Hypertension drugs

Question 1

What is desired blood pressure in adults?

Answer 1

120/80 mmHg “desired”

Question 2

Define stages of hypertension

Answer 2

1: 140/90 mmHg to 159/99 mmHg
2: 160/100 mmHg to 180/120 mmHg
3: higher than 180/120 mmHg

Question 3

Where is ACE found?

Answer 3

luminal surface of capillary endothelial cells, predominantly in the lungs

Question 4

What are the steps of angiotensinogen?

Answer 4

angiotensinogen from liver, renin from kidney converts it to angiotensin I. ACE from lungs converts that to angiotensin II,

Question 5

what are the actions of angiotensin II?

Answer 5

acts at AT1, vasoconstriction
stimulation of aldosterone which acts at distal renal tubule
cardiac and vascular muscle cell growth
vasopressin (ADH) release from posterior pituitary

Question 6

How is angiotensin II created?

Answer 6

converted from. the angiotensin I via ACE or chymases

Question 7

How do ACEi cause hypotension and dry cough

Answer 7

potentiates bradykinin

- vasodilatation via NOS/NO

Question 8

What are the ACEi names?

Answer 8

lisinopril, ramipril

Question 9

What is the mechanism of action for ACEi?

Answer 9

inhibiting circulating and tissue ACE •
A reduction in Angiotensin-II activity,
vasodilation (↓ peripheral resistance: ↓ afterload)
reduction in aldosterone release (↑ Na + H2O excretion)
reduced vasopressin (ADH) release (↑ H2O excretion)
reduced cell growth and proliferation

Question 10

ACEi

Answer 10

Hypotension, Dry cough (10-15% - bradykinin association)
hyperkalaemia (lower aldosterone - ↑[K+])
cause or worsen renal failure
angioedema

Question 11

X ACEi

Answer 11

Renal artery stenosis, AKD,, (CKD - caution),
idiopathic angioedema
pregnancy

Question 12

^ACEi

Answer 12

↑K+ drugs,
NSAIDs,
other antihypertensive agents

Question 13

ARB names

Answer 13

candesartan, losartan

Question 14

ARB mechanism

Answer 14

AT 1 and AT2 receptors antagonist, no effect on bradykinin

Question 15

ARB

Answer 15

Hypotension!
hyperkalaemia (low aldosterone ↑K+)
cause or worsen renal failure

Question 16

X ARB

Answer 16

Renal artery stenosis, AKD,, (CKD

pregnancy

Question 17

^ARB

Answer 17

↑K+ drugs,

NSAIDs

Question 18

What do CCB do?

Answer 18

target calcium initiated smooth muscle contraction, primary choice for low renin patients

Question 19

What are the 2 groups of CCB

Answer 19

dihydropyridines

- non-dihyropyridin

Question 20

What are dihydropyridines?

Answer 20

amlodipine (long half life) 
nifedipine 
nimodipine (selective for cerebral vasculature)

Question 21

dihydropyridine

Answer 21

Ankle swelling, flushing, headaches (vasodilation)

Palpitations

Question 22

mechanism for dihydropyridine

Answer 22

little chronotropic or inotropic effects

cerebral vs peripheral selectivity

Question 23

x dihydropyridine

Answer 23

Unstable angina, severe aortic stenosis

Question 24

^ dihydropyridine

Answer 24

amlodipine + simvastatin (increased effect of statin)

Question 25

non-dihydropyridine examples

Answer 25

phenylalkylamines =verapamil and benzothiazapines=diltiazem

Question 26

phenylalkylamines mechanism

Answer 26

depresses SA node and slows AV conduction, prolongs the action potential Class IV anti-arrhythmic agent Less peripheral vasodilatation, negative chronotropic and inotropic effects

Question 27

Phenylalkylamines

Answer 27

Constipation, | bradycardia (i .v. ), heart block and cardiac failure

Question 28

X Phenylalkylamines

Answer 28

Poor LV function (caution), AV nodal conduction delay

Question 29

^ Phenylalkylamines

Answer 29

β-blockers, | other antihypertensive and antiarrhythmic agents

Question 30

thiazide examples

Answer 30

bendroflumethiazide | indapamide

Question 31

thiazide mechanism

Answer 31

• Inhibit N+/Cl- co-transporter in distal convoluted tubule | ↓Na+ and H2O reabsorption

Question 32

thiazide

Answer 32

``` Hypokalaemia, hyponatraemia, hyperuricemia (gout), arrhythmia ↑glucose (especially with beta-blockers) small ↑cholesterol and triglycerid ```

Question 33

X thiazide

Answer 33

Hypokalaemia, hyponatraemia, gout

Question 34

^ thiazide

Answer 34

NSAIDs, ↓K+ drugs such as loop diuretics

Question 35

aldosterone antagonist example

Answer 35

spironolactone

Question 36

mechanism of spironolactone

Answer 36

K sparing, mineralcorticoid aldosterone antagonist

Question 37

#spironolactone

Answer 37

Hyperkalaemia, gynaecomastia (moobs)

Question 38

Xspironolactone

Answer 38

Hyperkalaemia, Addison’s

Question 39

^spironolactone

Answer 39

↑K+ drugs (monitoring), pregnancy

Question 40

β-adrenoceptor blockers examples

Answer 40

labetalol bisoprolol metoprolol

Question 41

β-adrenoceptor blockers mechanism

Answer 41

Decrease sympathetic tone reducing myocardial contraction bisoprolol resulting in reduced cardiac output ↓ renin secretion β1

Question 42

β-adrenoceptor blockers

Answer 42

Bronchospasm, heart block, Raynaud’s (cold hands), lethargy, impotence Mask tachycardia – sign of insulin induced hypoglycaemia

Question 43

X β-adrenoceptor blockers

Answer 43

Asthma, (COPD), haemodynamic instability, hepatic failure

Question 44

^β-adrenoceptor blockers

Answer 44

non-dihydropyridine CCBs - verapamil and diltiazem – asystole!

Question 45

α-adrenoceptor blockers examples

Answer 45

doxazosin, | tamulosin(renal, BPH)

Question 46

α-adrenoceptor blockers mechanism

Answer 46

Selective antagonism of α-1 adrenoceptors • Reduce peripheral vascular resistance • Urinary tract including bladder neck and prostate – benign prostatic hyperplasia (tamsulosin), Relatively safe in renal disease

Question 47

#α-adrenoceptor blockers

Answer 47

Postural hypotension | dizziness, syncope, headache and fatigue

Question 48

Xα-adrenoceptor blockers

Answer 48

postural hypotension

Question 49

^ α-adrenoceptor blockers

Answer 49

dihydropyridine CCB - ↑oedema

Question 50

What is MAP?

Answer 50

DBP+(SBP-DBP)/3)

Question 51

loop diuretics example

Answer 51

bumetanide | furosemide

Question 52

loop diuretics mechanism

Answer 52

• Inhibit N+/K+/2Cl- co-transporter in ascending limb of LoH, ↓ N+ K+ 2Cl- into epithelium H2O follows by osmosis Direct dilation of capacitance veins – reduces preload For :pulmonary oedema, fluid overload in HF, adjunct in nephrotic syndrome

Question 53

#loop diuretics

Answer 53

Dehydration, hypotension! Hypokalaemia, hyponatraemia, hyperuricemia (gout) with chronic treatment, arrhythmia, tinnitus ↑cholesterol and triglyceride

Question 54

X loop diuretic

Answer 54

Hypokalaemia, hyponatraemia, gout, hepatic encephalopathy

Question 55

^ loop diuretic

Answer 55

aminoglycosides, digoxin, lithium

Question 56

K sparing diuretic example

Answer 56

amiloride

Question 57

K sparing diuretic mechanism

Answer 57

Block ENaC | ↓Na+ reabsorption in DCT and reduce K+ excretion, adjunct to loop or thiazide like in HF to limit ↓K+

Question 58

K sparing diuretic

Answer 58

Hyperkalaemia, potential arrhythmia

Question 59

X K sparing diuretic

Answer 59

Addison’s, potassium supplement

Question 60

^ K sparing diuretic

Answer 60

K+ sparing drugs, ACEi, ARBs