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BCR 1 > Phamacology - Ace inhibitors and Angiotensin receptor blockers > Flashcards

Phamacology - Ace inhibitors and Angiotensin receptor blockers Flashcards

1
Q

which type of receptors found in the central veins detect salt/water loss?

a. baroreceptors
b. volume receptors
c. electrolyte sensors

A

b.volume receptors

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2
Q

Activation of volume and pressure receptors by low blood volume leads to disinhibition of which nerves?

a. renal parasympathetic nerves
b. renal sympathetic nerves

A

b.renal sympathetic nerves

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3
Q

what is noradrenaline release from renal sympathetic nerves coupled with in order to secrete renin secretion?

a. AT1 receptors
b. AT2 receptors
c. B2 adrenoceptors
d. B1 adrenoceptors

A

d. B1 adrenoceptors

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4
Q

what receptors respond directly to localised fall in renal arterial pressure by secreting renin?

a. macula densa
b. baroreceptors
c. pressure sensitive granular cells
d. juxtaglomerular cells in the afferent arteriole

A

c. pressure sensitive granular cells

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5
Q

reduced GFR and delivery of sodium to which cells causes them to stimulate the pressure sensitive granular cells?

a. macula densa cells
b. baroreceptors
c. chemoreceptors
d. juxtaglomerular cells in the afferent arteriole

A

a.macula densa cells

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6
Q

where does conversion of agt1 to agt 2 occur?

a. lungs
b. vascular beds
c. kidney
b. glomerulus
e. liver

A

b.vascular beds

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7
Q

what is aldosterone?

a. steroid
b. glucocorticoid
c. mineralocorticoid
d. vasoconstrictor

A

c.mineralocorticoid

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8
Q

where does aldosterone released from the adrenal cortex have its action?

a. PCT
b. glomerulus
c. nephron
d. DCT epithelial cell

A

d. DCT epithelial cell

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9
Q

where in the cell does aldosterone work?

a. cytoplasm
b. membrane
c. nucleus

A

c. nucleus

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10
Q

where is the receptor for aldosterone found?

a. cytoplasm
b. cell membrane
c. nucleus

A

c.nucleus

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11
Q

which of these are not synthesised as a result of aldosterone binding to its nuclear receptor?

a. b1 adrenoceptors
b. exchange and channel proteins
c. activators of Na+/k+ channels
d. synthesis of proteins regulating mitochondrial ATP production

A

a. b1 adrenoceptors

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12
Q

how does activation of RAAS lead to release of vasopressin (ADH) from the pituitary gland?

a. increases osmolality of ECF water and cell so increases hypothalamus osmoreceptor activity
b. increases osmolarity of ECF water and cell so increases hypothalamus osmoreceptor activity
c. decreases osmolarity of ECF water and cell so increases osmoreceptor activity

A

b.increases osmolarity of ECF water and cell so increases hypothalamus osmoreceptor activity

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13
Q

where is vasopressin (ADH) released from?

a. hypothalamus
b. kidneys
c. DCT
d. posterior pituitary
e. anterior pituitary

A

d. posterior pituitary

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14
Q

what substance binds to the V2 receptor in the kidney?

a. aldosterone
b. agt 2
c. ADH
d. Renin

A

c. ADH

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15
Q

what is the effect of vasopressin binding to the V2 receptor beneath the prinicpal cell of the collecting duct?

a. increased permeability to water as it moves towards the renal interstitium
b. decreased permeability to water as it moves towards the renal interstitium
c. increased permeability to water as it moves away from the renal interstitium

A

a. increased permeability to water as it moves towards the renal interstitium

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16
Q

what loop does vasopressin binding contribute to in order to stop RAAS activation?

a. positive feedback
b. negative feedback

A

b.negative feedback

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17
Q

what type of receptor are V2 receptors?

a. muscarinic
b. nicotinic
c. G coupled

A

c. G coupled

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18
Q

where are V2 receptors found?

a. distal convuluted tubule
b. proximal convuluted tubule
c. basolateral membrane of prinicipal cels of collecting duct
d. justaglomerular cells of the afferent arteriole

A

c. basolateral membrane of prinicipal cels of collecting duct

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19
Q

vasopressin binding leads to migration of vesicles containing water channels to the apical membrane via which two substances?

a. adenylyl cyclase and protein kinase B
c. aldosterone and protein kinas A
d. protein kinase A and adenyl cyclase

A

d. protein kinase A and adenyl cyclase

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20
Q

vesicles containing APQ-2 (water channels) migrate to the apical membrane due to the binding of which substance?

a. aldosterone
b. agt 2
c. agt 1
d. ADH

A

d. ADH

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21
Q

what do APQ-2 channels do?

a. increase water permeability
b. decrease water permeability
c. increase sodium permeability
d. decrease sodium permeability

A

a.increase water permeability

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22
Q

which type of channels are found in the basolateral membrane allowing passage of water into the hyperosmolar medullary interstitium?

a.AQP -2 and AQP 3
B. aqp 1 and aqp 2
c. AQP 3 and AQP 4

A

c. AQP 3 and AQP 4

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23
Q

how does aft 2 maintain glomerular filtration

a. contract renal mesangium and constricting efferent arteriole
a. relaxing renal mesangium and constricting efferent arteriole
a. contract renal mesangium and relaxing efferent arteriole

A

constricting efferent arteriole

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24
Q

which of agt 2 effects has a more significant effect on the maintainance of glomerular filtration?

a. contraction of renal mesangium
b. binding to V2 receptors
c. constriction of the renal efferent arteriole

A

c. constriction of the renal efferent arteriole

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25
Q

what is affected by renal artery stenosis?

a. glomerular filtration
b. blood flow to the tubule

A

b. blood flow to the tubule
(ischaemia)
puts a strain on the kidney

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26
Q 
which receptor is found in the blood vessels, 
heart, kidney, 
brain, lung, liver, 
adrenal and 
pituitary glands

a. V2
b. Mu
c. AT1
d. AT2
e. B1 adrenoceptor

A

c.AT1

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27
Q

which receptor is found mainly in brain,
reproductive
tissues, heart?
foetal tissues?

a. V2
b. Mu
c. AT1
d. AT2
e. B1 adrenoceptor

A

d.AT2

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28
Q 
which receptor has a role in vasoconstriction; cardiac 
contractility; remodelling of 
heart and vessels; release of 
aldosterone and vasopressin; 
drinking/thirst; noradrenaline 
release; negative feedback on 
renin release

a. V2
b. Mu
c. AT1
d. AT2
e. B1 adrenoceptor

A

c.AT1

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29
Q

which is true of the AT1 receptor agonist potency?

a. Agt 1> agt 2
b. agt 2> agt 3
c. agt 3> aldosterone

A

b. agt 2> agt 3

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30
Q

what drugs prevent metabolism of bradykinins (vasodilator peptide causing release of vasodilator prostaglandins) ?

a. B blockers
b. AT1 receptor antagonists
c. renin inhibitors
d. ACE inhibitors

A

d. ACE inhibitors

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31
Q

what is the role of bradykinin peptide?

a. vasoconstrictor
b. vasodilator

A

b.vasodilator

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32
Q

which of these substances causes release of vasodilator prostaglandins?

a. agt 2
b. aldosterone
c. bradykinins
d. renin inhibitor
e. ace inhibitors

A

c.bradykinins

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33
Q

-kirens

A

renin inhibitors

34
Q

-prils

A

ACE inhibitor

35
Q

-sartans

A

AT1 receptor antagonist

36
Q

-olol

A

B blockers

37
Q

which type of drug reduces peripheral vasodilation, aldosterone and ADH secretion and reduces sympathetic activation

a. Sartans
b. ACE inhibitors
c. AT1 receptor antagonists

A

b.ACE inhibitors

38
Q

which vessels do ACE inhibitors reduce the constrictor action of Agt 2 in?

a. veins and arteries
b. arteries and arterioles
c. veins and capillaries
d. arterioles and capillaries

A

a.veins and arteries

39
Q

peripheral vasodilation by ACE inhibitors is more pronounced in?

a. healthy patients
b. obese patients
c. elderly patients
d. hypertensives

A

d. hypertensives

40
Q

ACE inhibitors reduce sympathetic activation by reducing facilitation of release of which substance by agt2?

a. adrenaline
b. noradrenaline
c. epinephrine
d. norepinephrine

A

b.noradrenaline

41
Q

which function of ACE inhibitors reduces risk of events in atheromatous disease?

a. reduction of glomerular filtration rate
b. peripheral vasodilation
c. reduced aldosterone sceretion
d. reduced sympathetic activation
e. increased bradykinin /prostaglandin vasodilation

A

e.increased bradykinin /prostaglandin vasodilation

42
Q

what enzyme do ACE inhibitors inhibit in order to rduced agt mediated generation of reactive oxygen species?

a. ACE
b. cyclo oxygenase
c. NADPH oxidase

A

c.NADPH oxidase

43
Q

which role of ACE inhibitors is most useful in diabetic neuropathy?

a. reduction of glomerular filtration rate
b. peripheral vasodilation
c. reduced aldosterone sceretion
d. reduced sympathetic activation
e. increased bradykinin /prostaglandin vasodilation

A

a.reduction of glomerular filtration rate

44
Q

true or false ACE inhibitors can reduce vascular, heart and kidney remodelling

a. true
b. false

A

a.true

45
Q

-at

A

metabolite

pro drug activated by liver metabolism

46
Q

how are ace inhibitors cleared?

a. by kidneys
b. by liver
c. by spleen

A

a.by kidneys

47
Q

which ACE inhibitor is most commonly used due to slower onset, longer duration, less rash and taste disturbances?

a. captopril
b. enalapril
c. perindopril

A

c. perindopril

48
Q

patient with type 1 diabetic nephropathy what drug most suitable?

a. Sartans
b. ACE inhibitors
c. AT1 receptor antagonists

A

b.ACE inhibitors

49
Q

hypertensive with type 2 diabetes what is the first line treatment?

a. ACEi / ARB
b. CCB + ACEi/ ARB
c. CCB
d. ACEi/ARB + thiazide like diuretic

A

a.ACEi / ARB

50
Q

what is the first line treatment for patient age 55 yrs with hypertension?

a. ACEi / ARB
b. CCB + ACEi/ ARB
c. CCB
d. ACEi/ARB + thiazide like diuretic

A

c.CCB

51
Q

what is the first line treatment for a patient of black african / african caribbean origin?

a. ACEi / ARB
b. CCB + ACEi/ ARB
c. CCB
d. ACEi/ARB + thiazide like diuretic

A

c. CCB

52
Q

reduced cardiac output and BP triggering compensatory activation of RAAS to mainatin perfusion and promote remodelling leads to which condition?

a. systolic heart failure
b. cardiac myopathy
c. left ventricular hypertrophy

A

a.systolic heart failure

53
Q

what is offered to a patient with heart failure with reduced ejection fraction ?

a. Sartans
b. ACE inhibitors
c. AT1 receptor antagonists

A

b.ACE inhibitors

54
Q

in what group does ACEi have the most significant renal effects?

a. proteinuria
b. microalbuminuria
c. proteinuria and microalbuminuria

A

c.proteinuria and microalbuminuria

55
Q

what is the most common side effect of ACEis?

a. wet cough
b. dry cough
c. fever
d. nausea

A

b.dry cough

56
Q

which side effect is especially common in patients with renovascular disease/ generalised atherosclerosis?

a. dry cough
b. first dose hypotension
c. hyperkalaemia
d. skin rash
e. acute renal failure

A

e.acute renal failure

57
Q

How does ACEi lead to renal artery stenosis?

A

efferent vasodilation
decreased flow and pressure in afferent arteriole
stenosis

58
Q

what needs to be routinely monitored before and after starting/incresing dose of ACE inhibitor?

a. urea and electrolytes
b. sodium
c. blood pressure
d. potassium

A

a.urea and electrolytes

59
Q

which side effect is most common in those with heart failure ?

a. dry cough
b. first dose hypotension
c. hyperkalaemia
d. skin rash
e. acute renal failure

A

b. first dose hypotension

60
Q

skin rash and taste disturbance is most common when taking which ACE inhibitor?

a. captopril
b. enalopril
c. perindopril
d. diazepam

A

a.captopril

61
Q

which of these drugs do ACE inhibitors not interact with?

a. NSAIDS
b. Potassium sparing diuretics
c. CCBs
d. diuretics

A

c. CCBs

62
Q

ACE inhibitors taken in combination with NSAIDS increases risk of which adverse effect?

a. renal impairments
b. hyperkalaemia
c. hyponaturia

A

a.renal impairments

63
Q

what supplements should be avoided with ACEi?

a. sodium
b. potassium
c. iron
d. folic acid

A

b.potassium

64
Q

in what case should ACEi be avoided?

a. pregnancy
b. elderly
c. obese

A

a.pregnancy

//planned pregnancy

65
Q

ARBs

A

at1 receptor antagonists

66
Q

which side effect is avoided with ARBs?

a. dry cough
b. acute renal failure
c. first dose hypotension

A

a. dry cough

do not inhibit bradykinin metabolism

67
Q

how are ARBs cleared?

a. liver
b. kidneys
c. fecal

A

a.liver

68
Q

-sartan

A

ARBs

69
Q

when a patient is intolerant to an ACE inhibitor what should eb given?

a. thiazide like diuretic
b. ARB
c. CCB
d. Renin inhibitor

A

b. ARB

70
Q

patient with ventricular dysfunction post MI, what drug is most appropriate?

a. ACE inhibitor
b. renin inhibitor
d. ARB
e. CCB

A

d. ARB

71
Q

why are ACEi often used before ARB?

a. cost, experience and evidence
b. cost, efficacy and experience
c. side effects, experience and convenience

A

a. cost, experience and evidence

72
Q

which of these are ARBs not contraindicated in?

a. pregnancy
b. aortic stenosis
c. bilateral renal artery stenosis
d. elderly
e. obese

A

e.obese

73
Q

which of these are ARBs not contraindicated in?

a. pregnancy
b. aortic anuerysm
c. bilateral renal artery stenosis
d. history of renal impairment
e. generealised atherosclerosis

A

b. aortic anuerysm

74
Q

whatshould be moitored when checking renal function for a patient on ARBs?

a. serum Na + U and E
b. serum Ca + U and E
c. serum K. + U and E
d. serum Fe + U and E

A

c. serum K. + U and E

before and after

75
Q

what should ARBs be avoided in?

b. people at high risk of ischaemic heart disease
c. people with heart failure
d. post MI with ventricular dysfunction
e. aortic stenosis

A

e. aortic stenosis

76
Q

which side effect other than dry cough is less pronounced in ARBs than ACEi?

a. skin rash
b. taste disturbance
c. first dose hypotension
d. acute renal failure
e. hyperkalaemia

A

c.first dose hypotension

77
Q

what two drugs combined make up enteresto ( a dual NEP enzyme/ angiotensin receptor inhibitor?

a. catopril and losartan
b. sacubitril and valsartan
c. verapamil and valsartan

A

b.sacubitril and valsartan

78
Q

what does neprilysin enzyme do?

a. metabolises vasodilator peptides
b. antagonises agt2
c. converts agt 1 to agt 2
d. vasodilator peptide

A

a.metabolises vasodilator peptides

79
Q

which of these drugs will inhibit neprilysin enzyme so prevent metabolism of vasodilator peptides?

a. salbutomol
b. valsartan
c. sacubitril
d. enteresto

A

d.enteresto

80
Q

what should be given in replacement of ACE/ARB if ejection fraction in HF <35%
?

a. CCB
b. Thiazide like diuretic
c. beta blocker
d. ARNI

A

d. ARNI

BCR 1 (60 decks)

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