Cardiovascular pharmacology VII

Question 1

what are the ACE inhibitor agents?

Answer 1

1. captopril
2. lisinopril
3. fosinopril

Question 2

what is the mechanism of action for the ACE inhibitors?

Answer 2

1. decreases amount of circulating angiotensin II

2. bradykinin concentration builds up (vasodilation)

Question 3

the ACEI effect may be very potent in which populations?

Answer 3

patients with high plasma renin levels

1. heart failure
2. sodium depleted patients

Question 4

ACEIs should be avoided in which population?

Answer 4

pregnant women

Question 5

ACEIs have potentially favorable effects in which population?

Answer 5

prediabetes

Question 6

what are the potentially unfavorable effects of ACEIs?

Answer 6

1. hyperkalemia

2. volume depression

Question 7

what are the adverse effects of ACEIs?

Answer 7

1. hypotension

2. coughing

Question 8

what are the angiotensin I blockers?

Answer 8

1. losartan
2. valsartan
3. candesartan

Question 9

what is the mechanism of action for the angiotensin I blockers?

Answer 9

block binding of angiotensin II to AT1 receptor

Question 10

what is the role of calcium channel blockers for hypertension?

Answer 10

add on therapy for diabetes and coronary artery disease

Question 11

which calcium channel blocker class has more of a vascular action?

Answer 11

dihydropyridine (10:1 action compared to NDHP)

Question 12

what are the calcium channel blocker drugs for hypertension?

Answer 12

1. nifedipine
2. amlodipine
3. felodipine

Question 13

calcium channel blockers used for hypertension should be avoided in which population?

Answer 13

LV dysfunction

Question 14

what are the favorable effects of calcium channel blockers for hypertension?

Answer 14

elderly patients with isolated systolic HTN

Question 15

what are the unfavorable effects of calcium channel blockers for HTN?

Answer 15

high-normal HR or tachycardia

Question 16

what is the role of NDHP calcium channel blockers in HTN?

Answer 16

alternative to beta blockers in coronary artery disease - block decreased cardiac contraction

Question 17

what are the indications for NDHP calcium channel blockers for HTN?

Answer 17

1. migraine
2. arrhythmias
3. high-normal HR or tachycardia

Question 18

what is the role of thiazide diuretics for HTN?

Answer 18

1. uncomplicated HTN
2. LV dysfunction (first line)
3. previous ischemic stroke (first line)
4. patients with osteoporosis (increases calcium reuptake)

Question 19

what are the adverse effects of using thiazide drugs for HTN?

Answer 19

1. gout
2. hyponatremia
3. hypokalemia

Question 20

what are the indications for beta blockers for HTN?

Answer 20

1. coronary artery disease

2. LV dysfunction

Question 21

what are the indications for aldosterone blockers for HTN?

Answer 21

1. add on for resistant HTN

2. add on for coronary artery disease and LV dysfunction

Question 22

what are the favorable effects of aldosterone blockers for HTN?

Answer 22

1. low-normal potassium

2. chronic kidney disease

Question 23

what are the adverse effects of aldosterone blockers for HTN?

Answer 23

high-normal potassium

Question 24

what is the role of a1 receptor blockers in HTN (prazosin, doxazosin, terazosin)?

Answer 24

1. very effective especially with diuretic

2. added benefits of lowered LDL, TG, and total cholesterol

Question 25

a-methyldopa (a2 agonist) is good for what condition?

Answer 25

1. gestational hypertension | 2. chronic hypertension in pregnancy

Question 26

what is the MOA of hydralazine?

Answer 26

1. arterial vasodilator 2. decreases IP3 induced calcium release from smooth muscle SR - decreased contraction 3. opens calcium activated potassium channels in smooth muscle - relaxation 4. relaxes arterioles

Question 27

what is the role of hydralazine in HTN?

Answer 27

1. resistant HTN add on 2. severe chronic kidney disease 3. gestational HTN

Question 28

what are the adverse effects of hydralazine?

Answer 28

1. drug induced lupus (long use) 2. compensatory tachycardia and sodium retention should be used in combination with diuretic and beta blocker or NDHP CCB

Question 29

what is the MOA of minoxidil?

Answer 29

1. arterial vasodilator - direct | 2. potassium channel opener - relaxes arteriolar VSMCs

Question 30

what is the role of minoxidil in HTN?

Answer 30

1. only used for severe refractory HTN | 2. used in combination with beta blockers and diuretics

Question 31

what is the MOA of sodium nitroprusside?

Answer 31

1. arterial vasodilator 2. donates NO - cGMP mediated calcium sequestration 3. decreases preload and afterload

Question 32

sodium nitroprusside is good for what condition?

Answer 32

acute MI

Question 33

what is the MOA of aliskiren?

Answer 33

1. direct renin inhibitor | 2. binds directly to catalytic site of renin - prevents cleavage of angiotensinogen to generate angiotensin I

Question 34

what is the contraindication for aliskiren?

Answer 34

pregnancy

Question 35

what is the MOA of reserpine?

Answer 35

1. rauwolfia alkaloid 2. blocks transport of NE into storage vesicles 3. depletes NE from sympathetic nerve endings 4. decreases sympathetic tone, PVR, BP 5. depletes catecholamines in brain and myocardium - sedation, depression, decreased CO

Question 36

what is the role of reserpine in HTN?

Answer 36

combination with a thiazide diuretic

Question 37

what is the preferred thiazide agent for resistant HTN?

Answer 37

chlorthalidone

Question 38

what is idea behind renal sympathetic denervation in treating resistant HTN?

Answer 38

decrease sympathetic outflow to kidney to ultimately decrease renin output