB have in heart failure?

Answer 26

ACEi and ARB reduce preload, and so workload of heart. B blockers reduce HR, so workload- need to be careful that BP doesnt drop too low.

Question 27

What benefit does spironolactone have in heart failure?

Answer 27

Reduces odema, reduced pre and afterload, and reduces aldosterone. Aldosterone is high with ACEi, ARB, diuretics etc and increases myocardial fibrosis, hypertrophy, endothelial dysfunction, and so spironolactone actually helps slow course of heart failure as well as reduce risk of arrhythmias and acute coronary events.

Question 28

What does sacubitril and why is it good for heartfailure?

Answer 28

it inhibits breakdown of ANP and BNP, which help reduce BP

Question 29

Why are lots of people with heart failure on the cardiac glycoside digoxin?

Answer 29

Because it enhances vagal activity, leading to a slower heart rate. It also inhibits Na/K/ATPase leading to increased contractility. This means it can be used in those at risk of hypotension

Question 30

In what population is hydralazine and nitrate most effective at reducing blood volume, and so preload?

Answer 30

Ppl of african descent

Question 31

How does GTN spray work to reduce angina

Answer 31

Venous vasodilation–> lowers preload–> lowers workload of heart–> lowers metabolic demand.
Also vasodilation of collateral blood flow of coronary arteries

Question 32

What drug, other than GTN spray, can be used to treat angina?

Answer 32

Isosorbide mononitrate