Antihypertensive Agents

Question 1

What is responsible for rapid, moment-to-moment adjustments in blood pressure? (Transition from reclining to upright position.

This is stimulated by stretch of the vessel walls brought about by internal pressure.

Answer 1

Baroreflexes

Carotid Baroreceptors

Question 2

Primary responsible for long-term blood pressure control?

Answer 2

Kidney

Question 3

During decrease pressure in renal arterioles as well as sympathetic neural activity will stimulate production of?

Which will subsequently increase production of what?

Answer 3

Renin

Angiotensin II

Question 4

Angiotensin II causes what?

Answer 4

1. Direct constriction of resistant vessels
2. Stimulation of aldosterone synthesis in the adrenal cortex which increase renal sodium absorption and intravascular blood volume.

Question 5

Vasopressin is released from?

Which play a role in?

Answer 5

Posterior Pituitary Gland

Maintaining blood pressure through its ability to regulate water reabsorption by the kidney.

Question 6

What are the mode of action of the following anti hypertensive drugs:

DIURETICS

Answer 6

Lowers blood pressure by depleting the body of sodium and reducing blood volume and perhaps by other mechanisms.

**effective in lowering BP by 10-15mmHg

Question 7

DIRECT VASODILATORS

Answer 7

Reduce pressure by relaxing vascular smooth muscle, thus dilating resistance vessels.

Question 8

ACEi

Answer 8

Reduce peripheral vascular resistance and blood volume.

Question 9

Most common adverse effect of diuretics?

Other side effects?

Answer 9

Potassium Depletion

-Increase uric acid concentrations,
Magnesium depletion,
Impair glucose tolerance,
Increase serum lipid concentration

Question 10

CENTRALLY ACTING SYMPATHOPLEGIC DRUGS

Examples of this type of antihypertensive drug

Answer 10

METHYLDOPA

CLONIDINE

Question 11

Methyldopa Use:

Aside from lowering blood pressure what else are the action of this drug?

Answer 11

• REDUCING PERIPHERAL VASCULAR RESISTANCE
• VARIABLE REDUCTION IN HEART RATE AND CARDIAC OUTPUT

**potential advantage is that it causes reduction in renal vascular resistance.

Question 12

Most common undesirable effect of methyldopa

Answer 12

SEDATION

Question 13

Clonidine Use:

Aside from BP lowering effects, what else are the action?

Answer 13

• REDUCTION OF CARDIAC OUTPUT DUE TO DECREASED HEART RATE
• RELAXATION OF CAPACITANCE VESSELS
• REDUCTION IN PVR
• *accompanied by decreased renal vasc. Resistance and maintenance of renal blood flow
• *reduces blood pressure in the supine position

Question 14

Toxic effect of clonidine

Answer 14

DRY MOUTH AND SEDATION

**contraindicated to pts with risk of mental depression

Question 15

BETA-BLOCKERS: PROPANOLOL

1. This inhibits stimulation of what enzyme?
2. True or False. Can be given with asthma?

Answer 15

1. RENIN

2. FALSE. CAN CAUSE BRONCHIAL CONSTRICTION.

Question 16

METOPROLOL & ATENOLOL

Are CARDIOSELECTIVE

Answer 16

Yes thats true hahaha 😜

Question 17

Beta-blocker used in management of intraoperative and postoperative hypertension.

Answer 17

ESMOLOL

**administered by continuous IV infusion

Question 18

ALPHA1 BLOCKERS:

Should be administered with what drug to prevent salt and water retention?

Answer 18

PRAZOSIN should be given with DIURETICS.

**beneficial for men with HPN+BPH

Question 19

VASODILATORS:

True or False.

1. Sodium Nitroprusside and the Nitrates relax veins.
2. Cause orthostatic hypotension or sexual dysfunction.

Answer 19

1. TRUE

2. TRUE. because sympathetic reflexes are intact.

Question 20

Action of hydralazine in veins and arterioles

Answer 20

DILATES ARTERIOLES BUT NOT AFFECTS VEINS

Question 21

At dose of 200mg/dl of hydralazine, what would likely happen?

Answer 21

LUPUS-ERYTHEMATOSUS LIKE SYNDROME

Question 22

Which vasodilator is avoided in patients with glaucoma?

Answer 22

FENOLDEPAM

**peripheral arteriolar dilator for hypertensive emergencies and postoperative hypertension.

Question 23

In addition to antihypertensive effects of CALCIUM CHANNEL BLOCKERS, name 2 more actions of the drug.

Answer 23

ANTIANGINA

ANTIARRHYTHMIC

Question 24

Renin acts upon angiotensinogen to split off inactive precursor DICAPEPTIDE ANGIOTENSIN I.

Angio I is converted to Angio II by what enzyme? And the latter converted to Angio III where?

Answer 24

• ENDOTHELIAL ACE

- ADRENAL GLAND

Question 25

Activity of:
Angiotensin II
Angiotensin II & III

Answer 25

• VASOCONSTRICTION AND SODIUM RETAINING ACTIVITY

- STIMULATE ALDOSTERONE RELEASE

Question 26

ACEi inhibit what converting enzyme that hydrolyzes angio I to II?

ACEi also inactivates what potent vasodilator?

Answer 26

• PEPTIDYL DIPEPTIDASE
• BRADYKININ

**useful in treating pts with CKD because they diminish proteinuria and stabilize renal function.

Question 27

ACEi is contraindicated with patients with cough due to?

ACEi is contraindicated in what term of pregnancy. Why?

Important drug interaction of ACEi?

Answer 27

• RELEASE OF BRADYKININ AND SUBSTANCE P which can cause wheezing and angioedema
• 2nd and 3rd TRI BECAUSE OF RISK OF FETAL HYPOTENSION, ANURIA, RENAL FAILURE, MALFORMATIONS
• POTASSIUM SPARING DIURETICS which can result to hyperkalemia

Question 28

ARBS: Losartan, Valsartan, Telmisartan

BLOCKS ANGIOTENSIN II type1 receptor

Answer 28

🤓

Question 29

Hypertensive Emergencies (Malignant HPN), classic feature?

Answer 29

Hypertensive Encephalopathy

Question 30

Hypertensive Encephalopathy clinical presentation:

Answer 30

SEVERE HEADACHE
MENTAL CONFUSION
APPREHENSION

**may have blurring of vision, N&V, focal neuro deficit