Hypertension

Question 1

Typically uses what approach?

Answer 1

ABCD

Question 2

What do angiotensin converting enzyme inhibitors end in?

Answer 2

-pril

Question 3

e.g. of ace inhibitors

Answer 3

captopril, enalapril, perindopril, ramipril

Question 4

How do ACE inhibitors work

Answer 4

by blocking conversion of angiotensin I to angiotensin II by inhibiting ACE, thus relaxing blood vessels and decreasing the force of cardiac contraction and also o decrease the release of aldosterone from the adrenal cortex leading to sodium loss and potassium retention and block breakdown of bradykinin

Question 5

Common AEs of ACE inhibitors

Answer 5

dry persistent cough (10-20%), metallic taste (captopril), hyperkalaemia, confusion, restlessness, irregular HR, numbness and tingling of lips and limbs, muscle weakness and hypotension (common with first dose). Administer at night to avoid dizziness and syncope

Question 6

Clinical considerations of ACE inhibitors

Answer 6

avoid use with potassium supplements and spironolactone. When commencing treatment, start with the lowest dose.

Question 7

What to check before administering ace inhibitors

Answer 7

Renal function and electrolyte levels should be checked prior to administration and reviewed after 1-2 weeks

Question 8

Angiotensin II receptor blockers end in what

Answer 8

-artan

Question 9

E.g. of Angiotensin II receptor blockers

Answer 9

losartan, candesartan, irbesartan

Question 10

How do angiotensin II receptor blockers work?

Answer 10

By blocking binding of angiotensin II to angiotensin (AT1) receptors reducing vasoconstriction, blocking the release of aldosterone from adrenal cortex increasing sodium loss and potassium retention

Question 11

Common AEs of angiotensin II receptor blockers

Answer 11

hypotension, dizziness headache, hyperkalaemia, GI disturbances. The incidence of cough is less when compared to ACR inhibitors, however the clinical considerations are the same

Question 12

Alpha blockers end in

Answer 12

-osin

Question 13

Types of alpha blockers

Answer 13

There are alpha-adrenoceptors alpha1 and alpha2 medications

Question 14

Selective alpha1 blockers are

Answer 14

antagonists and include prazosin and terazosin

Question 15

Non-selective blockers are

Answer 15

both antagonist and agonist and include phentolamine (pheochromocytoma)

Question 16

mechanism of action of alpha1 blocker

Answer 16

block alpha1 receptors on arterioles and venules, reducing systemic vascular resistance, thus decreasing BP

Question 17

AEs of alpha1 blockers

Answer 17

o postural hypotension, nasal congestion, pupil constriction, fatigue, diarrhoea
 Hypotension is common on the first dose
 In older people there may be fluid depletion and diuretics
 The patient should slowly rise from a laying/sitting position to minimise postural hypotension
 Medications should start at a low dose at bedtime to avoid this complication

Question 18

Beta blockers end in

Answer 18

-lol

Question 19

beta1 blockers block

Answer 19

beta1 receptors causing decrease in the heart rate and force of contraction and decreases renin release

Question 20

beta2 blockers block

Answer 20

beta2 receptors causing bronchoconstriction, peripheral vasoconstriction and impaired insulin release (chronic use increases the risk of diabetes mellitus)

Question 21

E.g. of beta1 blockers that are cardio-selective

Answer 21

atenolol, bisoprolol and metoprolol

Question 22

E.g. of beta1 blockers that are non-cardio-selective (block beta1 and 2)

Answer 22

include carvedilol, pindolol and propranolol

Question 23

AEs of beta blockers

Answer 23

o bradycardia, hypotension, impaired peripheral circulation (cold extremities), vivid dreams, erectile dysfunction in males
 Treatment may mask hypoglycaemic symptoms (palpitations, tremor, hunger) in diabetic patients
 Abrupt withdrawal can also cause rebound HT

Question 24

Contraindications for beta blockers

Answer 24

asthma, COPD, bradycardia, cardiogenic shock, severe hypotension and diabetes

Question 25

If there is a need to reduce the dose…

Answer 25

always do it slowly to prevent rebound HT

Question 26

When is it best to administer beta blockers

Answer 26

in the morning to avoid vivid dreams (consider atenolol as it is less likely to enter the brain)

Question 27

calcium channel blockers end in

Answer 27

-pine

Question 28

e.g. of calcium channel blockers

Answer 28

amlodipine, felodipine, nifedipine, diltiazem, verapamil

Question 29

what do calcium channel blockers do

Answer 29

Act by blocking movement of calcium into cells (block L-type calcium channels) which relax muscle, cardiac contractility, cardiac conduction and vascular tone

Question 30

Which calcium channel blockers work on vascular smooth muscle

Answer 30

nifedipine

Question 31

Which calcium channel blockers work on cardiac and vascular muscle

Answer 31

diltiazem and verapamil. Verapamil has a greater effect in AV node function when compared to diltiazem

Question 32

AEs of calcium channel blockers

Answer 32

headache, hypotension, dizziness, palpitations, facial flushing and skin rashes

Question 33

Contraindications of calcium channel blockers

Answer 33

cardiogenic shock

Question 34

E.g. of potassium-sparing diuretics

Answer 34

spironolactone and amiloride

Question 35

What does spironolactone do

Answer 35

Inhibits sodium absorption in the distal tubule by blocking sodium channels and aldosterone.
It interferes with the sodium/potassium exchange causing sodium excretion and a decrease in urinary potassium excretion

Question 36

What does amiloride do

Answer 36

acts independently of aldosterone and inhibits sodium reabsorption in the distal convoluted tubule which decreases water retention

Question 37

AEs of potassium-sparing diuretics

Answer 37

hyperkalaemia, gynaecomastia in men, postmenopausal bleeding in women.

Question 38

What to avoid when taking potassium-sparing diuretics

Answer 38

Avoid potassium supplements and ACE inhibitors

Question 39

Clinical considerations for potassium-sparing diuretics

Answer 39

monitoring potassium levels

Question 40

Contraindications of potassium-sparing diuretics

Answer 40

patients with hyperkalaemia

Question 41

A once-daily dose of a potassium-sparing diuretic may

Answer 41

prevent nocturia

Question 42

Approaches to hypertensive management depends on

Answer 42

the presence of other coexisting factors

Question 43

treatment of mild to moderate HT usually starts with

Answer 43

One drug e.g. a diuretic or a beta-blocker

Question 44

If the BP remains above the target, consider

Answer 44

other factors such as nonadherence

Question 45

when one drug is only partially successful in lowering the BP, it is preferable to try

Answer 45

a combo of drugs rather than a higher dose of the one drug

Question 46

the combos that are effective and pharmacologically complementary are:

Answer 46

 A diuretic with either a beta-blocker or an ACE inhibitor

 A calcium channel blocker with either a beta-blocker or an ACE inhibitor