week 9

Question 1

mechanism of action of ACEi

Answer 1

inhibit ACE.
Inhibit conversion of angiotensin I to angiotensin II.
decrease vasoconstriction, aldosterone secretion.
decrease sodium and water retention

Question 2

what causes the cough with ACEi?

Answer 2

the break down of bradykinin

Question 3

physiological effects of ACEi

Answer 3

decrease afterload, decrease preload
decrease BP

Question 4

examples of ACEi?

Answer 4

enalopril, perindopril, ramipril, lisiopril

Question 5

Clinical uses of ACEi?

Answer 5

First line in HTN.
Decreases mortality and hospitalisation in heart failure.
Post MI.
Slows progression of CKD in diabetic nephropathy.

Question 6

Adverse effects of ACEi?

Answer 6

cough, angiooedema.
hyperkalaemia.
hypotension in volume deplete patients.
renal artery impairment.

Question 7

contraindications of ACEi?

Answer 7

Pregnancy - teratogenic.
Bilateral renal artery stenosis.
History of angiooedema.
severe hyperkalaemia.

Question 8

what CCB are used for hypertension?

Answer 8

Dihydropyridines
Amlodipine, nifedipine, felodipine

Question 9

clinical use of CCB in HTN ?

Answer 9

Elderly patients.
Afro carribean descent.
Isolated systolic HTN.
Angina, raynauds, hypertensive crisis

Question 10

location of action of loop diuretics

Answer 10

thick ascending limb

Question 11

examples of loop diuretics

Answer 11

furosemide
bumetanide

Question 12

main ions affected with loop diuretics

Answer 12

Na, Cl, K, Ca, Mg

Question 13

location of action of thiazide diuretics

Answer 13

distal convoluted tubule

Question 14

examples of thiazide diuretics

Answer 14

hydrochlorthiazide
indapamide

Question 15

main ions affected with thiazide diuretics

Answer 15

Na, Cl

Question 16

location of potassium sparing diuretics

Answer 16

collecting duct

Question 17

examples of potassium sparing diuretics

Answer 17

spironolactone
amiloride

Question 18

main ion affected with potassium sparing diuretics

Answer 18

Na

Question 19

location of action of osmotic diuretics

Answer 19

proximal tubule and loop of henle

Question 20

example of osmotic diuretics

Answer 20

mannitol

Question 21

location of action of carbonic anhydrase inhibitors

Answer 21

proximal tubule

Question 22

examples carbonic anhydrase inhibitors

Answer 22

Acetazolamide

Question 23

main ions affected with carbonic anhydrase inhibitors

Answer 23

HCO3, Na, K

Question 24

mechanism of action of loop diuretics

Answer 24

Inhibit Na/K/2Cl transporter in thick ascending limb

Question 25

mechanism of action of thiazide diuretics

Answer 25

inhibit Na/Cl cotransporter in distal tubule

Question 26

mechanism of action of potassium sparing diuretics

Answer 26

Spironolactone; aldosterone antagonists Amiloride; ENaC blockers

Question 27

mechanism of action of mannitol

Answer 27

osmotic diuretic increases osmolarity of filtrate

Question 28

mechanism of action of acetazolamide

Answer 28

carbonic anhydrase inhibitor decreases HCO3 reabsorption

Question 29

adverse reactions of loop diuretics

Answer 29

Hypokalaemia/calcaemia ototoxicity dehydration metabolic alkalosis

Question 30

adverse reactions of thiazide diuretics

Answer 30

Hypokalaemia Hypercalcaemia, hyperuricaemia, hyperlipidaemia Erectile dysfunction

Question 31

adverse effects of spironolactone

Answer 31

Hyperkalaemia. Gynaecomastia, impotence

Question 32

mechanism of action of GTN

Answer 32

Converted to NO in vascular smooth muscle. activates guanylate cyclase. Increased cGMP and causes smooth muscle relaxation. Venodilation > ateriodilation

Question 33

Primary effects of GTN

Answer 33

Venodilation > arteriodilation decreases preload and myocardial oxygen demand. relieves angina

Question 34

mechanism of action of sodium nitroprusside

Answer 34

Release NO and stimulates guanylate cyclase. Increase cGMP causing smooth muscle relaxation. Arterial = venous dilation. Decrease preload and afterload.

Question 35

Adverse effects of sodium nitroprusside

Answer 35

Hypotension, reflex tachycardia. Cyanide toxicity (confusion, seizures, lactic acidosis). Thiocynate toxicity - with renal failure or prolonged exposure

Question 36

Class of medication of methyldopa

Answer 36

Centrally acting alpha2 adrenergic agonist. Sympatholytic antihypertensive

Question 37

Mechanism of action of methyldopa

Answer 37

Converted to alpha methylnorepnephrine in CNS stimulates central alpha 2 receptors. Decraases sympathetic outflow. Leads to decrease systemic vascular resistance. Decrease HR and BP

Question 38

adverse effects of methyldopa

Answer 38

Sedation, fatigue, dry mouth. orthostatic hypotension. depression. hepatotoxicity. haemolytic anaemia - coombs test

Question 39

what class of drug is clonidine ?

Answer 39

central acting alpa 2 adrenergic agonist. Sympatholytic antihypertensive.

Question 40

mechanism of action of clonidine

Answer 40

stimulates central alpha 2 receptors in brainstem. decrease sympathetic outflow, decrease noriepinephrine release. decrease HR and BP