Antihypertensives

Question 1

What are 4 criteria for antihypertensive drug selection?

Answer 1

1-Underlying medical condition
2-Race (avoid ACE-I in black)
3-Severity
4-Combinations

Question 2

Which type of antihypertensive depletes sodium to reduce blood volume?

Answer 2

Diuretics

Question 3

Which type of antihypertensive reduces peripheral vascular resistance?

Answer 3

Sympathoplegics

Question 4

Which type of antihypertensive relaxes vascular smooth muscles thus dilating resistance vessels and increasing capacitance?

Answer 4

Direct vasodilators

Question 5

Which type of antihypertensive inhibit action/production of angiotensin and thus reduce peripheral vascular resistance?

Answer 5

Anti-angiotensin agents

Question 6

What are the 5 categories of diuretics?

Answer 6

1-Acetazolamide/canagliflozin (Proximal tubule)
2-Osmotic agents (Descending thin)
3-Loop agents (Thick ascending loop)
4-Thiazides (Distal convoluted tubule)
5-Aldosterone antagonists (Collecting tubule)

Question 7

Which drug is not reabsorbed and results in water retention, is not used for hypertension but for increased intracranial pressure after head trauma?

Answer 7

Mannitol

*Osmotic

Question 8

Which drug was discovered because it was related to bacteriostatic sulfonamides and is a carbonic anhydrase inhibitor?

Answer 8

Acetazolamide

*Not used for hypertension but as a diuretic. Results in more NA in the lumen

Question 9

Which 2 diuretics are very efficacious by inhibiting luminal Na/K/CL transporter in the thick ascending limb of loop of henle and cause caused Hypokalemia?

Answer 9

Loop diuretics:
1-Furosemide
2-Bumetanide

*inhibited by NSAIDs under certain conditions

Question 10

Which diuretics inhibit NaCl reabsorption from the luminal side of epithelial cells in the distal convoluted tubule by blocking Na/Cl transporter?

Answer 10

Thiazides:
1-Hydrochlorothiazide
2-Chlorthalindone

*also causes hypokalemia and is inhibited by NSAIDs under certain conditions

Question 11

Which diuretics prevent K secretion by antagonizing effects of aldosterone in collecting tubules or Na influx through ion channels?

Answer 11

Potassium sparing diuretics:
1-K blocker=Spironolactone (aldactone)
2-Na influx=amiloride

*often used in combination to offset hypokalemia

Question 12

Which drugs inhibit the converting enzyme peptide dipeptidase that hydrolyzes angiotensin I to II and can cause a dry cough?

Answer 12

ACE inhibitors (captopril)

*increases bradykinin to vasodilate

Question 13

Which drugs decrease peripheral vascular resistance without causing a dry cough because they do not act on bradykinin metabolism?

Answer 13

Angiotensin II inhibitors

Losartan (Cozaar)

*Side effects same as ACE-I *hyperkalemia)

Question 14

What are 3 groups of direct vasodilators that are primarily used for resistant cases?

Answer 14

1-Hydralazine (release of NO)
2-Verapamil, Diltiazem, Nifedipine (Reduce Ca influx)
3-Minoxidil (hyperpolarize smooth muscle by opening K channel)

Question 15

Which drug acts on central a2 receptors in the medulla and reduces sympathetic tone to decrease blood pressure?

Answer 15

Clonidine

*Dry mouth and sedation side effects

Question 16

Which drugs are competitively blocking nicotinic cholinoceptors on postganglionic neurons in both simp and parasymp ganglia?

Answer 16

Ganglionic blocking agents

*Mecamylamine (rarely used)

Question 17

Which drugs inhibit release of norepinephrine from sympathetic nerve endings?

Answer 17

Adrenergic blocking agents- Guanethidine (ismelin)

*orthostatic hypotension

Question 18

Which two beta blockers are cardioselective (B1 in heart)?

Answer 18

1-Atenolol (tenormin)

2-Metoprolol (metoprolol)

Question 19

Which beta blockers are non-cardioselective (B1 and B2?

Answer 19

1-Propranolol (inderal)

2-Nadolol (corgard)

Question 20

Which beta blockers are beta and alpha 1 blockers?

Answer 20

1-Labetalol (trandate)

2-Carvedilol (coreg)

Question 21

Which alpha-blockers are cardioselective?

Answer 21

1-Prazosin (minipress)

2-Terazosin (hytrin)

Question 22

Which alpha blockers are non-cardioselective (a1 and a2)?

Answer 22

1-Phetolamine (regitine)

2-Phenoxybenzamine (dibenzyline)

Question 23

Which drugs cause vasodilation and thus decrease TPR and BP and are used for hypertension as well as benign prostatic hypertrophy?

Answer 23

a1 antagonists (prazosin, terazosin)

*Orthostatic hypotension and nasal congestion