Hypertention II

Question 0

Benazepril
Captopril
Enalapril
Fosinopril
Lisinopril
Quinapril
Ramipril

Answer 0

Ace inhibitors
1FIrst drug of choice for HT
Decrease conversion of AT1 to ATII, decrease aldosterone secretion -> good for diabetic neuropathy ,CAD, MI, dilated cardiomyopathy, cardiac failure,chronic kidney disease !!first drug of choice
-salt must be restricted
a.E.- dry cough, angioedema** switch to ARBs , blacks

• don’t use in bilateral renal stenosis=decreased GFR
  No use in pregnancy (use methyl dopa or hydralazine)
  -enhance diuretic treatment (a.e. If excess sodium loss- hypotension reactions )

-Reduce after load
Prevent ATII induced remodeling

Question 1

Aliskiren

Answer 1

Renin inhibitor- decrease increase of renin when on ACE inhibitors or ARBS
Reactive risk , increase cough

Question 2

Ace inhibitors angioedema

Answer 2

Switch to ARB

Question 3

Candesartan
Irbesartan
Losartan**
Olmesteran
Telmistartan
Valsartan

Answer 3

Angiotensin receptor blockers ARBS
#1in HT

Competitive inhibitors
Same efficacy

a.E. Low cough , low angioedema, hyperkalemia ,
Not for people with renal stones or pregnant

Do not use ACE inhibitors and ARBs together

Question 4

Losartan

Answer 4

ARBs

Urosuric so also useful in goUt

Question 5

Reduce vascular smooth muscle tone

Answer 5

Diuretic -especially thiazides

Calcium channel blockers

Vasodilators ( hydralazine) ( open k channels- minoxidil) , ( liberate NO sodium nitroprusside) ( activating k/atpase channel- diazoxide)

Question 6

For mild hypertension

Answer 6

Thiazides

Question 7

For severe hypertension

Answer 7

Loop diuretics

Question 8

Chlorothiazide

Answer 8

Longer duration of action, Na/cl channel blocker
Thiazide
Lower bp

Question 9

Ace inhibitor enhances

Answer 9

Efficacy of diuretics

Question 10

Resistant hypertension

Answer 10

Aldosterone antagonist use

Question 11

Diuretics

Answer 11

In small dose
Can be combined with other drugs
Don't give too high or bad very low bp
-reduce CV death
-increase glucose when combined with b blockers(hypokalemia)
-unmask latent diabetes -thiazides

Question 12

Calcium channel blockers act on

Answer 12

L channel smooth muscles. Used in Angina and HT

A.e. Sa nodal inhibition -Brady cardia or sa node arrest

Don’t use on patients with congestive cardiac failure or sa , av
nodal abnormalities

-good for mono therapy use

Question 13

Verapamil
Diltiazam
Nifedipine
Isradipine
Nicardipine
Feiodipine
Amlodipine

Answer 13

The dihydropyridines

Calcium channel blockers for angina

Question 14

Verapamil

Diltiazem

Answer 14

Calcium channel block
Displayed dialate vessels and affects cardiac contraction
-no RACE importance
Good for HT and angina
Not good for cardiac failure - because reduce conduction
–verapamil most used a.e. Constipation
-diltiazem -reduce work of heart

Bradycardia, decrease myocardial contraction,
** give to patients who cannot tolerate beta blockers

Question 16

Hydralazine

Minoxidil

Answer 16

Vasodilators - most often combined with propranolol and diuretics

-barco reflex mediated

A.e. Angina,sodium water retention , vertigo nausea,yacht

Question 17

Minoxodil

Answer 17

Vasodilator- k channels
Direct relaxation of arterial smooth muscle
Severe hypertension( renovascular disease, transplant rejection, renal failure ) - combine with beta blocker
Helps in hair loss
A.e. Can cause hypertrichosis - hairy face

Question 18

Sodium nitroprusside

For hypertension crisis ***

Answer 18

Direct acting NO , relaxation of arterial and venous vascular smooth muscle

• IV, maintain dose
• interact with oxyhemoglobin-methemoglobin, cyanide -NO increase gyanylyl cyclase- no calcium entry ^ Ca uptake store
• use bloodless surgery
• good brain perfusion
• short half life
• for emergency reduction of after load, chf, , preclampsia, eclampsia

Question 19

Diazoxide

Answer 19

Vasodilator -Involves activation of ATP sensitive K channels- activate hypotension agent
As. Salt and water retention, hyperglycemia, inhibit insulin release to treat insulinomas**

Question 20

Amlodopine

Nifedipine

Answer 20

Calcium channel blocks that decrease TpR but no effect on conduction - unless reflex
-reduce after load and vasodilate

• use for angina and hypertension
• long term basis

Question 21

Diuretic thiazides

Loop diuretics

Answer 21

For mild HT- do not use in gout .increases uric acid *
For severe BP

Enhanced by ACE inhibitors

Question 22

Unmask DM

Answer 22

Reduce glucose tolerance as well - thiazides

Question 23

Hydralazine

Answer 23

-hydralazine-dialate arterioles but not venous side
-greater effect in diastolic bp
- renin activity increased so sodium wAter retention. - give diuretics
** slow acetylators- drug induced SLE
S.e. Increased hr, Increased 02 demand - angina

Question 24

Isosorbide mononitrate

Answer 24

Oral nitrate for prevention of angina

Question 25

Atenolol
Bisprolol
Metoprolol
Nevibolol

Answer 25

Cardio selective beta blockers good for angina

Pindolol - partial agonist not good for angina

Question 26

Ranolazine

Answer 26

Alters Slow Na current hence prevents Ca

• increase qt interval
• inhibit cyp2d6

Question 27

Ivabradine

Answer 27

Selective Ifunny sodium channel blocker

• slows cardiac rate
• anti angina

Question 28

What drugs are good for black people that have hypertension

Answer 28

Thiazides

CCB