Antihypertensives

Question 1

Thiazide diuretics (2)

Answer 1

HYDROCHLOROTHIAZIDE, and CHLORTHALIDONE

Question 2

Loop diuretic

Answer 2

Furosemide

Question 3

Aldosterone Antagonists

Answer 3

Spironolactone

Question 4

ACE inhibitor

Answer 4

Captopril

Question 5

ARBs

Answer 5

Losartan

Question 6

Direct renin inhibitors

Answer 6

Aliskiren

Question 7

Calcium Channel Blockers

Answer 7

Dihydropyridine: Nifedipine

Non-Dihydropyridines: Verapamil, Diltiazem

Question 8

Vasodilators

Answer 8

Nitroprusside, hydralazine, minoxidil

Question 9

Sympatholytics

Answer 9

1) Clonidine, methyldopa: Centrally acting alpha-2 adrenergic agonists.
2) Beta blockers (Propranolol, metoprolol, atenolol).
3) Alpha Blockers (terazosin)

Question 10

First-line agents for HTN

Answer 10

Thiazide diuretics, ACE inhibitors or ARBs, CCBs

Question 11

Third-line agents for HTN

Answer 11

Loop diuretics, aliskiren, alpha-1 blockers, vasodilators, central alpha-2 aonists, reserpine, aldosterone antagonists, beta blockers

Question 12

MOA of hydrochlorothiazide and chlorothalidone

Answer 12

1) Initially descreses vascular volume and CO via its direct diuresis effect (inhibits NA-Cl symporter in DCT)
2) Long term- indirectly decreases TPR- mechanism unclear

Question 13

For thiazide diuretics, you only need a low dose (12.5-25 mg). Why is that?

Answer 13

Doses >25 mg provide no further benefit but increases risks and adverse effects. Low dose used as monotherapy for stage 1; lowers BP 10-15 mm in most patients 4-6 after onset of therapy.

Question 14

Thiazide diuretics are used with other antihypertensives how?

Answer 14

In combination due to a synergistic effect and to reduce Na+/water retention caused by vasodilators and sympatholytics.

Question 15

hydrochlorothiazide vs. chlorothalidone: Which drug is less potent and has a shorter duration of action yielding lower efficacy in controlling nocturnal BP?

Answer 15

hydrochlorothiazide

Question 16

hydrochlorothiazide vs. chlorothalidone: Which drug may be inferior in reducing the risk of CV events?

Answer 16

hydrochlorothiazide

Question 17

Adverse effects of Thiazide diuretics?

Answer 17

1) Hypokalemia
2) Hyperuricemia (gout), hyperglycemia, hyperlipidemia
3) Erectile dysfunction

Question 18

Drug and MOA for loop diuretics

Answer 18

Furosemide: decrease CO by reducing volume overload- blocks Na-Cl-K symporter in ascending limb of henle’s loop

Question 19

When is furosemide mostly used?

Answer 19

For malignant HTN and volume-dependent patients with renal disease.

Question 20

Name an Aldosterone Antagonist and its MOA:

Answer 20

Spironolactone: Decreases CO by reducing volume overload. 1) Blocks aldosterone receptors in collecting duct of epithelial cells. 2) Prevents cardiovascular remodeling.

Question 21

Adverse effects for Spironolactone:

Answer 21

Hyperkalemia, Gynecomastia, impotence, hirsutism

Question 22

Name an ACE inhibitor and the MOA:

Answer 22

Captopril: Decrease TPR

1) Inhibits enzymatic conversion of AngI to AngII (vasoconstrictor) and degradation of bradykinin (vasodilator).
2) Reduces stimulation of both AngII AT1 and AT2 receptors
3) Decreases AngII-mediated cardiovascular remodeling and renal dysfunction

Question 23

Anti-HTN uses for Captopril:

Answer 23

1) Monotherapy for stage 1; lowers BP even in patients with normal Plasma renin activity.
2) In combination with other anti-HTN; mitigates the risk of hypokalemia from thiazide diuretic therapy

Question 24

True/False: Ace inhibitors have no interference with cardiovascular reflexes- exercise capacity is not impaired and orthostatic Hypotension is minimal

Answer 24

TRUE- this is a clinical advantage over 2nd-line drugs

Question 25

True/False: Ace Inhibitors are associated with are associated with metabolic disturbances

Answer 25

False: Ace inhibitors are NOT associated with metabolic disturbances.- An advantage compared to 2nd line drugs

Question 26

True/False: Ace inhibitors can be used safely in patients with bronchial asthma and does not induce lethargy, weakness or sexual dysfunction.

Answer 26

TRUE- this is a clinical advantage over 2nd-line drugs

Question 27

True/False: Ace inhibitors reduce the risk of HTN-induced cardiovascular mortality?

Answer 27

TRUE- this is a clinical advantage over 2nd-line drugs

Question 28

Adverse Effects and Contraindications of Ace Inhibitors:

Answer 28

1) First-dose hypotension 2) Hyperkalemia, cough, angiodema 3) Contraindicated in pregnancy

Question 29

List an ARB and the MOA

Answer 29

Losartan: Selective antagonist of AngII AT1 receptors. Does NOT affect bradykinin levels.

Question 30

True/False: ARBs anti_HTN efficacy is roughly the same as ACE-Inhibitors

Answer 30

TRUE

Question 31

True/False: ARBs are not alternatives for patients who cannot tolerate ACE inhibitors (cough)?

Answer 31

False- they are alternatives

Question 32

True/False: Combining ARBs with ACE inhibitors has a beneficial effect?

Answer 32

False: Not beneficial and may be harmful

Question 33

Adverse effects of Losartan:

Answer 33

Similar to ACE inhibitors but cough and angiodema are less prevelant

Question 34

Name a direct renin inhibitor and the MOA:

Answer 34

Aliskiren: Decreases TPR; blocks rate-limiting step in enzymatic formation of AngII

Question 35

What type of calcium channel blockers are most frequently used?

Answer 35

Long acting DHPs. Heart rate lowering CCBs can be given for HR control in patients with IHD or Atrial fib.

Question 36

HRL-CCBs and Beta blockers are usually avoided because:

Answer 36

due to potential for bradyarrhythmias.

Question 37

MOA of Nitroprusside

Answer 37

Decomposes to release NO. Similar mechanism to nitroglycerin, but tolerance does NOT develop.

Question 38

Adverse effects of Nitroprusside

Answer 38

Excessive vasodilation and hypotension. Cyanide toxicity

Question 39

MOA of Hydralazine and what population is it used in?

Answer 39

``` Produces arterolar (not venous) dilation. Mechanism unclear. Used in AfricanAmerican patients in fixed -dose combination with BiDil ```

Question 40

Hydralazine Adverse Effects

Answer 40

Reflex Tachycardia and headache. Lupus-like syndrome (slow acetylators).

Question 41

Minoxidil kills people. What is the MOA and what is it used for?

Answer 41

Arterial dilation by opening K+ channels on VSM cells. Used as add-on in severe HTN and used to promote hair growth.

Question 42

Name centrally-acting alpha-2 adrenergic agonist and what it does.

Answer 42

Clonidine, methyldopa: Decreases sympathetic outflow by stimulating alpha-2 receptors resulting in decreased CO and TPR

Question 43

Name an alpha blocker

Answer 43

Terazosin: Block alpha1 receptors in VSM