medicines used to treat hypertension

Question 1

BP target

Answer 1

systolic below 140 mmHg
diastolic below 90 mmHg

Question 2

lifestyle modification as first line treatment

Answer 2

• weight reduction
• regular physical exercise
• DASH diet ( rich in veggies/fruits/whole grains)
• reduction of dietary sodium intake
• moderation of alcohol intake

Question 3

Drugs that act on Beta 1 receptors on juxtaglomerular cells

Answer 3

• propranolol
• bisoprolol
• metoprolol

Question 4

drugs that act on the angiotensin converting enzyme

Answer 4

ACE inhibitors
- captopril
- enalapril
- lisinopril
- ramipril

Question 5

drugs that act on angiotensin II receptors

Answer 5

ARBs
- losartan
- valsartan
- candesartan
- irbesartan

Question 6

drugs that act on the aldosterone receptors

Answer 6

• eplerenone
• spironolactone

Question 7

Diuretics

Answer 7

Promote diuresis by helping your kidneys release sodium into your urine which helps remove water from your blood decreasing the amount of fluid flowing through your veins and arteries reducing blood pressure

Question 8

Sympatholytics

Answer 8

Opposes the downstream effects of postganglionic nerve firing in effector organs innervated by the sympathetic nervous system and can have an antihypertensive effect
example: methyldopa (used in Parkinson’s disease)

Question 9

Drugs that act on vascular smooth muscle

Answer 9

• minoxidil
• nitroprusside
• Ca channel blockers
• thiazides

Question 10

drugs that act on alpha 1 receptors

Answer 10

• prazosin
• terazosin
• labetalol

Question 11

drugs that act on renal tubules

Answer 11

• thiazide diuretics
• furosemide
• K+ sparring diuretics

Question 12

Loop diuretics

Answer 12

Act on the Na/K/Cl cotransporter along the ascending limb of the loop of henle in the kidney
Examples : furosemide, bumetanide, torsemide

Question 13

Thiazides

Answer 13

• First line treatment for high blood pressure
• they inhibit the apical sodium/chloride transporter in epithelial cells of the distal convoluted tubules to reduce extracellular fluid and cardiac output
  Examples : chlorothiazide, hydrochlorothiazide, indapamide

Question 14

Potassium sparing diuretics

Answer 14

Act to prevent sodium reabsorption in the collecting tubule by either:
- binding epithelial sodium channels (amiloride, triamterene)
- inhibiting aldosterone receptors (spironolactone, eplerenone) preventing excessive potassium in urine and decreasing retention of water

Question 15

Loop diuretics are more effective than thiazides because

Answer 15

Loop diuretics are more efficacious at producing diuresis and natriuresis because the sodium chloride transporter (which thiazides act on) only reabsorbs 5% of filtered sodium

Question 16

Diuresis

Answer 16

Condition which kidneys filter too much bodily fluid

Question 17

Natriuresis

Answer 17

Process which sodium excretion in the urine through the action of the kidneys

Question 18

Hypokalaemia

Answer 18

Lower than normal potassium level in your bloodstream

Question 19

Calcium channel blockers - dihydropyridines

Answer 19

Block Ca2+ channels in arterioles preventing calcium from entering the cells allowing blood vessels to relax and open
Examples : nifedipine, amlodipine

Question 20

Dilation of peripheral vessels causes

Answer 20

Decrease in blood pressure

Question 21

Dilation of coronary arteries causes

Answer 21

Increased coronary perfusion

Question 22

Dihydropyridines indirect effects

Answer 22

Lowering blood pressure causes a baroreceptor reflex that stimulates the medulla increasing the firing of SNS to beta receptors in the heart thus increasing heart rate and contractility
not desirable in patients with heart disease

Question 23

Non-dihydropyridines

Answer 23

• mainly used for heart to slow conduction and decrease contractility for patients with arrhythmias
• can also be used for hypertension - reduced trans-catheter pulmonary valve replacement (TPvR)
  Examples : verapamil, diltiazem

Question 24

Verapamil

Answer 24

Blocks Ca2+ channels in arterioles in the heart
- dilation of peripheral vessels - decreases BP
- dilation of coronary arteries - increases coronary perfusion
- blockade of SA node - decreases heart rate
- blockade of AV node - decreases nodal conduction
- blockade in myocardium - decreases contractile force