Hypertension

Question 1

ACE Inhibitors (…prils)

Answer 1

Inhibits the conversion of Angiotensin 1 to Angiotensin 11
Decreases activity of ACE
Drug choice for young patients
causes a SMALL drop in BP in normotensive but a GREATER drop in BP in Hypertensive
Reduces cardiac load and arterial pressure

Question 2

ACE Inhibitors (…prils) contraindications

Answer 2

Pregnancy (Foetal toxicity)
Hyperkalaemia (Arrhythmias)
Renal failure
NSAIDS
K supplements
K-sparing diuretics (amiloride)

Question 3

ACE Inhibitors (…prils) adverse effects

Answer 3

Dry cough
1st dose hypotension
Higher doses can lead to:
taste disturbances
angioneurotic oedema (0.1%)
Neutropaenia

Question 4

Angiotensin II Receptor Antagonists (…sartans)

Answer 4

Competitively blocks the action of Angiotensin II
NO COUGH
Well tolerated
Young Px 
Diabetics

Question 5

Angiotensin II Receptor Antagonists (…sartans) Contraindications

Answer 5

same as ACE Inhibitors
Pregnancy (Foetal toxicity)
Hyperkalaemia (Arrhythmias)
Renal failure
NSAIDS
K supplements
K-sparing diuretics (amiloride)

Question 6

B-Adrenoceptor Antagonists (…olols)

Answer 6

Cardio Selective Preferred: Atenolol, metoprolol
Act on beta-1 receptors found in Heart & Kidney
Decrease HR Contractility & Renin release

Improve filling time by slowing HT rate

Inhibition of Renin in KD, block of NAd release -> reduces sympathetic activity

Less Tolerated than ACE Inhibitors & ARBs

Question 7

B-Adrenoceptor Antagonists (…olols) contraindications

Answer 7

Bradycardia

NEVER use non-selective B-blockers in asthmatics

Question 8

B-Adrenoceptor Antagonists (…olols) adverse effects

Answer 8

Cold extremeties
Tiredness / fatigue
Mask sympathetic response to Hypoglycaemic events
Bad dreams
Postural hypotension

Question 9

Calcium Channel Blockers (…dipines)

Answer 9

OFTEN used in conjunction with beta blockers as side effect profile is exact opposite

High compliance (helpful with elderly)

DO NOT stimulate Renin Release

Relaxation of large & small arteries leading to reduction of peripheral resistance and/or cardiac output

Question 10

Calcium Channel Blockers (…dipines) drug types

Answer 10

Phenlalkylamines (verapamil)
Benzothiazepines (diltiazem)
Dihydropyridines (…dipines)

Question 11

Calcium Channel Blockers (…dipines) adverse effects

Answer 11

Flushing (due to vasodilation)
Headache
Ankle oedema
Bradycardia (verapamil & diltiazem)
Constipation

Question 12

Calcium Channel Blockers (…dipines) contraindications

Answer 12

Acute MI
Heart Failure
Bradycardia

Question 13

CCB _Phenylalkylamines (verapamil)

Answer 13

Cardioselective

Used as antiarrhythmic

Question 14

CCB _Benzothiazepines (diltiazem)

Answer 14

Non-selective
Little to no change in HR
Used as antianginal

Question 15

CCB _Dihydropyridines (..dipines)

Answer 15

MAIN CCBs used as antihypertensives
Blood vessel selective
Can cause reflex tachycardia

Question 16

Thiazide Diuretics (…thiazide)

Answer 16

FIRST line treatment in mild-moderate hypertensive ELDERLY patients
Dosed in morning to avoid nocturnal diuresis
Proven benefit in stroke & MI reduction

Question 17

Thiazide Diuretics (…thiazide) adverse effects

Answer 17

Gout
Hypokalaemia
Hyponatraemia
Impotence

Question 18

Thiazide Diuretics (…thiazide) drug types

Answer 18

Hydrochlorothiazide
Chlorthalidone
Indapamide
Metolazone (thiazide like)

Question 19

Digoxin

Answer 19

Increases force of contraction

Increases Ca2+ release

Question 20

Centrally acting agents

Answer 20

Methyldopa
Clonidine
Moxonidine

Question 21

Methyldopa

Answer 21

Only drug of choice for pregnant women

Side effects: 
Sedation 
dry mouth
nasal congestion
orthostatic hypotension

Question 22

Clonidine

Answer 22

Centrally acting alpha-2 and imidazoline agonist

Used acutely by IV injection (e.g hypertension by head trauma)

Question 23

Moxonidine

Answer 23

Centrally acting imidazoline agonist

Causes less drowsiness than clonidine

Question 24

HYPERTENSION DRUGS

Answer 24

ACE Inhibitors (...prils)
Angiotensin II Receptor Antagonists (...sartans)
B-Adrenoceptor Antagonists (...olols) 
Calcium Channel Blockers (...dipines)
Thiazide Diuretics (...thiazide) 
Digoxin
Centrally acting agents