Hypertension & Heart Failure

Question 1

What are some examples of ACE inhibitors?

Answer 1

Ramipril
Captopril
Lisinopril

Question 2

How do ACE inhibitors exert their actions?

Answer 2

Inhibit ACE therefore preventing conversion of Angiotensin I to Angiotensin II

Question 3

What are the effects of ACE inhibitors?

Answer 3

Reduction in blood pressure

Vasodilation
Reduction in aldosterone release
Reduction in ADH release
Reduced cell growth and proliferation

Question 4

What is the effect of ACE inhibitors on bradykinin?

Answer 4

Prevents breakdown

Build up of bradykinin => vasodilation via NO

Question 5

What are some side effects of ACE inhibitors?

Answer 5

Persistent dry cough (bradykinin build up)
Angioedema
Renal failure
Hyperkalaemia

Question 6

What are some examples of Angiotensin II receptor blockers?

Answer 6

Losartan
Candesartan
Eprosartan

Question 7

How do ARBs exert their effects?

Answer 7

Block AT1 receptors

Inhibit Ang-II mediated vasoconstriction

Question 8

What are some side effects of ARBs?

Answer 8

Renal failure

Hyperkalaemia

Question 9

What are different classes of calcium channel blockers?

Answer 9

Dihydropyridine

Non-dihydropyridine

Question 10

How do dihydropyridine CCBs act?

Answer 10

More selective for peripheral vasculature

Have little chronotropic or inotropic effect

Question 11

What are some examples of dihydropyridine CCBs?

Answer 11

Amlodipine

Nifedipine

Question 12

What are some adverse effects of dihydropyridine CCBs?

Answer 12

Sympathetic nervous system activation - tachycardia
Palpitations
Flushing, sweating
Oedema

Question 13

What are some types of non-dihydropyridine CCBs?

Answer 13

Phenylalkyamine

Benzothiazapines

Question 14

What is an example of a phenylalkyamine?

Answer 14

Verapamil

Question 15

How do phenylalkyamines work?

Answer 15

Depress SA node and slows AV conduction - negative inotropic effect

Question 16

What is the action of phenylalkyamines?

Answer 16

Impedes calcium transport across myocardial and smooth muscle cell membrane

Question 17

What are some adverse effects of phenylalkyamines?

Answer 17

Constipation
Risk of bradycardia
Negative inotrope, can worsen heart failure

Question 18

What is an example of a benzothiazapine?

Answer 18

Diltiazem

Question 19

How do benzothiazapines work?

Answer 19

Impedes calcium transport across myocardial and vascular smooth muscle wall
Prolongs action potential/refractory period

Question 20

What are some adverse effects of benzothiazapines?

Answer 20

Risk of bradycardia

Can worsen heart failure

Question 21

What is an example of a thiazide diuretic?

Answer 21

Bendroflumethiazide

Question 22

How do thiazide diuretics work?

Answer 22

Inhibit Na+ reabsorption in the DCT
Results in diuresis therefore lowering blood and ECF
Leads to lower TPR

Question 23

What are some adverse effects of thiazide diuretics?

Answer 23

Hypokalaemia
Increased uric levels
Impaired glucose tolerance
Increased cholesterol and triglyceride levels
Activation of RAAS

Question 24

What are the NICE guidelines for treating a patient <55yrs with primary HTN?

Answer 24

Step 1 - ACE inhibitor or ARB
Step 2 - ACE inhibitor/ARB and CCB or thiazide diuretic
Step 3 - ACE inhibitor/ARB, CCB and diuretic
Step 4 - all of the above, βB or spironolactone

Question 25

What are the NICE guidelines for treating a patient >55yrs or African/Caribbean origin with primary hypertension?

Answer 25

Step 1 - CCB or thiazide like diuretic Step 2 - ACE inhibitor/ARB and CCB or thiazide diuretic Step 3 - ACE inhibitor/ARB, CCB and diuretic Step 4 - all of the above, βB or spironolactone

Question 26

What is an example of an α-adrenoceptor blocker?

Answer 26

Doxazosin

Question 27

How do α-adrenoceptor blockers work?

Answer 27

Antagonise the contraction effects of noradrenaline on vascular smooth muscle Reduce peripheral resistance Safe in renal disease

Question 28

What are some adverse effects of α-adrenoceptor blockers?

Answer 28

Postural hypotension due to compromised baroreceptor reflex Headache and fatigue Oedema

Question 29

What is an example of a β-blocker?

Answer 29

Bisoprolol

Question 30

How do β-blockers exert their anti-hypertensive effects?

Answer 30

Decrease sympathetic tone by blocking noradrenaline and reducing myocardial contraction Leads to reduced cardiac output

Question 31

What are some adverse effects of β-blockers?

Answer 31

``` Bronchoconstriction - contraindicated in asthmatics and COPD pts Tachycardia Lethargy and impaired concentration Reduced exercise tolerance Bradycardia Raynaud’s ```

Question 32

How is heart failure managed?

Answer 32

Diuretics are used to manage symptoms, but have little impact on survival Furosemide is typically used

Question 33

How do β-blockers exert their effects in heart failure?

Answer 33

Slower HR => longer diastolic filling period => increased filling => increased output May also stabilise electrical conduction => reduced arrhythmias May also inhibit renin, but this is a minor effect as ACE-inhibitors probs also being used