antihypertensive drugs

Question 1

Name four main antihypertensive drug classes.

Answer 1

ACE inhibitors, ARBs, CCBs, thiazide diuretics, beta‑blockers.

Question 2

How do ACE inhibitors lower BP?

Answer 2

Block Ang II formation, reducing vasoconstriction, aldosterone, and sympathetic tone; raise bradykinin → vasodilation.

Question 3

Why do ACE inhibitors cause cough?

Answer 3

Build-up of bradykinin sensitizes airway nerves → dry cough in ~10–20%.

Question 4

How do ARBs differ from ACE inhibitors?

Answer 4

Block Ang II receptor directly, don’t raise bradykinin, and have fewer cough/angioedema side effects.

Question 5

What adverse effects are typical of dihydropyridine CCBs?

Answer 5

Flushing, headache, ankle edema, reflex tachycardia.

Question 6

Adverse effects of non-dihydropyridine CCBs?

Answer 6

Bradycardia, AV block, reduced contractility—use with caution in conduction disease.

Question 7

What are the main side effects of thiazide diuretics?

Answer 7

Hypokalaemia, hyponatraemia, metabolic alkalosis, dehydration, hypotension, hyperglycaemia

Question 8

How do beta-blockers lower BP?

Answer 8

Block β₁ receptors → ↓heart rate, contractility, and AV conduction.

Question 9

In which patients are ACE inhibitors less effective or contraindicated?

Answer 9

Pregnant, bilateral renal artery stenosis, Black Caribbean adults, significant renal impairment.

Question 10

When are ARBs preferred over ACE inhibitors?

Answer 10

In patients intolerant of ACEi (e.g. with cough or angioedema), with similar renal/cardiovascular benefits.

Question 11

What are the ‘pril’ drugs and their class?

Answer 11

ACE inhibitors — captopril, ramipril, enalapril, lisinopril, perindopril, etc.

Question 12

What are the ‘sartan’ drugs and their class?

Answer 12

ARBs — losartan, valsartan, candesartan, olmesartan, irbesartan.

Question 13

What suffix is common to dihydropyridine calcium channel blockers?

Answer 13

“-dipine” (e.g., amlodipine, nifedipine)

Question 14

Give examples of thiazide and thiazide-like diuretics.

Answer 14

Hydrochlorothiazide, bendroflumethiazide, indapamide, chlortalidone.

Question 15

Name common beta-blockers used in hypertension.

Answer 15

Atenolol, bisoprolol, propranolol, metoprolol, carvedilol, labetalol.

Question 16

Which ACE inhibitors are not prodrugs?

Answer 16

Captopril and lisinopril.

Question 17

What is the key PK difference between captopril and ramipril?

Answer 17

Captopril has a shorter half-life; ramipril is a long-acting prodrug.

Question 18

What adverse effect is unique to ACE inhibitors but not common in ARBs?

Answer 18

Dry cough due to bradykinin accumulation.

Question 19

What electrolyte imbalance is caused by thiazides?

Answer 19

Hypokalaemia and hyponatraemia.

Question 20

What are the non-dihydropyridine CCBs?

Answer 20

Verapamil and diltiazem.

Question 21

Which CCBs affect the heart more than vessels?

Answer 21

Non-dihydropyridines (verapamil, diltiazem).

Question 22

What is a major caution when combining beta-blockers with non-dihydropyridine CCBs?

Answer 22

Risk of bradycardia and AV block.

Question 23

What receptor does angiotensin II act on?

Answer 23

AT1 receptor, a Gq-coupled receptor.

Question 24

What is the downstream effect of AT1 receptor activation?

Answer 24

Vasoconstriction, aldosterone release, ADH release, cardiac hypertrophy.

Question 25

What are the beneficial therapeutic outcomes of ACE inhibitors?

Answer 25

Lower BP, reduced cardiac remodeling, renal protection, reduced cardiovascular events.

Question 26

What adverse outcome is associated with ACEi and ARBs in renal artery stenosis?

Answer 26

Worsening renal function or renal failure.

Question 27

When are ACE inhibitors not recommended first-line?

Answer 27

Age >55 or Black African/Caribbean ethnicity due to lower RAAS activity.

Question 28

How should ACEi be monitored?

Answer 28

Regular checks of renal function (creatinine, eGFR) and potassium.

Question 29

What patients are at risk of hypotension on ACEi and need dose titration or stopping?

Answer 29

Dehydrated patients (vomiting, diarrhoea), those with AKI, or on diuretics.

Question 30

Why are ARBs preferred in patients with ACEi-induced cough?

Answer 30

ARBs do not increase bradykinin levels.

Question 31

What diuretic combination may reduce hypokalaemia caused by thiazides?

Answer 31

Add potassium-sparing diuretics or ACEi.

Question 32

Why should beta-blockers be avoided in asthma?

Answer 32

They can cause bronchoconstriction (especially non-selective types like propranolol).

Question 33

Which class should be avoided in pregnancy?

Answer 33

ACE inhibitors and ARBs.

Question 34

What lifestyle advice should be offered alongside antihypertensives?

Answer 34

Diet changes (low salt, DASH diet), exercise, smoking cessation, weight loss, limit alcohol.

Question 35

What should patients on diuretics be monitored for?

Answer 35

Electrolytes (esp. potassium), dehydration symptoms, blood glucose (long term).

Question 36

Differentiate between dihydropyridines and nondihydropyridines.

Answer 36

Dihydropyridines (e.g., amlodipine) mainly cause vasodilation. Non-dihydropyridines (e.g., verapamil, diltiazem) also reduce heart rate and contractility.

Question 37

What are common side effects of dihydropyridines?

Answer 37

Flushing, headache, ankle swelling, reflex tachycardia.

Question 38

When should verapamil and beta-blockers not be used together?

Answer 38

Due to risk of bradycardia and AV block from combined cardiac depression.

Question 39

How do thiazide diuretics reduce blood pressure?

Answer 39

They inhibit Na+/Cl− symporter in the DCT, reducing blood volume and peripheral resistance.

Question 40

What are side effects of thiazide diuretics?

Answer 40

Hypokalaemia, dehydration, hyponatremia, metabolic alkalosis.

Question 41

Name a thiazide-like diuretic.

Answer 41

Indapamide or chlortalidone.

Question 42

How do potassium-sparing diuretics work?

Answer 42

They block ENaC or antagonize aldosterone receptors, reducing K+ loss and sodium reabsorption.

Question 43

Name two potassium-sparing diuretics.

Answer 43

Spironolactone, Amiloride.

Question 44

What is a risk of potassium-sparing diuretics?

Answer 44

Hyperkalaemia, especially with ACE inhibitors or ARBs.

Question 45

What is the mechanism of beta-blockers in hypertension?

Answer 45

Block β1-receptors, decreasing heart rate, contractility, and renin release.

Question 46

Name 3 beta-blockers.

Answer 46

Bisoprolol, Atenolol, Propranolol.

Question 47

When should beta-blockers be avoided or used cautiously?

Answer 47

In bradycardia, heart block, and with non-dihydropyridine CCBs like verapamil.

Question 48

Describe a drug-target interaction for ACE inhibitors.

Answer 48

ACE inhibitors bind to and inhibit the zinc-dependent ACE enzyme, preventing Ang II production.

Question 49

What is a non-specific outcome of ACE inhibitors?

Answer 49

Bradykinin accumulation leading to cough or angioedema.

Question 50

Which hypertensive drugs are contraindicated in pregnancy?

Answer 50

ACE inhibitors, ARBs, and renin inhibitors.

Question 51

What clinical assessments should be done before starting ACE inhibitors or ARBs?

Answer 51

Renal function (serum creatinine, eGFR) and serum potassium levels.