Hypertension and Heart Failure

Question 0

ACE inhibitors mechanism

Answer 0

Competitive inhibitors of ACE
Reduce angiotensin II formation
Cause arteriolar dilation and some venodilation
Reduce aldosterone so promote diuresis

Question 1

Hypertension first line therapy

Answer 1

ACE inhibitors or angiotensin receptor blockers
Calcium channel blockers
Diuretics

Question 2

ACE inhibitors uses

Answer 2

HF, left ventricular dysfunction

Question 3

ACE inhibitors ADRs

Answer 3

Dry cough due to increased bradykinin
Angio oedema
Renal failure
Hyperkalaemia

Question 4

ACE inhibitor contraindications

Answer 4

Care - renal impairment, peripheral vascular disease

Not in pregnancy, renovascular hypertension

Question 5

Lisinopril

Answer 5

ACE inhibitor

Question 6

Ramipril

Answer 6

ACE inhibitor

Question 7

Angiotensin receptor blockers mechanism

Answer 7

Bind to AT1 receptor

Inhibit vasoconstriction and aldosterone stimulation

Question 8

Angiotensin receptor blockers ADRs

Answer 8

Renal failure

Question 9

Angiotensin receptor blockers contraindications

Answer 9

Care - renal impairment, peripheral vascular disease

Not in pregnancy, renovascular hypertension

Question 10

Losartan

Answer 10

Angiotensin receptor blocker

Question 11

Valsartan

Answer 11

Angiotensin receptor blocker

Question 12

Calcium channel blocker mechanism

Answer 12

Bind to specific alpha subunits of L type calcium channel
Reduces calcium entry
Vasodilation of peripheral, coronary and pulmonary arteries
Little effect on veins

Question 13

Calcium channel blocker uses

Answer 13

Angina

Question 14

Dihydropyridines

Answer 14

Class of calcium channel blocker

Question 15

Dihydropyridines pharmacokinetics

Answer 15

Good oral absorption
>90% protein bound
Metabolised by liver
Few have active metabolites

Question 16

Dihydropyridines ADRs

Answer 16

Oedema
SNS activation via baroreceptor reflex - tachycardia, palpitations
Flushing, sweating, headache
Gingival hyperplasia (rare)

Question 17

Rifedipine

Answer 17

Dihydropyridine CCB

Question 18

Amlodipine

Answer 18

Dihydropyridine CCB

Question 19

Phenylalkylamines

Answer 19

Class of CCB
impede calcium transport across myocardial and vascular smooth muscle cell membranes
Peripheral vasodilation
Decreased preload
Decreased contractility
Class 4 anti arrhythmics- prolong refactory period
Verapamil depresses SAN and blocks AVN conductance

Question 20

Phenylalkylamines ADRs

Answer 20

Bradycardia
Constipation
Negative inotrope, worsens heart failure

Question 21

Verapamil

Answer 21

Phenylalkylamines
CCB
Also class 4 antiarrhythmic

Question 22

Benzothiazepines

Answer 22

CCBs
Impede calcium transport across myocardial and vascular smooth muscle membranes 
Prolong AP and refactory period 
Peripheral vasodilation
Reduced preload
Reduced contractility

Question 23

Benzothiazepines ADRs

Answer 23

Negative inotrope, but less than verapamil

Bradycardia

Question 24

CCB contraindications

Answer 24

Care with beta blockers | Not in heart block or heart failure

Question 25

Diltiazem

Answer 25

Benzothiazepines | CCB

Question 26

Alpha blocker mechanism

Answer 26

Selective antagonism at post synaptic alpha 1 receptors Antagonise NA TPR reduced More effective in upright position Benign effects on plasma lipid and glucose

Question 27

Uses of alpha blockers

Answer 27

Safe in renal disease | BPH

Question 28

Contraindications for alpha blockers

Answer 28

Care in postural hypotension, heart failure | Not in urinary incontinence

Question 29

Doxazosin

Answer 29

Alpha blocker

Question 30

Beta blockers mechanism

Answer 30

Reduce HR and CO Developed for angina but found to lower blood pressure Inhibit renin release TPR initially increases, later falls to normal

Question 31

Beta blocker ADRs

Answer 31

``` Bradycardia Lethargy Impaired concentration Reduced exercise tolerance Cold hands ```

Question 32

Beta blocker contraindications

Answer 32

Care in HF, PVD, diabetes Not in asthma, COPD, heart block Not in pregnancy (low blood flow causes intrauterine growth retardation)

Question 33

Alskiren mechanism

Answer 33

Direct renin inhibitor, blocks angiotensinogen conversion to AT1 Reduces plasma renin activity 50-80%

Question 34

Alskiren pharmacokinetics

Answer 34

``` Bioavailability 2.6% T1/2~40 hrs Steady state takes 5-8 days Less than 1% renal excretion 78% unchanged in faeces Not cyp450 ```

Question 35

Alskiren contraindications

Answer 35

Care in HF, hyperkalaemia, Na/h2o deplete, renal impairment/ stenosis Not in pregnancy

Question 36

Alskiren DDIs

Answer 36

Frusemide

Question 37

Centrally acting agents for hypertension

Answer 37

Methyldopa-alpha 2 receptor agonist Moxonidine - imidazoline receptor agonist - alpha 2 effect Cause tiredness, lethargy, depression

Question 38

Dobutamine

Answer 38

Beta receptor agonist Positive inotrope Used in cardiogenic shock or acute reversible heart failure to increase CO

Question 39

Treatment for hypertensive emergency

Answer 39

IV sodium nitroprusside (acts like NO)

Question 40

If stopping beta blockers

Answer 40

Come off slowly- triggers arrhythmia.

Question 41

Candesartan

Answer 41

ARB

Question 42

Target BPs

Answer 42

Systolic 130 in kidney disease 140 in diabetes 150 in normal