Antihypertensive Agents

Question 1

Diuretics

1) How effective are they?
2) How do they work?

Answer 1

1) lower BP 10-15 mmHG

2) deplete body sodium stores

Question 2

Chlorothiazide

1) Use
2) Mechanism of action
3) Major side effects

Answer 2

1) First line therapy for mild to moderate HTN with normal renal and cardiac function
2) Inhibits sodium-chloride transporter in the distal tubule and early collecting duct
3) Hypokalemia, hyperglycemia

Question 3

Chlorthalidone

1) Use
2) Mechanism of action
3) Major side effects

Answer 3

1) First line therapy for mild to moderate HTN with normal renal and cardiac function
2) Inhibits sodium-chloride transporter in the distal tubule and early collecting duct
3) Hypokalemia, hyperglycemia

Question 4

Hydrochlorothiazide

1) Use
2) Mechanism of action
3) Major side effects

Answer 4

1) First line therapy for mild to moderate HTN with normal renal and cardiac function
2) Inhibits sodium-chloride transporter in the distal tubule and early collecting duct
3) Hypokalemia, hyperglycemia

Question 5

Furosemide

1) Use
2) Mechanism of action
3) Major side effects

Answer 5

1) Severe HTN, renal insufficiency, cardiac failure
2) Acts upon Na/K/2Cl in the thick loop of Henle
3) Hypokalemia, ototoxicity

Question 6

Torsemide

1) Use
2) Mechanism of action
3) Major side effects

Answer 6

1) Severe HTN, renal insufficiency, cardiac failure
2) Acts upon Na/K/2Cl in the thick loop of Henle
3) Hypokalemia, ototoxicity

Question 7

Ethacrynic acid

1) Use
2) Mechanism of action
3) Major side effects

Answer 7

1) Severe HTN, renal insufficiency, cardiac failure
2) Acts upon Na/K/2Cl in the thick loop of Henle
3) Hypokalemia, ototoxicity

Question 8

Bumetanide

1) Use
2) Mechanism of action
3) Major side effects

Answer 8

1) Severe HTN, renal insufficiency, cardiac failure
2) Acts upon Na/K/2Cl in the thick loop of Henle
3) Hypokalemia, ototoxicity

Question 9

Spironolactone

1) Use
2) Mechanism of action
3) Side effects

Answer 9

1) Avoid excessive potassium depletion and enhance effects of other diuretics
2) Bind to mineralocorticoid receptors and blunt aldosterone activity to act on the collecting duct and tubules
3) hyperkalemia, hyperchloremic acidosis

Question 10

Eplerenone

1) Use
2) Mechanism of action
3) Side effects

Answer 10

1) Avoid excessive potassium depletion and enhance effects of other diuretics
2) Bind to mineralocorticoid receptors and blunt aldosterone activity to act on the collecting duct and tubules
3) hyperkalemia, hyperchloremic acidosis

Question 11

Amiloride

1) Use
2) Mechanism of action
3) Side effects

Answer 11

1) Avoid excessive potassium depletion and enhance effects of other diuretics
2) Inhibit Na influx through luminal channels in the collecting duct and tubules
3) hyperkalemia, hyperchloremic acidosis

Question 12

Triamterene

1) Use
2) Mechanism of action
3) Side effects

Answer 12

1) Avoid excessive potassium depletion and enhance effects of other diuretics
2) Inhibit Na influx through luminal channels in the collecting duct and tubules
3) hyperkalemia, hyperchloremic acidosis

Question 13

Aliskiren

1) Use
2) Mechanism of action

Answer 13

1) Hypertension

2) Oran renin inhibitor

Question 14

Catopril

1) Use
2) Mechanism of action

Answer 14

1) Hypertension
2) ACE inhibitor = Inhibits conversion of angiotensin to angiotensin II to aldosterone AND inhibits breakdown of bradykinin

Question 15

Enalapril

1) Use
2) Mechanism of action

Answer 15

1) Hypertension
2) ACE inhibitor = Inhibits conversion of angiotensin to angiotensin II to aldosterone AND inhibits breakdown of bradykinin

Question 16

Fosinopril

1) Use
2) Mechanism of action

Answer 16

1) Hypertension
2) ACE inhibitor = Inhibits conversion of angiotensin to angiotensin II to aldosterone AND inhibits breakdown of bradykinin

Question 17

Lisinopril

1) Use
2) Mechanism of action

Answer 17

1) Hypertension
2) ACE inhibitor = Inhibits conversion of angiotensin to angiotensin II to aldosterone AND inhibits breakdown of bradykinin

Question 18

What are three side effects of ACE inhibitors?

Answer 18

Dry cough from increased bradykinin levels
Hyperkalmeia
Angioedema
Hypotension in the presence of hypovolemia

Question 19

What are the effects of ACE inhibitors on CO and HR

Answer 19

Remain unchanged

Question 20

What are additional benefits of ACE inhibitors?

Answer 20

1) Improved renal hemodynamics in renal disease
2) decreased hypertrophy and remodeling in MI and HF
3) protects from diabetic nephropathy

Question 21

Losartan

1) Use
2) Mechanism of action

Answer 21

1) Hypertension

2) AT1 receptor antagonists causing vasodilation and increased sodium and water excretion

Question 22

Valsartan

1) Use
2) Mechanism of action

Answer 22

1) Hypertension

2) AT1 receptor antagonists causing vasodilation and increased sodium and water excretion

Question 23

Candesartan

1) Use
2) Mechanism of action

Answer 23

1) Hypertension

2) AT1 receptor antagonists causing vasodilation and increased sodium and water excretion

Question 24

Irbesartan

1) Use
2) Mechanism of action

Answer 24

1) Hypertension

2) AT1 receptor antagonists causing vasodilation and increased sodium and water excretion

Question 25

What are the side effects of ARBs?

Answer 25

Same as ACEs, but reduced cough and angioedema

Question 26

Propranolol 1) Use 2) Mechanism 3) Effect on CO

Answer 26

1) Hypertension 2) Non-selective B1-B2 receptor antagonist 3) Decreases CO by decreasing HR and contractility

Question 27

Metoprolol 1) Use 2) Mechanism 3) Effect on CO

Answer 27

1) Hypertension 2) Selective B1 receptor antagonist 3) Decreases CO by decreasing HR and contractility

Question 28

Atenolol 1) Use 2) Mechanism 3) Effect on CO

Answer 28

1) Hypertension 2) Selective B1 receptor antagonist 3) Decreases CO by decreasing HR and contractility

Question 29

1) What are the side effects of beta blockers? | 2) Who should avoid beta blockers?

Answer 29

1) Nausea/vomiting, dizziness, sleep disorders with propranolol 2) Asthmatics, PVD, cardiac conduction delay

Question 30

Prazosin 1) Use 2) Mechanism

Answer 30

1) HTN and pheochromocytoma | 2) blockade of a1 receptors --> dilation of arterioles and capacitance veins

Question 31

Terazosin 1) Use 2) Mechanism

Answer 31

1) HTN and pheochromocytoma | 2) blockade of a1 receptors --> dilation of arterioles and capacitance veins

Question 32

Doxazosin 1) Use 2) Mechanism

Answer 32

1) HTN and pheochromocytoma | 2) blockade of a1 receptors --> dilation of arterioles and capacitance veins

Question 33

What are the side effects of a1 antagonists?

Answer 33

Reflex tachycardia, fluid retention, orthostatic hypotension

Question 34

Labetalol 1) Use 2) Mechanism

Answer 34

1) Hypertensive emergencies IV, HTN orally | 2) B blocking and vasodilating effects of combined a and B antagonism (B>a)

Question 35

Carvedilol 1) Use 2) Mechanism

Answer 35

1) Reducing mortality in HF, HTN | 2) B blocking and vasodilating effects of combined a and B antagonism (1:1 ratio B:a)

Question 36

Clonidine 1) Use 2) Mechanism

Answer 36

1) resistant hypertension | 2) stimulate presynaptic a2 receptors decreases sympathetic outflow and baroreceptor response

Question 37

Methyldopa 1) Use 2) Mechanism

Answer 37

1) pregnancy induced hypertension | 2) stimulate presynaptic a2 receptors decreases sympathetic outflow and baroreceptor response

Question 38

Nifedipine 1) Use 2) Mechanism

Answer 38

1) HTN esp. w low renin, AA with systolic hypertension | 2) Block voltage sensitive L-type Ca++ channels in the vascular smooth muscle

Question 39

Nimodipine 1) Use 2) Mechanism

Answer 39

1) HTN esp. w low renin, AA with systolic hypertension | 2) Block voltage sensitive L-type Ca++ channels in the vascular smooth muscle

Question 40

Amlodipine 1) Use 2) Mechanism

Answer 40

1) HTN esp. w low renin, AA with systolic hypertension | 2) Block voltage sensitive L-type Ca++ channels in the vascular smooth muscle

Question 41

Verapamil 1) Use 2) Mechanism

Answer 41

1) HTN esp. with low renin | 2) Block voltage sensitive L-type Ca++ channels in the heart (cardiac and AV node selective)

Question 42

Benzothiazepine 1) Use 2) Mechanism

Answer 42

1) HTN esp. with low renin | 2) Block voltage sensitive L-type Ca++ channels in the heart (cardiac and AV node selective)

Question 43

``` What are the effects on: 1) PVR 2) Baroreceptor Reflex 3) HR when using calcium channel blockers? ```

Answer 43

1) decrease PVR 2) decreased baroreceptor reflex increases in HR 3) decreased HR

Question 44

Hydralazine 1) Use 2) Mechanism

Answer 44

1) mild to moderate HTN in combination with diuretic and B-blocker 2) acts through the release of NO (NO required)

Question 45

Minoxidil 1) Use 2) Mechanism

Answer 45

1) resistant HTN in combination with diuretic and B-blocker | 2) opens K channels and hyperpolarizes the cell, closing Ca++ voltage gated channels

Question 46

Nitroprusside 1) Use 2) Mechanism

Answer 46

1) Produce hypotension in surgery and HTN emergencies | 2) direct vasodilation by generating NO, increasing cGMP

Question 47

Nitroglycerin 1) Use 2) Mechanism

Answer 47

1) Cardiac surgery and HTN emergencies | 2) generates NO increasing cGMP --> vasodilation with preferential effect on veins over arteries**

Question 48

Epoprostenol 1) Use 2) Mechanism

Answer 48

1) Primary pulmonary HTN | 2) synthetic analog of prostacyclin (PGI2) --> direct vasodilation and counteracts thromboxane A2

Question 49

Bosentan 1) Use 2) Mechanism

Answer 49

1) Primary pulmonary HTN | 2) Non-selective Endothelin receptor blocker

Question 50

Ambrisentan 1) Use 2) Mechanism

Answer 50

1) Primary pulmonary HTN | 2) Selective endothelia receptor blocker of ETa receptor