antihypertensive agents 2

Question 1

name 5 classes of antihypertensive agents?

Answer 1

• ACE inhibitors and angiotensin receptor blockers
• calcium channel antagonists
• diuretics
• beta blockers
• vasodilators

Question 2

what are the steps of dealing with high blood pressure for people under 55? 4

Answer 2

• ace inhibitor or angiotensin receptor blocker
• step 1 and a calcium Chanel blocker
• step 2 and a thiazide-like diuretic
• resistant hypertension, consider further diuretics or alpha-blocker/beta-blocker

Question 3

what are the steps of dealing with high blood pressure for people over 55 or with a African/ Caribbean origin of any age? 4

Answer 3

• calcium channel blocker
• step 1 and an ace inhibitor or angiotensin receptor blocker
• step 2 and a thiazide-like diuretic
• resistant hypertension, consider further diuretics or alpha-blocker/beta-blocker

Question 4

what are the side effects of ACE inhibitors? 7

Answer 4

• dry cough
• first dose hypotension- given at night
• renal impairment
• contraindicated in bilateral renal artery stenosis
• hyperkalaemia
• no adverse affects on serum glucose or lipids
• anything that ends in ‘pril’

Question 5

what are the side effects of angiotensin receptor antagonists (ARBS)? 3

Answer 5

• block the actions of And II on AT1-R
• end in ‘artan’
• side effects are minimal

Question 6

when are aldosterone antagonists used? 2

Answer 6

• as an add on for resistant hypertension, but frontline for hypertension in patients with primary aldosteronism
• spironolactone

Question 7

what are CA2+ channel antagonists? 3

Answer 7

• main class= dihydropyridines (amlodipine)
• target L-type Ca2+ channels on smooth muscle in arteries
• phenylalkylamines (verapamil) and benzodiazepines (diltiazem) target L-type channels in the heart and decrease the frequency and force of contraction, they are less useful to treat hypertension

Question 8

what are the side effects of a Ca2+ channel antagonist? 4

Answer 8

-peripheral oedema= preferential dilation of pre-capillary arteriole and impairment of the function of the pre-capillary sphincter increases hydrostatic pressure across the capillary and reduces fluid absorption

• flushing and headaches
• combinations of Ca2+ channel agonists are no recommended
• grapefruit juice enhances action

Question 9

what do thiazide and thiazide diuretics do? 2

Answer 9

• some diuretic action but also acts via activation of K(ATP) in smooth muscle of blood vessel to dilate arterioles and decrease blood pressure
• indapamide hyper-polarises smooth muscle cells causing a relaxation/ dilation of the arteriole and a decrease in TPR

Question 10

what are the side effects of thiazide and thiazide- like diuretics? 6

Answer 10

• hypokalaemia
• increase in urate
• increase in glucose
• increase in blood lipids
• newer recommended thiazide-like diuretics include indapamide
• thiazde-like diuretics may be contraindicated in patients with diabetes

Question 11

what are the side effects of beta blockers? 2

Answer 11

• fatigue= vaso/broncho constriction of smooth muscle in the airways or peripheral arterioles perfusing skeletal muscle
• this could cause further bronchoconstriction in asthma patients

Question 12

describe hyperglycaemia? 4

Answer 12

• low blood glucose activates the release of adrenaline, mobilises glucose release from the liver
• this leads to a tremor, palpitations and sweats
• blocked by beta blockers
• combinations of beta blockers and thiazides contraindicated in diabetics

Question 13

name 2 types of beta blocker?

Answer 13

• non selective (beta1 and 2)= propranolol

- selective beta 1 antagonist= bisoprolol

Question 14

describe vasodilators? 3

Answer 14

• alpha 1 antagonist
• used to treat hypertension in patients with benign prostatic hypertrophy (doxazosin)
• some open K+ channels