Antihypertensives And Heart Failure

Question 1

Give three effects of hyperglycaemia and insulinaemia.

Answer 1

Increased ROS
Decreased NO
Endothelial dysfunction

Question 2

Give four lifestyle changes for pre-hypertension

Answer 2

Less sodium 
More exercise
Less caffiene
Less stress
Less smoking

Question 3

Give four function of ANGII acting at AT1 receptor.

Answer 3

Vasoconstriction
ADH release
Aldosterone secretion
Cardiac and vascular cell growth

Question 4

Give 4 side effects of ACEi.

Answer 4

Dry cough
Angioedema
Renal failure
Hyperkalemia

Question 5

Name two ARBs.

Answer 5

Losartan
Candesartan
(Eprosartan)
(Irbesartan)

Question 6

Why may ARBS be less effective in low renin hypertensives compared to ACEi?

Why are they more effective at inhibiting AngII mediated vasoconstriction?

Give two side effects.

Answer 6

They do not potentiate BK therefore you do not get BK induced NO formation leading to vasodilation.

ACEinhibitors still allow some AngII formation via chymase reaction.

Renal failure and hyperkalemia.

Question 7

Name 2 DHP CCBs.

Name some ADRs.

What is their interaction with simvastatin?

High or low degree of protein binding?

Answer 7

Amlodipine
Nicardipine

Flushing 
Peripheral oedema 
Sweating 
Headache
Gingival enlargement 

Increased plasma concentration of simvastatin.

90% protein bound and metabolised by the liver.

Question 8

Name a PA CCB.

Name 3 ADRs.

Answer 8

Verapamil.

Bradycardia
Constipation
Worsen heart failure (negative inotropy)

Question 9

Name a BTP CCB.

Answer 9

Diltiazem

Bradycardia
Worsen heart failure (negative inotropy)

Question 10

Give two thiazide diuretics.

Side effects?

Answer 10

Bendroflumethiazide
Indapamide

Hypokalemia 
Hyperuricaemia 
Increased urea levels
Impaired glucose tolerance
Increased TAGs and cholesterol 
RAAS activation

Question 11

What should be firstlie in heart failure and diabetics?

Answer 11

ACEi

Question 12

Hypertensive energy?

Answer 12

Nitrates (SNP)

Labetalol

Question 13

Labetalol use?

Answer 13

Gestational hypertension

Can not use ACEi or ARBs.

Question 14

Name an alpha 1 blocker.

Answer 14

Doxazosin

Postural hypotension (baroreceptor reflex blunted)
Headache
Fatigue
Oedema with DHP

Question 15

Name some ADRs of bisoprolol.

Why may you give caution in diabetics?

Why cautious in asthmatics?

Another condition you dont give it in?

Answer 15

Bradycardia
Raynauds
Bronchoconstriction.

Mask tachycardia associated with hypoglycaemia.

Bronchoconstriction

2nd/3rd degree heart block

Question 16

Give two causes of inherited cardiomyopathy.

Answer 16

Congenital hypertrophic CM

Arrhythmogenic RV CM

Question 17

Give to initial lifestyle changes for heart failure.

What should you watch out for when giving spironolactone?

Answer 17

Decreased fluids
Decreased salt

Refractory hyperaldosteronism

Question 18

Why do you want to give a low initial dose of ACEi or ARB in heart failure patients?

Answer 18

Reduce risk of sudden BP fall
Already reduced perfusion to tissues and decreased CO
Especially if taking diuretics.

Question 19

In CHF what should be added in along with ACEi and ARBs.

Why are they used?

Answer 19

B blockers

Reduce heart rate and therefore increase filling time - increase EDV= greater output due to starlings law