Hypertension

Question 1

Give some examples of ACEi:

Answer 1

-ramipril
-lisinopril
Limit conversion of angiotensin 1 to angiotensin 2
-reduced angiotensin 2 means vasodilation, reduced aldosterone release, reduced ADH release and less cell proliferation and growth

Question 2

Function of angiotensin 2:

Answer 2

• vasoconstriction
• increase ADH release from posterior pituitary
• increased aldosterone release from adrenal cortex (zone glomerulosa) which acts on distal tubule
• increased cardiac and vascular cell proliferation and growth

Question 3

What is Ag2 also produced by?

Answer 3

Chymases regardless of ACE

Question 4

Adverse effects for ACEi

Answer 4

• hypotension
• dry cough (due to bradykinin potentiation)
• hyperkalaemia
• cause or worsen renal failure
• angioedema

Question 5

Contraindications for ACEi

Answer 5

• renal artery stenosis
• aki/ckd
• pregnancy
• idiopathic angioedema

Question 6

Drug interactions for ACEi

Answer 6

• drugs that increase K+
• NSAIDs (as these stop prostaglandin synthesis which are powerful vasodilators)
• other antihypertensive agents

Question 7

Examples of ARBs

Answer 7

Candesartan and Losartan

-directly target AT1 receptors, more effective at inhibiting Ag11 mediated vasoconstriction than ACEi due to chymases

Question 8

Adverse effects of ARBs

Answer 8

• hypotension
• hyperkalaemia
• cause/worsen renal failure

Question 9

Contraindications for ARBs

Answer 9

• renal artery stenosis
• pregnancy
• aki/ckd

Question 10

Drug interactions for ARBs

Answer 10

• K+ increasing drugs

- NSAIDs

Question 11

Action of CCBs

Answer 11

Target calcium initiated smooth muscle contraction (LTCC expressed in vascular smooth muscle and cardiac myocytes)

Question 12

3 classes of CCBs

-1st choice antihypertensive in low renin patients

Answer 12

Act on different sites of the alpha1 subunit of LTCC

• dihydropyridines: act on peripheral vasculature, no chronotropic/inotropic effects
• non-dihydropyridines: phenylalkylamines and benzothiazipines

Question 13

Examples of dihydropyridines

Answer 13

-amlodipine (long half life), nifedipine, nimodipine (selectivity for cerebral vasculature-usueful for ischaemic effects of subarachnoid haemorrhage)

Question 14

Adverse effects of dihydropyridines

Answer 14

• ankle swelling
• flushing
• headaches
• palpitations (compensatory tachycardia due to low BP)

Question 15

Drug interactions of dihydropyridines

Answer 15

amlodipine with simvastatin- increases effect of statin

Question 16

Contraindications of dihydropyridines

Answer 16

• unstable angina

- severe aortic stenosis

Question 17

Example of phenylakylamines

Answer 17

Verapamil
-class 4 anti-arhythmic agent
–ve chronotropic and ionotropic effect
Used for arrythmias/angina/hypertension

Question 18

Adverse effects of phenylakylamines

Answer 18

• constipation
• bradycardia
• heart block
• cardiac failure

Question 19

Contraindications of phenylakylamines

Answer 19

• poor LV function

- Av nodal conduction delay

Question 20

Drug interactions of phenylakylamines

Answer 20

• B blockers

- other anti-hypertensives/antiarrythmic agents

Question 21

Example of benzothiazepine

Answer 21

Diltiazem