Hypertension and Angina

Question 1

BP Treatment Targets

3 groups

Answer 1

General pop <140
High risk <120
Diabetes <130

Question 2

Antihypertensive drugs (4)

Answer 2

Angiotensin converting enzyme inhibitors (ACE)
Angiotensin II receptor blockers (ARBs)
Calcium channel blockers (CCBs)
Diuretics

Question 3

RAAS Drugs

Stands for?

Answer 3

Renin angiotensin aldosterone system

Causes release of aldosterone, which increases sodium retention and increases BP

Question 4

ACE inhibitors
Name one
Mechanism: 
adverse effects:
Contraindications:

Answer 4

Captopril (shortest half-life)

Hypertension and also for heart failure
combined with thiazide diuretic or CCB

Mechanism: prevents conversion of angiotensin I to II, therefore reduces aldosterone production

adverse effects: dry, nonproductive cough (caused by excess bradykinin because ACE breaks it down) and hyperkalemia

Contraindications: Pregnancy

Question 5

ARBs
Name one
Mechanism
Contraindication

Answer 5

Losartan

Hypertension and HF
No dry cough

Mechanism: Angiotensin II receptor antagonist to prevent vasoconstriction and block release of aldosterone

Contraindication: pregnancy

Question 6

CCBs
Name two
Mechanism
Adverse effects:

Answer 6

Diltiazem (Cardiac+V), amlodipine (Vascular only)

Mechanism: block calcium channels on smooth muscle and cardiac muscle. Alters electrical activity of cardiac cells (SA, AV nodes)
Vascular smooth muscle relaxation, decrease BP

However, with amlodipine you might get baroreceptor reflex where HR increases as BP goes down. Diltiazem prevents this by acting directly on cardiac muscle

Adverse effects:
Diltiazem - CONSTIPATION (due to decrease in smooth muscle activity)
Amlodipine - no constipation but maybe palpitations

Question 7

Thiazides

Name one

Answer 7

Hydrochlorothiazide

Decrease extracellular fluid volumes to decrease preload

Long-acting preferred over short-acting

Question 8

Pill combos

Answer 8

ACE or ARB + CCB or diuretic

Question 9

Adrenergic
Name one
Contraindication

Answer 9

Metoprolol (B-1 selective)

B-adrenergic receptor blockers - reduce heart rate and force of contraction

Contraindication: Do not give in ASTHMA

Question 10

First-line drug for hypertension in pregnancy

Answer 10

Methyldopa - centrally acting a2 receptor agonist

Question 11

What is angina?
Stable
Unstable
Variant

Answer 11

Insufficient supply of oxygen to the heart causing pain.

Stable - exercise induced (more common). Atherosclerosis/plaque buildup

Unstable - occurs without activity. Sudden platelet buildup/stuck to plaque

Variant - vasospasm

Question 12

Treatment goals (2)

Answer 12

Improve blood flow

Reduce heart muscle metabolic demands

Question 13

Organic nitrates
Name two
Mechanism:
Adverse effects:

Answer 13

Nitroglycerin, SL tablets (large first pass effect so NOT PO)
Isosorbide mononitrate (prophylaxis, exercise or long-term)

Mechanism: cause relaxation of smooth muscle cells. Causes vasodilation of coronary arteries
They decrease the preload and afterload*

Adverse effects: headache, postural hypotension, reflex tachycardia
Tolerance to drugs (stop giving/remove transdermal patch at night)

Don’t get isosorbide mononitrate confused with ipratropium bromide, which is anticholinergic used in asthma and COPD

Question 14

B-Blockers for angina

Name two

Answer 14

Metaprolol and atenolol

Long-term prevention of angina, prophylactic only
Propranolol for migraines

Adverse effect: bradycardia

Question 15

CCBs
Name one
Bads

Answer 15

Diltiazem - causes arterial vasodilation

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