antihypertensive drugs

Question 1

what combination of drugs cause triple whammy?

Answer 1

RASi + diuretics + NSAIDs

RASi : vasodilation of efferent arterioles
NSAIDs: vasoconstriction of afferent arterioles
diuretics: decrease plasma volume

Question 2

contraindications of RASi

Answer 2

1. pregnancy
2. renal artery stenosis
3. do not use with NSAIDs and diuretics

Question 3

what is perindopril?

Answer 3

ACE inhibitor

Question 4

what is irbesartan?

Answer 4

Angiotensin-receptor blocker

Question 5

what are some adverse effects of RASi?

Answer 5

1. Cough (dry - (increased bradykinin for ACEi)
2. Angioedema
3. Teratogen
4. increased Creatinine
5. Hyperkalaemia
6. Hypotension (dizziness)

Question 6

what is propranolol?

Answer 6

non-selective beta blocker

Question 7

what is atenolol?

Answer 7

b1-selective beta blocker

Question 8

contraindications of beta blockers

Answer 8

1. asthma, COPD
2. diabetes (mask hyperglycaemia)
3. avoid combination with Ca2+ channel blockers

Question 9

what is verapamil?

Answer 9

cardio-selective Ca2+ channel blocker

Question 10

what is amlodipine/nifedipine?

Answer 10

peripheral-selective Ca2+ channel blocker

Question 11

contraindications of Ca2+ channel blockers

Answer 11

1. avoid with beta blocker
2. heart failure –> Ca2+ channel blockers decrease cardiac output

Question 12

what are some adverse effects of beta blockers?

Answer 12

1. bradycardia
2. diarrhoea
3. impotence
4. exercise intolerance
5. sleep disturbance
6. depression
7. bronchoconstriction

Question 13

what are some adverse effects of Ca2+ channel blockers?

Answer 13

symptoms related to vasodilation
1. oedema
2. flushing
3. headaches
4. bradycardia

Question 14

what is Aliskiren?

Answer 14

renin inhibitor

Question 15

what is the mechanism of action of renin inhibitors?

Answer 15

competitive inhibitor to renin –> decrease formation of ATII –> decrease BP

Question 16

what is endothelin receptor antagonist indicated in?

Answer 16

pulmonary hypertension (not effective in primary hypertension)

Question 17

what is bosentan and its MOA?

Answer 17

mixed ETa and ETb receptor antagonist
- prevents vasoconstriction

ETa mediates vasoconstriction
ETb mediates vasodilation
- overriding effect is vasoconstriction

Question 18

what is ambrisentan and its MOA?

Answer 18

ETa-selective receptor antagonist

ETa mediates vasoconstriction –> drug blocks this –> vasodilation –> decrease BP

Question 19

what is phentolamine?

Answer 19

non-selective a-receptor blocker (vasodilator used as add-on therapy for hypertension)

Question 20

what is prazosin indicated in?

Answer 20

patients with benign prostate hyperplasia and hypertension

Question 21

what are the adverse effects of prazosin?

Answer 21

1. postural hypotension
2. reflex tachycardia
3. urinary urgency

Question 22

what is prazosin?

Answer 22

selective a1 antagonist

Question 23

what is methyldopa?

Answer 23

brain a2-receptor inhibitor

Question 24

what is methyldopa indicated in?

Answer 24

pregnancy-related hypertension

Question 25

what is hydralazine indicated in?

Answer 25

pregnancy-related hypertension

Question 26

what is sodium nitroprusside (vasodilator) indicated in?

Answer 26

used IV for emergency treatment of hypertension

Question 27

A combination of RASi + NSAID + diuretic can cause renal failure, as:

a. RASi decrease efferent blood flow and diuretics decrease plasma volume
b. NSAIDs decrease afferent blood flow and RASi increase efferent blood flow
c. NSAIDs increase afferent blood flow and RASi decrease efferent blood flow
d. NSAIDs decrease afferent blood flow and diuretics increase plasma volume

Answer 27

b. NSAIDs decrease afferent blood flow and RASi increase efferent blood flow

NSAIDs: afferent arteriole constriction –> decrease afferent blood flow –> lower GPF
RASi: efferent arteriole dilation –> increase efferent blood flow –> lower GFR