Hypertension

Question 1

HTN Treatment - Drug Classes

Answer 1

1. Diuretics;
2. B-Blockers;
3. RAS (Renin-Angiotensin System) Inhibitors;
4. CCBs;
5. a-Blockers;
6. Other

Question 2

MoA for Thiazide Diuretics in treatment of HTN

Answer 2

decrease Na+ reabsorption in distal tubule

Question 3

MoA for Loop Diuretics in treatment of HTN

Answer 3

Decrease Na+ reabsorption in ascending limb, Drug of choice for reducing acute pulmonary edema of heart failure

Question 4

MoA for K+ SparingDiuretics in treatment of HTN

Answer 4

Inhibit sodium transport at the late distal and collecting duct; or work as an aldosterone antagonist - Spironolactone (Aldactone ®) and eplerenone (Inspra ®)

Question 5

Adverse Effects for Thiazide Diuretics in treatment of HTN

Answer 5

Hypokalemia; Hyperuriemia; may precipitate gouty attack

Question 6

Adverse Effects for Loop Diuretics in treatment of HTN

Answer 6

Ototoxicity

Question 7

Adverse Effects for K+ SparingDiuretics in treatment of HTN

Answer 7

Gynecomastia in males

Question 8

MoA for B-blockers in treatment of HTN

Answer 8

1. Reduction of cardiac output;
2. possible reduction in sympathetic output from CNS;
3. Some inhibition of renin release

Selective b-1 receptor blockers are most commonly prescribed: (i.e. metoprolol, atenolol)

Question 9

MoA for ACE-inhibitors in treatment of HTN

Answer 9

1. Decrease BP by reduction of peripheral vascular resistance;
2. Decrease transformation of Angiotensin I to Angiotensin II;
3. ACE is also responsible for the breakdown of bradykinin (bradykinin levels are increased with ACEI treatment > persistent dry cough)

Question 10

MoA for ARBs in treatment of HTN

Answer 10

1. Block AT1 receptors (where angiotensin II binds);
2. Effects similar to ACEIs;
3. Decreased BP thru vasodilation and reduced aldosterone;
4. Does not increase bradykinin levels

Question 11

MoA for Non-Dihydropyridine CCBs in treatment of HTN

Answer 11

1. Act on Ca+ channels of vascular smooth muscle & myocardial smooth muscle;
2. slow automaticity/AV nodal conduction

Question 12

MoA for Dihydropyridine in treatment of HTN

Answer 12

1. Greater affinity for vascular calcium channels than for Ca⁺⁺ channels in heart;
2. Cause vasodilation & decreased peripheral vascular resistance;
3. fewer drug interactions

Question 13

MoA for Alpha Blockers in treatment of HTN

Answer 13

1. Competitive blockade of α1-receptors;
2. Relaxation of arterial & venous smooth muscle > Decrease peripheral vascular resistance & BP;
3. Minimal changes to cardiac output, renal blood flow and GFR

Question 14

Drug Classes Indicated for Treating HTN with High-Risk Angina Pectoris

Answer 14

Preferred: B-blockers & CCBs; Secondary: Diuretics & ACEIs

Question 15

Drug Classes Indicated for Treating HTN with Diabetes

Answer 15

Preferred: Diuretics, ACEIs, & ARBs; Secondary: B-Blockers, CCBs

Question 16

Drug Classes Indicated for Treating HTN with Recurrent Stroke

Answer 16

Preferred: ACEIs; Secondary: Diuretics

Question 17

Drug Classes Indicated for Treating HTN with HF

Answer 17

Preferred: Diuretics, B-Blockers; ACEIs; ARBs; Aldosterone-receptor antagonists

Question 18

Drug Classes Indicated for Treating HTN with Previous MI

Answer 18

B-Blockers, ACEIs, Aldosterone-receptor antagonists

Question 19

Drug Classes Indicated for Treating HTN with Chronic Renal Disease

Answer 19

ACEIs; ARBs