Antihypertensives

Question 1

MOA Diuretics

Answer 1

-Inhibits reabsorption of sodium and water
-Works on volume of blood and SVR

Question 2

Three types of diuretics

Answer 2

1. Thiazide like: Hydrochlorothiazide,, chlorthalidone, Indapamide
2. Loop diuretics: furosemide
3. Mineralocorticoid receptor antagonist: spironolactone

Question 3

Key notes of diuretics

Answer 3

-1st line therapy Thiazide for uncomplicated hypertension
-Don’t start initial therapy on potassium sparing

-S/E: Hypotension, weakness, hypokalemia, hyponatremia, hyperuricemia, hyperglycaemia, hyperlipidimia

Question 4

Contraindication to diuretics

Answer 4

-Sulpha allergy, gout, anuria, hyponatremia

Question 5

MOA of ACE “pails”

Answer 5

-Blocks angiotensin II (prevents absorption of sodium and water)
-Works on volume of blood and SVR

Question 6

Key notes of ACE

Answer 6

-1st line therapy in non-black patients with uncomplicated HTN and for patients with DM, ischemic heart disease, recent MI, HF, or CKD

-S/E: dry cough (switch to ARB), hyperkalemia, angioedema very rare, can worsen renal failure, volume depletion or those receiving NSAIDS (hypotension effect)

Question 7

Contraindication to ACE

Answer 7

-Pregnancy
-Artery stenosis
-Hx of angioedema

Question 8

MOA of ARBs “sartan”

Answer 8

-Blocks angiotensin II (prevents absorption of sodium and water)
-Works on volume of blood and SVR

Question 9

Key notes of ARBS

Answer 9

-1st line therapy in non-black patients with uncomplicated HTN and for patients with DM, ischemic heart disease, recent MI, HF, or CKD

-S/E: hyperkalemia, can worsen renal failure, volume depletion or those receiving NSAIDS (hypotension effect)

-DO NOT USE ARBS and ACE together for HTN risk of hyperkalemia and renal impairment

Question 10

Contraindication to ARBs

Answer 10

-Pregnancy
-Artery stenosis
-Hx of angioedema

Question 11

MOA of Beta blockers “lol”

Answer 11

-Blocks beta receptors in the heart causing reduced heart rate and contractility
-Decrease renin secretion so less angiotensin II and aldosterone
-Works on heart rate, contractility and SVR

Question 12

Examples of beta blockers

Answer 12

-Non selective (nadolol, propranolol, sotalol, timolol): can be helpful in comorbid migraines, stage fright, tremor, tachycardia

-Beta 1 cardioselective (metoprolol, atenolol, bisoprolol, acebutolol)

-Non selective combo B and alpha 1 blocker (carvedilol, labetalol)

Question 13

Key notes on beta blockers

Answer 13

-1st line in patients <60 years or who have stable angina, HF or history of MI

-Not as effective as ACE/ARBS or diuretics as initial therapy for patients >60 years

-S/E: fatigue, bradycardia, decrease exercise capacity, less common (hyperglycaemia, depression, heart failure, heart block)

Question 14

Contraindications to beta blockers

Answer 14

-Severe asthma/COPD, PVD, 2/3 degree blocks, decompensated HF

Question 15

MOA of calcium channel blockers “dipine”

Answer 15

-Relaxes smooth muscles by blocking calcium binding to receptors in muscle
-works on heart contractility and SVR

Question 16

Examples of calcium channel blockers

Answer 16

-Non-dihydropyridine (non-DHP): verapamil, diltiazem

-DHP: amlodipine, felodipine, nifedipine

Question 17

Key notes of calcium channel blockers

Answer 17

-Long acting CCBs DHP are first line
-Short acting nifedipine should not used, only used in acute management of HTN

-S/E: ankle edema, flushing

Question 18

Contraindication of CCBs

Answer 18

-recent MI, 2nd or 3rd degree AV block, pulmonary edema, does not block other forms of calcium in dietary