HTN

Question 1

Lisinopril and Ramipril

Answer 1

ACEi - potentiates bradykinin = vasodilation. Stops AG1-AG2 = vasodilation, less aldosterone and less ADH = decrease afterload, more water out

Question 2

S/E ACEi

Answer 2

Hypotension, hyperkalemia, worsening renal failure, not in pregnancy

Question 3

Candesartan and Losartan

Answer 3

ARB- inhibit AG2 mediated vasoconstriction

Question 4

S/E ARB

Answer 4

Hypotension, Hyperkalemia

Question 5

Amlodopine

Answer 5

Dihydropyridine CCB- selective peripheral. Blocks intake of Calcium= dilation

Question 6

S/E Dihydropyridine CCB

Answer 6

Swollen ankles, Flushes, headache, palpitations

Question 7

Contra-indications Dihydropyridine CCB

Answer 7

Simvastatin = increase simvastatin. Also in unstable angina

Question 8

Verapamil

Answer 8

Phenylalkylamines CCB- neg inotropic. Depress SA node and slows AV conduction.

Question 9

S/E Phenylalkylamines CCB

Answer 9

Constipation, heart block, heart failure

Question 10

Contraindications Phenylalkylamines CCB

Answer 10

B Blockers and low liver function

Question 11

Bendroflumethiazide and indapamide

Answer 11

Thiazide like. Inhibit Na/Cl in DCT = decreased water reabsorbed

Question 12

S/E Thiazides

Answer 12

Hypokalemia, high glucose, gout, hyponatremia

Question 13

Contraindications Thiazides

Answer 13

NSAIDs, Loop diuretics, low K, high uric

Question 14

Spironolactone

Answer 14

Aldosterone antagonist, stops ENAC presentations = less Na and water reabsorbed

Question 15

S/E aldosterone antagonist

Answer 15

Gynecomastia, hyperkalemia

Question 16

Contraindication for aldosterone antagonists

Answer 16

Pregnancy, addisons, hyper potassium

Question 17

Bisoprolol

Answer 17

B Blocker- decrease sympathetic tone by blocking Na and decrease heart contractions = decrease cardiac output. Also works on B1 = decrease renin

Question 18

S/E B Blocker

Answer 18

Bronchospasm, raynauds, impotence

Question 19

Contraindication for B Blocker

Answer 19

Asthma, hepatic failure, verapamil and diltiazem = asystole

Question 20

Doxazosin

Answer 20

A Blocker- selective antagonism for A1 = decrease peripheral vascular resistance

Question 21

S/E A blockers

Answer 21

Postural hypotension, syncope, dizzy

Question 22

Contraindications for A Blocker

Answer 22

CCBs- amlodipine = oedema

Question 23

Something interesting about AG2

Answer 23

Also produced independently of ACE via Chymases

Question 24

Stage 1: Treat under 55 and non black, T2DM

Answer 24

ACEi or ARB

Question 25

Stage 1: Treat over 55 or black

Answer 25

CCB

Question 26

Stage2: <55 and not black, T2DM

Answer 26

ACEi or ARB + CCB or Thiazide like

Question 27

STage 2: >55 and black, non diabetic

Answer 27

CCB + ACEi or ARB or Thiazide like

Question 28

Stage 3 all

Answer 28

ACEi or ARB + CCB + Thiazide like

Question 29

Stage 4 all

Answer 29

Check adherence. Add low does spironolactone if K<4.5 add A or B blocker if > 4.5