Antihypertensives

Question 1

What is high normal?

Answer 1

120/80 to 139/89

Question 2

Draw the table of hypertension grades

Answer 2

Check the doc.
You only need to know that “high normal” starts at 120/80 and ends at 139/89.
For each grade starting with mild (140/90), we know that systolic moves up 20 points and diastolic moves up 10.

Question 3

Who makes ACE?

Answer 3

The lungs.

Question 4

Who makes angiotensin?

Answer 4

The liver.

Question 5

What does renin catalyse?

Answer 5

Angiotensinogen to angiotensin I.

Question 6

ACE does what?

Answer 6

Angiotensin I to Angiotensin II

Question 7

What four effects of Angiotensin II raise blood pressure?

Answer 7

Vasoconstriction
Anti-natriuretic
Aldesterone secretion (anti-natriuretic)
Vascular hypertrophy

Question 8

ACE converts angiotensin I to angiotensin II. What’s the other thing it does?

Answer 8

Metabolises bradykinin.

Question 9

ACE inhibiting drugs all end in….

Answer 9

… ‘-pril’

Question 10

ACE inhibitors are more effective when ___, especially when ____.

Answer 10

When blood pressure is high, especially when the RAAS system is active.

Question 11

What two [immediately related] effects do ACE inhibitors have on the heart?

Answer 11

Reduction of CARDIAC LOAD

Reduction of PERIPHERAL RESISTANCE

Question 12

Because they are more angiotensin II sensitive, ACE inhibitors are more selective for the H,B,K

Answer 12

Heart, brain, kidneys.

Question 13

ACE inhibitors are NOT for three kinds of people. They are…
(One is a disease, one relates to side effects)

Answer 13

1. pregnant ones (category D)
2. ones with bilateral renal stenosis (think about it: reduced GFR plus lower BP… bad).
3. Hyperkalaemics.

Question 14

How do ACEIs decrease K+ excretion?

Answer 14

Fewer Na+ ions and ENaC channels to reabsorb them with in the CD, meaning less loss of K+ via exchange with.

Question 15

Which ACE inhibitor is known to sometimes cause neutropaenia at high doses?
It captures the hell out of those neutrophils.

Answer 15

Captopril.

Question 16

What ends in -pril?

Answer 16

ACE inhibitors

Question 17

What ends in -sartan?

Answer 17

Angiotensin II receptor blockers

Question 18

If you’re name ends in -sartan, where are you cleared?

Answer 18

ARBs: HEPATIC CLEARANCE

Question 19

If your name ends in -olol, what are you?

Answer 19

A beta blocker.

Question 20

What do all beta blockers end in?

Answer 20

-olol

Question 21

What two places do you mainly find B1 receptors?

Hong Kong #1

Answer 21

Heart and Kidney

Question 22

Which beta receptors do you mainly see in arterial smooth muscle?
Bonus: what other two places

Answer 22

B2.

Bonus: liver and LUNGS.

Question 23

How is it beta blockers also influence the RAAS system?

Answer 23

The kidney (juxtaglomerular cells) have B1 receptors.

Question 24

Which beta blockers are the most cardiac (B1) selective?

I give that metal bison statue a 10/10.

Answer 24

Atenolol,
metoprolol
Bisoprolol

Question 25

Which beta blockers are the most cardiac selective?

Answer 25

Atenolol,
Metaprolol
Bisoprolol

Question 26

Which group of diseases is totally contraindicated for non-selective beta blockers

Answer 26

Respitory (COPD, asthma)

Even selective ones can be a problem since they lose selectivity at higher doses.

Question 27

Two blood-flow problems contraindicated with beta blockers?

Answer 27

Claudication (intermittent cramping) and Raynaud’s disease.

Question 28

Which CCBs would you want if you were just treating hypotension?

Answer 28

Vascular selective ones.

Question 29

Low importance:
Vascular CCBs
Cardiac CCBs
Vascular+Cardiac CCBs

DeFenestrate Bush.

Answer 29

Dihydropyridine
Phenylalkylamine
Benzothiazapene

Question 30

Low importance:
Dihydropyridine
Phenylaklylamine
Benzothiazepine

Give the drugs for each class

Answer 30

Miodipine, nifedipine
Verapamil
Diltiazem

Question 31

Which class of CCBs would we use for hypotension and what are the two drugs called?

Ah, my darling knife (Italian).

Answer 31

Dihyropyridine;

Amiodipine, nifedipine

Question 32

What are three benefits of CCBs for high BP?

Answer 32

High compliance
No renin release
Side effects cancel out B-blocker side effects.

Question 33

Crossover with angina: Who would you NOT give amiodipine or nifedipine to?

Answer 33

MI or angina patients (vascular steal).

Question 34

What two unwanted effects of CCB are paradoxical?

Answer 34

constipation and flushing.

Question 35

With thiazide diuretics you’ll get an initial fall in BP from peeing. What’s the more long term mechanism?

Answer 35

They desensitise smooth muscle to calcium.

Question 36

What antiquated antihypertensives might we use in a hypertensive crisis? (not too important)

Answer 36

Hydralazine, miloxidil

Question 37

Miloxidil and hydralazine are antiquated antihypertensives used in hypertensive crisis, but they have a limiting factor -

Answer 37

reflexive tachycardia.

Question 38

What is the only drug for hypertension during pregnancy?

Answer 38

methyldopa

Question 39

Bob’s CV risk is low-moderate. What is the response?

Answer 39

Tell him to stop being such a fatty. Check to see if he hasn’t stopped being such a fatty within 6 (moderate) or 12 (mild) months.

Question 40

We check blood pressure. At grade ___ we’d always to an absolute CV risk assessment.
If they’re at grade ___ we start an antihypertensive straight away.

Answer 40

1 or 2 (mild or moderate)

3 (severe)

Question 41

Which group that we’ve looked at in detail isn’t used until, like, the fourth round of attempts to reduce hypertension?

Answer 41

beta blockers.

Question 42

First line for antihypertensive treatments depends on age.
In the young (<55) it’s ___
In the old it’s ___ or ____

Answer 42

Young: ACEIs or ARBs.
Old: CCBs or Diuretics.

Question 43

If monotherapy fails, we try a combination of A + ___ or ___

Answer 43

A with CCBs or Diuretics.

Question 44

Third step combination therapy is…

If that fails then we think about beta blockers or more diuretics.

Answer 44

A+C+D