Antihypertension

Question 1

Complementary actions, lower dose, reduced side effects and Improved compliance are all advantages of _ regarding hypertension treatment

Answer 1

Combined therapy

Question 2

What is the short range effect of diuretic therapy? What is the long range effect?

Answer 2

Short - reduce extracell. fluid volume and cardiac output

Long - Decrease vascular resistance

Question 3

What is the major condition where diuretics are used? What is the major adverse effect associated with the use of most diuretics? What are the exceptions to this adverse effect?

Answer 3

Congestive heart failure
Potassium depletion
Potassium sparing agents

Question 4

What are the 3 examples of thiazide diuretics provided? What is their mechanism of action? What class of drug reduces their activitiy?

Answer 4

Chlorothiazide, chlorthalidone, hydrochlorothiazide
Block Na/Cl symporter in distal convoluted tubule
NSAIDs

Question 5

What are 3 adverse effects associated with the use of thiazide diuretics?

Answer 5

Hypokalemia
Decreased uric acid secretion
Thiazide and sulfonamide cross reactivity

Question 6

What is an advantage of using thiazide diuretics in post menopausal women?

Answer 6

Reduce calcium excretion good for osteoporosis

Question 7

What are the 4 examples of loop diuretics provided?

Answer 7

Furosemide, ethacrynic acid, bumetanide and torsemide

Question 8

What is the mechanism of action of loop diuretics?

Answer 8

Blocks the Na/2Cl/K cotransporter in the ascending loop

Question 9

What are 2 major adverse effects associated with the use of loop diurectics?

Answer 9

Hypokalemia

Decreased uric acid secretion

Question 10

What is a major adverse effect associated with the use of ethacrynic acid?

Answer 10

Deafness

Question 11

Regarding K+ sparing diuretics, what are 2 mineralocorticoid receptor antagonists? What are 2 sodium channel blockers?

Answer 11

Mineralocort - Spironolactone and eplerenone

Na blocker - triamterene and amiloride

Question 12

What is the major side effect associated with the use of potassium sparing diuretics?

Answer 12

Hyperkalemia

Question 13

Beyond the kidney, what are 2 additional sources of renin / RAS?

Answer 13

Vasculature

Brain

Question 14

Vasoconstriction of peipheral microvessels, increased thirst, increase sympathetic activation, increased cardiac and vacular remodeling. These are all events mediated by _

Answer 14

Angiotensin II actions

Question 15

What are the 2 hormones by which angiotensin 2 stimulates thirst?

Answer 15

Aldosterone and vasopressin (ADH)

Question 16

What are 5 examples of ACE inhibitors provided?

Answer 16

Captopril, enalapril, lisinopril, ramipril and fosinopril

Question 17

What are the 2 conditions for which ACE inhibitors are used?

Answer 17

Mild/moderate hypertension

Heart failure

Question 18

What are 4 major side effects associated with ACE inhibitors? What is an “annoyance” associated with ACE inhibitors?

Answer 18

Hyperkalemia, angioedema, hypotension, rash

Dry cough

Question 19

What are the 5 examples of angiotensin receptor antagonists provided? What is their receptor target?

Answer 19

Losartan, valsartan, candesartan, eposartan, irbesartan

AT1 receptor

Question 20

What are the 2 major conditions for which angiotensin receptor antagonists are used?

Answer 20

Hypertension and Heart failure

Question 21

What are 2 major side effects associated with angiotensin receptor antagonists? What population, similar to ACE inhibitors, should not use this class of drug? Why?

Answer 21

Hypotension, hyperkalemia
Pregnant women
Fetal renal damage

Question 22

What are 2 distinguishing side effects when comparing ACE inhibitors to AT1R blockers?

Answer 22

ACE inhibitors give cough and angioedema, ATIR blockers don’t

Question 23

What is the example of the renin inhibitor provided? What is its mechanism? What is its effect on plasma renin levels?

Answer 23

Aliskiren
Blocks the plasma renin receptor
Increases plasma renin

Question 24

What medical condition are renin inhibitors used for?

Answer 24

Hypertension

Question 25

What are 4 major side effects associated with renin inhibitors?

Answer 25

Diabetic / renal impairment Hypotension Dry cough Hyperkalemia

Question 26

What are the 2 examples of cardioselective calcium channel blockers? What are the 4 examples of vascular smooth muscle selective calcium channel blockers? What calcium channel subtypes are targeted?

Answer 26

- Verapamil, diltiazem - Nifedipine, nimodipine, nicardipine, amlodipine - L-type voltage sensitive channels

Question 27

What are 2 negative chronotropic calcium channel blockers?

Answer 27

Verapamil and Diltiazem

Question 28

What calcium channel blocker is used specifically for cerebral hemorrhage and vasospasm? What medical condition is use of calcium channel blockers contraindicated?

Answer 28

Nimodipine | Heart failure

Question 29

What is the example of a beta 1 and 2 combined antagonist provided? What are the 2 beta 1 selective antagonists provided?

Answer 29

- combined: propranolol | - 1 selective: metoprolol and atenolol

Question 30

What 3 populations should avoid the use of beta blockers?

Answer 30

Asthmatics Peripheral vascular disease Diabetics

Question 31

What are the 3 alpha 1 adrenergic receptor antagonists provided as examples?

Answer 31

Prazosin, terazosin and doxazosin

Question 32

By blocking alpha1 receptors on vascular smooth muscles, what is the corresponding effect?

Answer 32

Dilation of arterioles and capacitance veins

Question 33

How can water retention be avoid when using alpha1 antagonists?

Answer 33

Use with diuretic or beta-antagonist

Question 34

What are the 2 examples of beta and alpha 1 receptor antagonists provided? What 2 conditions are they used for?

Answer 34

Labetalol and carvedilol | Hypertension and heartfailure

Question 35

What is the adrenergic tranmssion blocker ised in the treatment of hypertension? What is its mechanism? (2)

Answer 35

Reserpine - blocks NE reuptake - Depletes NE from nerve endings

Question 36

Postural hypotension, sedation, dry mouth, nightmare and mental depression are all side effects associated with _

Answer 36

Reserpine

Question 37

What are 3 central mediated anti-hypertensives (i.e. affect brainstem alpha 2 receptors)? What is their effect on these receptors? How do they affect cardiac function?

Answer 37

- Clonidine, alpha-methyldopa and guanabenz - Stimulate these receptors - Increased vagal activity to heart, decrease vascular resistance

Question 38

Sedation, nightmares, depression, drowsiness, dry mouth nasal stuffiness and postural hypotension. These are all side effects associated with _

Answer 38

Centrally acting antihypertensives

Question 39

Hydralazine, minoxidil and diazoxide. These 3 drugs are used as _

Answer 39

Vasodialators

Question 40

Nitroprusside, nitroglycerine, epoprostenol and bosentan. These 4 drugs are used as _

Answer 40

Vasodialators

Question 41

Among the vasodilators, which 2 are used for hypertension?

Answer 41

-hydralazine and minoxidil

Question 42

Among the vasodilators, which 2 are used for hypertensive crisis?

Answer 42

- nitroprusside and diazoxide

Question 43

Among the vasodilators, which 2 are used for pulmonary hypertension?

Answer 43

- Epoprostenol and bosentan

Question 44

Among the vasodilators, which is associated in reflex increase in HR, contractility and cardiac output as well as Lupus?

Answer 44

Hydralazine

Question 45

Among the vasodilators, which has preferential effects on arteries?

Answer 45

Hydralazine

Question 46

Among the vasodilators, which 2 have preferential effects on arterioles?

Answer 46

Minoxidil and diazoxide

Question 47

Among the vasodilators, which has the adverse effects of pericardial effusion, cardiac tamponade, reflex tachycardia and abnormal hair growth?

Answer 47

Minoxidil

Question 48

Among the vasodilators, which 2 directly affect potassium channels?

Answer 48

Minoxidil and diazoxide

Question 49

What vasodialator has the side effect of fluid retention, hyperglycemia and hyperuricemia?

Answer 49

Diazoxide

Question 50

What 2 vasodilators produce nitric oxide and are used for hypertensive emergencies?

Answer 50

Nitroprusside and nitroglycerine

Question 51

Which vasodialator reduces preload and afterload and is associated with cyanide accumulation?

Answer 51

Nitroprusside

Question 52

What vasodilator is a prostacyclin (PGI2) analogue, mediates vasodilation via cAMP and directly conteracts thromboxane? How must it be administered? What is it used for?

Answer 52

Epoprostenol Continuous infusion Primary pulmonary hypertension

Question 53

Among the endothelin receptor blockers, which is the non selectove blocker? Which is the ETa specific blocker? What are they primarily used to treat?

Answer 53

Bosentan Ambrisentan Primary pulmonary hypertension

Question 54

Decreased hematocrit, inhibition of spermatogenesis, hepatic effects are all associated with the use of _

Answer 54

endothelin receptor blockers (Bosentan, Ambrisentan)