Anti-hypertensives

1. What are the consequences of untreated chronic hypertension?

Heart diseases such as myocardial infarction, heart failure, angina

Renal diseases
Stroke

2. What are the four main categories of anti-hypertensives?

Diuretics
Sympatholytics
RAAS inhibitors
Direct vasodilators

3. Which beta blockers are different from the others in that they improve dyslipidemia?

Third generation beta blockers (carvedilol, labetalol, nebivolol)

*** They have also been demonstrated to improve glycemic control and insulin resistance

4. What are the effects of beta blockers?

Decrease HR and contractility

Decrease renin release
Suppress reflex tachycardia that results from vasodilators
Increase levels of LDL and triglycerides in the blood due to attenuation of lipolysis

5. What are the indications for beta blockers?

Hypertension
Heart failure
Ischemic heart disease
Arrythmias
Other conditions like glaucoma, hyperthyroidism, migraines, tremors, performance
anxiety...

6. What are the indications for alpha-1 blockers?

Treatment of essential HTN

For benign prostatic hyperplasia
Treatment of pheochromocytoma

7. Which adrenergic neuronal blocker has been associated with severe depression leading to increasing rates
of suicide and is therefore out of the marker?

Reserpine

8. Which antihypertensive drug is also used to ease symptoms of opiod withdrawal?

Clonidine (an alpha-2 agonist)

9. Which antihypertensive is safe to use during pregnancy?

Methyldopa

10. What are the four classes of drugs that work on the Renin-Angiotensin-Aldosterone system?

Direct renin inhibitors

 ACE inhibitors
Angiotensin receptor blockers
Aldosterone receptor blockers

11. Which ACE inhibitor is the only one that is not given orally?

Enalaprilat

12. Which ACE inhibitors contain sulfhydryl and phosphorus groups respectively?

Captopril and Fosinopril

13. Which ACE inhibitors cannot be administered with food?

Captopril and Moexipril

14. Which ACE inhibitors are not prodrugs?

Captopril, lisinopril, enalaprilat

15. Which ACE inhibitor doesn't require dosage adjustment during kidney diseases?

Fosinopril (because it is eliminated through the feces)

16. What is the mechanism of action of ACE inhibitors?

Decreased formation of angiotensin II

Decreased catabolism of bradykinin

17. What are the indications for ACE inhibitors?

Hypertension
Heart failure
MI
Diabetic and non-diabetic nephropathy

18. What are the side effects of ACE inhibitors in relation to the increased bradykinin levels?

Dry cough
Angioedema

19. What is the effect of using ACE inhibitors in pregnant women?

Can cause a range of congenital malformations like skull hypoplasia and dehydration in
the fetus

20. What are the two subtypes of angiotensin II binding receptors?

AT1 - cardiovascular deleterious effects

AT2 - cardiovascular protective effects

21. Which angiotensin receptor blocker is converted to an active metabolite during hepatic metabolism?

Losartan

22. Which ARB is not highly plasma protein bound?

Candesartan

23. What is the consequence of prolonged use of Nitroprusside?

 Cyanide toxicity

*** It should only be used during a hypertensive crisis

24. What is the main difference between Dihydropyridine and non-dihydropyridine calcium channel
blockers?

Non-dihydropyridine calcium channel blockers can slow down the heart rate while
dihydropyridine CCB donot

25. What are the sites of action for the calcium channel blockers?

Peripheral arterioles, arteries and arterioles of the heart

*** No significant effect on veins

26. Why are calcium channel blockers contraindicated in systolic heart failure?

Because they exacerbate the reduced force of contraction in systolic HF

27. Which calcium channel blocker doesn't require sustained release formulation due to its long half life?

Amlodipine

28. Which vasodilator is associated with drug induced lupus?

Hydralazine

29. Which antihypertensive has been indicated as a topical treatment for baldness?

Minoxidil

30. Which antihypertensive can cause severe hyperglycemia and can sometimes used to treat the
hypoglycemia caused by insulinoma?

Diazoxide

31. Which calcium channel blocker causes Gingival hyperplasia?

Nifedipine