Drugs for Hypertension and Heart Failure

Question 1

Name the types of drugs used to treat hypertension

Answer 1

ACE inhibitors

Angiotensin-II antagonists and ARBs

Calcium channel blockers

Alpha receptor blockers

Beta receptor blockers

Question 2

What are the effects of an ACEi

Answer 2

Vasodilation

Reduced aldosterone release

Reduced ADH release

Reduced cell growth and proliferation

Question 3

Name some ACEi

Answer 3

End with suffix -pril

Catopril

Enalapril

Lisinopril

Ramipril

Question 4

Name some common side effects of ACEi

Answer 4

Persistant dry cough

Angioedema

Renal failure

Hyperkalaemia

Question 5

Name some ARBs

Answer 5

End with the suffix -sartan

Losartan

Candesartan

Eprosartan

Irbesartan

Question 6

Name some side effects of ARBs

Answer 6

Renal failure

Hyperkalaemia

Question 7

What are the type of CCBs ,and where and how do they act

Answer 7

Dihydropyridines - selective for peripheral vasculature. Cause vasodilation

Phenylalkylamines - affect myocardium. Depress SA node and slow AV condution. Cause -ve inotropy and -ve chronotropy

Benzothiazepines - affect vasculature and myocardium

Question 8

Name some dihydropyridines

Answer 8

Named using suffix -ipine

Amlodipine

Nifedipine

Nicardipine

Question 9

What are the adverse effects of dihydropyridines

Answer 9

SNS activation and tachycardia

Palpitations

Flushing

Sweating

Throbbing headache

Oedema

Interaction with amlopidine and simvastatin causes an increased plasma concentration of simvastatin

Question 10

Name a phenylalkylamine and name some adverse effects

Answer 10

Verapamil

Adverse effects:

Constipation

Risk of bradycardia

Negative inotropic effect can worsen HF

Question 11

Name a benzothiazepine and name some adverse effects of the drug

Answer 11

Diltiazem

Adverse effects:

Bradycardia

Negative inotropy which can worsen HF

Question 12

Why should a patient of African or Caribbean origin with hypertension be treated with CCBs or a thiazide-like diuretic first instead of being treated with an ACEi/ARB

Answer 12

Patients with an African or Caribbean origin have lower levels of renin activity so use the CCBs or thiazide-like diuretics first instead of ARBs/ACEi

Question 13

How do alpha-adrenoreceptor blockers work and give an example of one

Answer 13

Alpha-receptor blockers work by antagnoising alpha-1 receptors and antagonise contractile effects of NA on vascular SM

Example is doxazosin

Question 14

Name some adverse effects of alpha-receptor blockers

Answer 14

Postural hypotension

Headache and fatigue

Oedema

Question 15

How do beta-receptor blockers work and give an example of one

Answer 15

Beta-receptors blockers work by decreasing sympathetic tone by blocking NA and reducing myocardial contraction -> decrease CO

Are an add on in hypertension

E.g. bisoprolol

Question 16

Name some adverse effects of beta-receptor blockers

Answer 16

Bronchoconstriction

Mask tachycardia

Lethargy and imparied concentration

Decreased exercise tolerance

Bradycardia

Raynaud’s - cold hands

Question 17

Name some inherited and acquired causes of heart failure

Answer 17

Inherited - congenital hypertrophic CM, arrhythmogenic RV CM

Acquired - ischaemic CM, pressure overload, valve disease, infection, inflammation, alcohol

Question 18

What are the aims of heart failure treatment

Answer 18

To reduce symptoms

Managed increase in exercise tolerance

Decreased mortality

Address arrhythmias, hyperlipidaemia and diabetes

Question 19

What drugs can be used to treat HF

Answer 19

ACEi and ARBs - ACEi mainly but if they cannot be tolerated, then give ARB

Give spironolactone (aldosterone antagonist) if patient has hyperaldosteronism or as an adjunct along with ACEi and diuretic

Beta-receptor blocker for all patients with stable HF, unless contraindicated or not tolerated. Introduce once ACEi or ARB is initiated

May use digoxin - produces symptomatic benefits