Hypertension

Question 1

Beta Blocker - Types (5)

Answer 1

Cardio-selective
Non-selective
Water soluble
Lipid soluble
Intrinsic sympathetic activity

Question 2

Atenolol
(Tenormin)

Answer 2

Cardio-selective BB
Higher affinity for cardiac B1 recepetor
Lower affinity for bronchial and vascular B2 receptors
(little influence)

Question 3

Labetalol (Trandate)
400-2400mg

Answer 3

Intrinsic sympathetic activity BB
not full agnoist to receptor
cause less bradycardia, less fatigue and less cold extremities

Question 4

Propranolol
(Inderal)

Answer 4

Liquid soluble BB
will enter blood brain barrier and cause CNS side effect

Question 5

Sotalol
(Sotacor)

Answer 5

Water soluble BB
Less likely to enter the brain and cause less sleep disturbance and nightmares

Question 6

Carvedilol
(Dilatrend)

Answer 6

Non-selective BB with additional a-blocking activity
Not effective at all

Question 7

Atenolol
(Tenormin)

Answer 7

Water soluble BB
Less likely to enter the brain and cause less sleep disturbance and nightmares

Question 8

Propanoolol
(Inderal)

Answer 8

Non-selective BB with additional a-blocking activity
Not effective at all

Question 9

Betaxolol
(Betac)

Answer 9

Cardio-selective BB
Higher affinity for cardiac B1 recepetor
Lower affinity for bronchial and vascular B2 receptors
(little influence)

Question 10

Bisoprolol
(Concor)

Answer 10

Cardio-selective BB
Higher affinity for cardiac B1 recepetor
Lower affinity for bronchial and vascular B2 receptors
(little influence)

Question 11

Esmolol
(Brevibloc)

Answer 11

Cardio-selective BB
Higher affinity for cardiac B1 recepetor
Lower affinity for bronchial and vascular B2 receptors
(little influence)

Question 12

Metoprolol
(Betaloc)

Answer 12

Cardio-selective BB
Higher affinity for cardiac B1 recepetor
Lower affinity for bronchial and vascular B2 receptors
(little influence)

Question 13

BB side effects

Answer 13

Bradycardia
Bronchospasm
Fatigue, Cold extremities
Nightmare and insomnia
Affect the glucose control in patient with DM
Decrease libido and impotence

Question 14

BB contraindication

Answer 14

Heart block

Question 15

Beta 1 agonist

Answer 15

Heart -> Increase HR and contractility
Kidney->Increase Renin secretion

Question 16

Beta 2 agonist

Answer 16

Skeletal Muscle-> Breakdown of glycogen to glucose
Peripheral Vessel -> Relaxation
Bronchi-> Relaxation

Question 17

Beta Blocker MOA

Answer 17

1) Blocking the B-receptors in the heart—>Decrease contractility of the heart and Cardia output
Decrease BP
2) Decrease renin secretion from the kidneys
Decrease production of angiotensin2
Decrease aldosterone secretion and decrease peripheral resistance and decrease BP

Question 18

Calcium Channel Blocker MOA
@heart, smooth muscle of the coronary and peripheral arteriolar vasculature

Answer 18

1) Decrease calcium influx into vascular smooth muscle cells
->cause relaxation of vascular smooth muscle and vasodilatation
-> Decrease peripheral resistance and BP
2) Decrease Ca influx into myocardial cells
-> Decrease the contractility of the heart
-> Decrease heart rate and cardiac output

Question 19

CCB -type (2)

Answer 19

Dihydropyridines and Non-dihydropyridines

Question 20

Amlodipine (Norvasc)

Answer 20

Dihydropyridines CCB
I : hypertension and angina
have greater affinity for vascular CCB than in heart
More influence on vessel smooth muscle and less on the myocardium
(wukk bit reduce myocardial contractility and do not cause deterioration of hear failure)

Question 21

Felodipine
(Plendil)

Answer 21

Dihydropyridines CCB
I : hypertension and angina
have greater affinity for vascular CCB than in heart
More influence on vessel smooth muscle and less on the myocardium
(wukk bit reduce myocardial contractility and do not cause deterioration of hear failure)

Question 22

Lacidipine
(Lacipil)

Answer 22

Dihydropyridines CCB
I : hypertension and angina
have greater affinity for vascular CCB than in heart
More influence on vessel smooth muscle and less on the myocardium
(wukk bit reduce myocardial contractility and do not cause deterioration of hear failure)

Question 23

Nifedipine
(Adalat/Adalat Retard)

Answer 23

Dihydropyridines CCB
I : hypertension and angina
have greater affinity for vascular CCB than in heart
More influence on vessel smooth muscle and less on the myocardium
(wukk bit reduce myocardial contractility and do not cause deterioration of hear failure)

Question 24

Nimodipine
(Nimotop)

Answer 24

Dihydropyridines CCB
I : hypertension and angina
have greater affinity for vascular CCB than in heart
More influence on vessel smooth muscle and less on the myocardium
(wukk bit reduce myocardial contractility and do not cause deterioration of hear failure)

Question 25

Verapamil (Isoptin)

Answer 25

Non-dihydropyridines CCB used in angina They have effects on both cardiac and vascular smooth muscle cells they will decrease the contraction of the cardiac muscle and produce negative inotropic effect

Question 26

Diltiazem (Herbesser)

Answer 26

Non-dihydropyridines CCB used in angina They have effects on both cardiac and vascular smooth muscle cells they will decrease the contraction of the cardiac muscle and produce negative inotropic effect

Question 27

CCB Side effect

Answer 27

Hypotension Peripheral edema/ ankle edema in chronic use Flushing Headache, dizziness and fatigue Palpitation/tachycardia(reflex) DHP Bradycardia Non-DHP Constipation (especially with verapamil)

Question 28

Use of graphefruit with CCB

Answer 28

Inhibit the hepatic(liver) metabolism of CCB Lead to increase of concentration of CCB Increase side effect especially felodipine, nifedipine

Question 29

Verapamil

Answer 29

can inhibit cytochrome P450 inhibit metabolism of other drugs and increase their effect e.g Digoxin, theophylline, simvastatin, lovastatin, cyclosporin

Question 30

Aliskiren (Rasilez)

Answer 30

Direct Renin Inhibitor directly inhibits renin and results in reduced plasma renin ❌ pregnancy Diarrhoea, cough, angioedema and hyperkalemia