Antihypertensives

Question 1

What are the 4 anatomic sites of BP control?

Answer 1

• resistance in arterioles
• capacitance in venules
• pump output of the heart (CO)
• kidneys (most common site of action to treat HTN)

Question 2

What are two compensatory response to ↓ BP?

Answer 2

• tachycardia (due to the ↑ sympathetic outflow that results form the dec. BP)
• salt and water retention

Question 3

What are first line agents for treatment of HTN?

Answer 3

• ACE inhibitors, alpha receptor blockers, calcium channel blocker and thiazide diuretics

Question 4

Second line agents for HTN:

Answer 4

• β blockers, aldosterone antagonists

Question 5

α blockers are _______ line treatment for HTN

Answer 5

1st line

Question 6

What drugs are ACE inhibitors? And what patients are they usually given to?

Answer 6

• captopril
• enalapril
• lisinopril
• PRIL

1st line for HTN, especially for diabetics and patients with chronic kidney disease

Question 7

Patient with HTN and also has diabetes and/or chronic renal disease. What drug would you give to treat their HTN?

Answer 7

Ace inhibitor: captopril, enalapril, lisinopril

Question 8

ACE converts _______ to _______ and also breaks down _________

Answer 8

Angiotensin I → angiotensin II

Bradykinin

Question 9

______________ drugs to treat HTN do NOT induce reflex tachycardia

Answer 9

ACE inhibitor

Question 10

what is the effect of bradykinin levels in someone taking ACE inhibitors?

Answer 10

↑ bradykinin because ACE breaks it down;

The ↑ bradykinin produces a cough in patients

Question 11

Angiotensin II acts on the __________ receptors which leads to: (3)

Answer 11

AT1 receptors;

• vascular growth
• vasoconstriction
• Na retention

Question 12

When giving an ACE inhibitor, can expect ↑ levels of ________ and ______

Answer 12

Renin and angiotensin I ; but doesnt do anything because ACE is inhibited

Question 13

What is the effect of ACE inhibitors on sodium and postssium?

Answer 13

↓ in sodium retention

↑ in potassium rention (HYPERKALEMIA)

Question 14

__________ preserve renal function in patients with either diabetic or non diabetic nephropathy when treating HTN

Answer 14

ACE inhibitors; angiotensin constricts the efferent arterioles so ACE inhibitors will vasodilate it and thus improving blood flow

Question 15

Drugs that effect the renin pathway to treat HTN has show to be more effective in white/black patients

Answer 15

White

Question 16

Someone taking a ACE inhibitor will have a slight ________ in GFR

Answer 16

↓ (vasodilation of efferent arteriole)

Question 17

Clinical uses of ACE inhibitors:

Answer 17

• HTN
• preserve renal function in patients with diabetic or non diabetic nephropathy
• treatment in chronic heart failure
• standard fo care in patients following MI

Question 18

What is a potential life threatening adverse effect of ACE inhibiti9ors?

Answer 18

Angioedema

Question 19

ACE inhibitors should be given to patients with unilateral/bilateral/both renal artery stenosis.

Answer 19

UNILATERAL

Giving ACE inhibitors to someone with BILATERAL renal artery stenosis is CONTRAINDICATED

Question 20

Contraindications of ACE inhibitors

Answer 20

• pregnancy
• patients wit BILATERAL renal artery stenosis → the efferent arteriole constriction is what maintains the GFR but giving ACE inhibitor will take this away and there is no other functional kidney to compensate
• patients with history of angioedema related to previous treatment with an ACE inhibitor and in patients with hereditary or idiopathic angioedema

Question 21

Losartan and Vallartan and what type of drugs?

Answer 21

Angiotensin receptor blockers

Question 22

MOA of angiotensin receptor blocker drugs:

Answer 22

• drugs: losartan and valsartan
• blocks angiotensin 2 type 1 receptors
• ↓ BP by: arteriolar and venous dilation
• blocks aldosterone secretion
• ↓ diabetic nephrotoxicity

NO INCREASE IN BRADYKININ LEVELS

Question 23

With ARB’s we will see an ↑ in _______ which we dont see with ACE inhibitors

Answer 23

Angiotensin II; both will have ↑ renin and angiotensin I

Question 24

What is the risk of angioedema in angiotensin receptor blockers?

Answer 24

Significantly lower compared to the risk seen with ACE inhibitors

Question 25

_______ is a angiotensin receptor blocker that can be used to treat gout because ________

Answer 25

Losartan; it blocks URAT1 which then reduces plasma uric acid levels

Question 26

What drug is a renin inhibitor and what conversion does it inhibit?

Answer 26

Aliskiren; Angiotensinogen → angiotensin I

Question 27

Patient has HTN and also has diabetes with albnumuria. What drug would you give to treat their HTN?

Answer 27

Captopril or other ACE inhibitors

Question 28

Which drugs are calcium channel blockers?

Answer 28

- verapamil, diltiazem, nifedipine, amlodipine

Question 29

Verapamil and other similar drugs in its class are 1st line agents for ______

Answer 29

HTN particularly in black or elderly patients

Question 30

The least selective calcium channel blocker is _________ and thus has significant effects on:

Answer 30

Verapamil; Cardiac AND vascular smooth muscle

Question 31

What is verapamil used to treat?

Answer 31

Angina, supraventricular tachyarrhythmias, HTN, migraine and cerebral vasospasm

Question 32

________ is also another non selective calcium channel blocker but has more/less effect on the heart than verapamil

Answer 32

Diltiazem; LESS Both have same uses

Question 33

Dihydropyridines (_________ and _________) which is a sub class of calcium channel blockers, have a greater affinity for _____________ calcium channels

Answer 33

Amlodipine and nifedipine; Greater affinity for VASCULAR calcium channels than cardiac

Question 34

The primary use of amlodipine is ________

Answer 34

HTN because it has affinity for vascular calcium channels

Question 35

_____________ reduce calcium entry into smooth muscles to cause coronary and peripheral _________ and ____ BP

Answer 35

Dihydropyridines: amlodipine and nifedipine; | Vasodilation; ↓

Question 36

You will not see reflex tachycardia in calcium channel blockers EXCEPT: ___________

Answer 36

Dihydropyridines: amlodipine and nifedipine

Question 37

Can dihydropyridines be used to treat arrythmias?

Answer 37

NO because amlodipine/nifedipine only work on the vascular calcium channels and not the cardiac ones so they have no effect on the action potentials

Question 38

High doses of short actin dihydropyridines calcium channel blockers can ↑ risk of ______

Answer 38

MI: excessive vasodilation and reflex cardiac stimulation)

Question 39

Constipation is an adverse effect of what calcium channel blocker?

Answer 39

Verapamil

Question 40

What are the AE’s of verapamil?

Answer 40

- constipation - NEGATIVE inotropic effects - gingival hyperplasia

Question 41

non - dihydropyridine calcium channel blockers are contraindicated in:

Answer 41

- patients taking β blockers - patients with 2nd or 3rd degree AV block - patients with severe left ventricular systolic dysfunction

Question 42

Thiazides are first line agents for ___________

Answer 42

Black or elderly patients with HTN

Question 43

_____ diuretics are given in conjunction with loop or thiazides

Answer 43

K sparing

Question 44

A patient has HTN with severe left ventricular dysnfunction, what is the first line treatment you prescribe them?

Answer 44

Aldosterone antagonist: spironolactone