Hypertension Drugs

Question 1

Name some first line drugs used for hypertension

Answer 1

ACE inhibitors/Angiotensin II receptor blocker
Calcium channel blockers
Diuretics

Question 2

Name a diuretic that could be used in first line treatment of hypertension

Answer 2

Thiazides/thiazide like

Question 3

What are some second line drugs used for hypertension?

Answer 3

Diuretics (K+ sparing)
Alpha and beta blockers 
Direct renin inhibitor 
Centrally acting agents 
Vasodilators

Question 4

Describe the treatment flow chart used when dealing with hypertension

Answer 4

Age: <55 ACE inhibitor, >55/black calcium channel blocker
First line doesnt work? add alternative treatment (ACEi +CCB)
Still not working? Add thiazide like diuretic
Last effort? Add second line drug

Question 5

What drugs is given for hypertensive emergencies?

Answer 5

Sodium nitroprusside

Question 6

What is the action of ACEi?

Answer 6

Competitive inhibitors of ANG1
Causes (Arteriole) vasodilation
Decreases circulating aldosterone
Stop bradykinin breakdown

Question 7

Give an example of an ACEi

Answer 7

Ramipril

Lisinopril

Question 8

What are the side effects of ACEi?

Answer 8

Dry cough (bradykinin in the lung)
Angioedema (black pop.)
Renal failure
Hyperkalaemia

Question 9

What is the action of ARBs?

Answer 9

Blocks AT1 receptor 
More Ang binds to AT2 receptor 
More Nitric oxide release 
Decreases vasoconstriction 
Decreases aldosterone stimulation

Question 10

What are the side effects of ARBs?

Answer 10

Well tolerated (compared to ACEi)
No dry cough 

Renal failure
Hyperkalaemia

Question 11

Give an example of a ARB?

Answer 11

Losartan

Candersartan

Question 12

What is the action of thiazides?

Answer 12

Block Na-C transport on DCT (less sodium reabsorption)

Decreases blood volume (and then TPR)

Question 13

What are side effects of thiazides?

Answer 13

Hypokalaemia, hyponatraemia, hypercalcaemia
Gout (also contraindication)
Hyperglycaemia (contraindication-diabetes)
Alkalosis
Increase cholesterol
RAAS activation
ED

Question 14

Give some examples of thiazide/thiazide like drugs

Answer 14

Bendroflumethiazide

Indopamide

Question 15

What is the action of K+ sparing sparing diuretic?

Answer 15

Indirect/direct inhibition of ENaC

reduces ROMK action preventing K+ loss

Question 16

Give examples of K+ sparing diuretics

Answer 16

Spironolactone (Aldosterone receptor blocker- indirect effects on ENaC)
Amiloride (direct ENaC)

Question 17

What are some side effects of spironolactone?

Answer 17

Hyperkalaemia
ED
Painful gynaecomastia (enlargement of man boobs)

Question 18

What are some side effects of amiloride?

Answer 18

Hyperkalaemia

Question 19

What is the action of alpha blockers?

Answer 19

Selective antagonism at post-synaptic a1 receptors
Blocks contractile effects of NA on vascular SM
Decreases TPR
(More effect when upright)

Benign effect on glucose and plasma lipids

Question 20

What are the adverse effects of alpha blockers?

Answer 20

Postural hypotension- dizziness
Headaches
Fatigue
Oedema (peripheral pooling of blood)

Question 21

What is a contraindication of alpha blockers?

Answer 21

Urinary incontinence

Question 22

Give an example of an alpha blocker

Answer 22

Doxazosin

Question 23

What is the action of a direct renin inhibitor? (Aliskiren)

Answer 23

Blocks renin and prevents cleavage of Ang

Some vasodilator properties

Question 24

Why is sodium nitroprusside used for hypertensive emergencies?

Answer 24

Mimics the action of nitric oxide
Is potent vasodilator

Has rapid onset and offset when given IV

*avoid chronic use