3. Hypertension

Question 1

What are the actions of angiotensin-II?

Answer 1

Vasoconstriction
Stimulation of aldosterone which acts at distal renal tubule
Cardiac and vascular muscle cell growth
ADH release from posterior pituitary

Question 2

What do ACE-i do?

Answer 2

Limit conversion of angiotensin-I o angiotensin-II by inhibiting circulating and tissue ACE

Question 3

What does a reduction in angiotensin-II activity result in?

Answer 3

Vasodilation
Reduction in aldosterone release
Reduced AD release
Reduced cell growth and proliferation 
All contributing to antihypertensive effects

Question 4

What are the most common ACEi?

Answer 4

LisinoPRIL

RamiPRIL

Question 5

What are some adverse affects to ACEi?

Answer 5

Hypotension
Dry cough (bradykinin association)
Hyperkalaemia (low aldosterone)
Cause or worsen renal failure
Angioedema

Question 6

What are the contradictions of ACEi?

Answer 6

Renal artery stenosis
AKD
Pregnancy
CKD
Idiopathic angioedema

Question 7

What are the important drug interactions with ACEi?

Answer 7

Hyperkalaemic drugs
NSAIDs
Other antihypertensive agents

Question 8

What are the most common angiotensin-II and receptor antagonists (ARBs) prescribed?

Answer 8

CandeSARTAN

LoSARTAN

Question 9

What are some adverse effects with ARBs?

Answer 9

Hypotension
Hyperkalaemia
Cause or worsen renal failure

Question 10

What are the contraindications for ARBs?

Answer 10

Renal artery stenosis
AKD
Pregnancy
CKD

Question 11

What are some important drug interactions with ARBs?

Answer 11

Hyperkalaemic drugs

NSAIDs

Question 12

What are L-type calcium channels?

Answer 12

Allow inward Ca2+ flux into cells - voltage operated calcium channel
Expressed throughout the body, including vascular smooth muscle cells and cardiac myocytes plus SA and AV node

Question 13

What is the role of calcium channel blockers?

Answer 13

Target calcium initiated smooth muscle contraction

Question 14

What are the 2 main categories of calcium channel blockers?

Answer 14

Dihydropyridines

Non-dihydropyridines (phenylalkylamines and benzothiazepines)

Question 15

What is the role of dihydropyridines?

Answer 15

Selective for peripheral vasculature

Little chronotropic or inotropic effects

Question 16

What is the role of phenylalkylamines?

Answer 16

Depresses SAN and slows AV conduction, negative inotropy

Question 17

When are CCBs usually given?

Answer 17

Primary choice antihypertensive in low renin patients

Question 18

Gives some examples of dihydropyridines?

Answer 18

AmlodIPINE
NifedIPINE
NimodIPINE

Question 19

What is nimodipine useful for?

Answer 19

Selectivity for cerebral vasculature so useful for ischaemic effects of subarachnoid haemorrhage

Question 20

What are the adverse effects of dihydropyridine drugs?

Answer 20

Ankle swelling
Flushing
Headaches
Palpitations

Question 21

What are the contraindications for dihydropyridine drugs?

Answer 21

Unstable angina

Severe aortic stenosis

Question 22

What are some important drug interactions with dihydropyridine drugs?

Answer 22

Amlodipine + simvastatin (increased effect of statin)

Question 23

Name the phenylalkylamines drug

Answer 23

Verapamil

Question 24

What is phenylalkylamines used for?

Answer 24

Arrhythmia
Angina
Hypertension

Question 25

What are the adverse effects of phenylalkylamines?

Answer 25

Constipation Bradycardia Heart block Cardiac failure

Question 26

What are the contraindications for phenylalkylamines?

Answer 26

Poor LV function | AV nodal conduction delay

Question 27

What are the important drug interactions with phenylalkylamines?

Answer 27

Beta blockers | Other antihypertensive and antiarrhythmic agents

Question 28

Name a benzothiazapine

Answer 28

Diltiazem

Question 29

Name a thiazide diuretic

Answer 29

Bendroflumethiazide

Question 30

Name a thiazide-like diuretic

Answer 30

Indapamide

Question 31

What do thiazide and thiazide-like diuretics do?

Answer 31

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

Question 32

What are the adverse effects of thiazide and thiazide-like diuretics?

Answer 32

``` Hypokalaemia Hyponatraemia Hyperuricemia (gout) Arrhythmia Increased glucose Small increase in cholesterol and triglyceride ```

Question 33

What are the contraindications for thiazide and thiazide-like diuretics?

Answer 33

Hypokalaemia Hyponatraemia Gout

Question 34

What are the important drug interactions with thiazide and thiazide-like diuretics?

Answer 34

NSAIDs | Decrease K+ drugs such as loop diuretics

Question 35

What drug is given in resistant hypertension?

Answer 35

Spironolactone - aldosterone receptor antagonist

Question 36

What are the adverse effects of spironolactone?

Answer 36

Hyperkalaemia | Gynaecomastia

Question 37

What are the contraindications of spironolactone?

Answer 37

Hyperkalaemia | Addison’s

Question 38

What are the important drug interactions with spironolactone?

Answer 38

Increased K+ drugs | Pregnancy

Question 39

What is the role of beta-adrenoceptor blockers?

Answer 39

Decrease sympathetic tone by blocking NA and reducing myocardial contraction resulting in reduced cardiac output Decreased renin secretion

Question 40

What are the adverse effects of beta-adrenoceptor blockers?

Answer 40

``` Bronchospasm Heart block Raynaud’s Lethargy Impotence Mask tachycardia ```

Question 41

What are the contraindication for beta-adrenoceptor blockers?

Answer 41

Asthma COPD Haemodynamic instability Hepatic failure

Question 42

What are the important drug interactions with beta-adrenoceptor blockers?

Answer 42

Non-dihydropyridine CCBs verapamil and diltiazem

Question 43

Name some beta-adrenoceptor blockers

Answer 43

LabetaLOL BisoproLOL MetoproLOL

Question 44

Name a alpha-adrenoceptor blocker

Answer 44

DoxazOSIN

Question 45

What is the role of alpha-adrenoceptor blockers?

Answer 45

Reduce peripheral vascular resistance | Selective antagonism of alpha-1 adrenoceptors

Question 46

What are the adverse effects of alpha-adrenoceptor blockers?

Answer 46

``` Postural hypotension Dizziness Syncope Headache Fatigue ```

Question 47

What are the contraindications for alpha-adrenoceptor blockers?

Answer 47

Postural hypotension

Question 48

What are the important drug interactions with alpha-adrenoceptor blockers?

Answer 48

Dihydropyridine CCBs - oedema