Antihypertension drugs

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Questions and Answers

Which of the following is a symptom of hypertension?

High stress

Obesity

Smoking

All of the above (correct)

What is the equation for blood pressure?

Blood Pressure = Cardiac output (CO) + arterioles resistance (TPR)

Blood Pressure = Cardiac output (CO) - arterioles resistance (TPR)

Blood Pressure = Cardiac output (CO) x arterioles resistance (TPR) (correct)

Blood Pressure = Cardiac output (CO) / arterioles resistance (TPR)

What is the main function of the baroreflex?

To regulate heart rate

To regulate minute to minute blood pressure (correct)

To regulate blood volume

To regulate sodium intake

Which type of hypertension is of unknown origin?

Essential hypertension Signup and view all the answers

What is the fourth site where volume of intravascular fluid is regulated?

Kidney Signup and view all the answers

What is the role of local agents like eNOS in regulating blood pressure?

To decrease blood pressure Signup and view all the answers

Which system regulates the blood pressure?

All of the above Signup and view all the answers

What happens to baroreceptor activity when there is a reduction in vessel wall stretch?

Increases Signup and view all the answers

What is the effect of baroreceptor stimulation on sympathetic discharge when there is a stretch in the vessel walls?

Decreases sympathetic discharge Signup and view all the answers

How do antihypertensive medications act?

By decreasing blood pressure Signup and view all the answers

Which class of antihypertensive drugs acts on the kidneys to increase excretion of sodium and water, leading to a decrease in blood volume and blood pressure?

Diuretics Signup and view all the answers

Which class of antihypertensive drugs inhibits the synthesis of Angiotensin II, resulting in a decrease in peripheral resistance and blood volume?

ACE inhibitors Signup and view all the answers

Which class of antihypertensive drugs blocks the binding of Angiotensin II to its receptors?

Angiotensin (AT1) blockers Signup and view all the answers

Which class of antihypertensive drugs acts on central α2A receptors to decrease sympathetic outflow, resulting in a fall in blood pressure?

Centrally acting Signup and view all the answers

Which class of antihypertensive drugs bind to beta adrenergic receptors and block the activity of both beta and alpha adrenergic receptors?

ß-adrenergic blockers Signup and view all the answers

Which class of antihypertensive drugs block the influx of Ca++ in smooth muscle cells, leading to relaxation of smooth muscle cells and a decrease in blood pressure?

Calcium Channel Blockers Signup and view all the answers

Which class of antihypertensive drugs leak K+ due to opening, resulting in hyperpolarization of smooth muscle cells and relaxation of smooth muscle cells?

K+ Channel activators Signup and view all the answers

Which class of antihypertensive drugs acts as arteriolar vasodilators?

Vasodilators Signup and view all the answers

Which class of antihypertensive drugs acts as arterio-venular vasodilators?

Vasodilators Signup and view all the answers

Which class of antihypertensive drugs causes direct constriction of renal arterioles and stimulation of aldosterone synthesis, leading to sodium absorption and an increase in intravascular blood volume?

Angiotensin II Signup and view all the answers

Which class of antihypertensive drugs causes a net loss of Na+ and water in urine?

Diuretics Signup and view all the answers

What is the mechanism of antihypertensive action for diuretics?

Decrease in total peripheral resistance Signup and view all the answers

What is the main adverse effect of thiazide diuretics?

Hyperlipidemia Signup and view all the answers

What is the average fall in blood pressure observed with low doses of thiazide diuretics?

10 mm Hg Signup and view all the answers

Which class of diuretics is commonly combined with potassium-sparing diuretics?

Thiazide diuretics Signup and view all the answers

What is the lipid profile effect of indapamide (a modified thiazide diuretic)?

No effect on blood lipid concentration Signup and view all the answers

In which cases are loop diuretics used?

Chronic renal failure Signup and view all the answers

What is the temporary nature of the Na+ deficient state caused by loop diuretics?

It is not maintained round-the-clock Signup and view all the answers

Which enzyme does captopril inhibit in the renin-angiotensin system?

Angiotensin-I Signup and view all the answers

What is the route of administration for captopril?

Oral Signup and view all the answers

What is the half-life of captopril?

2 hours Signup and view all the answers

What is the main pharmacological action of captopril in hypertensive individuals?

Lowers total peripheral resistance Signup and view all the answers

What are the common adverse effect of captopril?

All of the above Signup and view all the answers

Which condition is a contraindication for the use of captopril?

Pregnancy Signup and view all the answers

What is the effect of captopril on renal blood flow?

Maintained Signup and view all the answers

What is the adverse effect of captopril on taste?

Everything tastes sweet Signup and view all the answers

What is the potential effect of captopril on fetal development?

Both A and B Signup and view all the answers

What is one advantage of Enalapril over captopril?

Longer half life Signup and view all the answers

Which drug is a prodrug that is converted to enalaprilate?

Enalapril Signup and view all the answers

Which drug has a longer onset of action compared to captopril?

Enalapril Signup and view all the answers

Which of the following is NOT a use for Ramipril?

Liver disease Signup and view all the answers

Which statement about Ramipril is correct?

It is tissue specific Signup and view all the answers

Which of the following is a characteristic of Lisinopril?

It is excreted unchanged in urine Signup and view all the answers

Which of the following is true about the absorption of Lisinopril?

It has a slow oral absorption Signup and view all the answers

Which class of drugs is considered the first-line treatment for hypertension?

ACE inhibitors Signup and view all the answers

Which of the following is NOT a use for ACE inhibitors?

Eye disease Signup and view all the answers

Which of the following is a benefit of ACE inhibitors in hypertension?

Reverse ventricular hypertrophy Signup and view all the answers

Which group of patients can safely take ACE inhibitors?

Diabetics and asthmatics Signup and view all the answers

What is the effect of ACE inhibitors on the plasma lipid profile?

No effect on plasma lipid profile Signup and view all the answers

Which angiotensin receptor is responsible for mediating most of the physiological actions of angiotensin?

AT1 receptor Signup and view all the answers

What is the specific angiotensin receptor targeted by Losartan?

AT1 receptor Signup and view all the answers

Which receptor mediates long term effects of angiotensin in myocardium and vascular smooth muscles?

AT1 receptor Signup and view all the answers

Which transducer mechanism is responsible for vascular and visceral smooth muscle contraction?

PhospholipaseC-IP3/DAG-intracellular Ca++ release mechanism Signup and view all the answers

Which receptor does Losartan primarily target?

AT1 receptor Signup and view all the answers

What is the main advantage of ARBs over ACEIs in terms of adverse effects?

Complete inhibition of AT1 Signup and view all the answers

What is the pharmacokinetic characteristic of Losartan?

High first pass metabolism Signup and view all the answers

What is not adverse effect associated with ARBs?

Dysgeusia and dry cough Signup and view all the answers

What is the clinical benefit of ARBs over ACEIs?

Unknown Signup and view all the answers

What is the effect of losartan on blood pressure in hypertensive patients?

Decreases blood pressure Signup and view all the answers

What is the main action of ARBs on the actions of angiotensin I?

Blocks all the actions of A-I Signup and view all the answers

What is the bioavailability of losartan compared to ACEIs?

Low Signup and view all the answers

What is the main advantage of losartan over ACEIs in terms of cough?

Cough is rare with losartan Signup and view all the answers

Which of the following is a cardioselective beta-adrenergic blocker?

Metoprolol Signup and view all the answers

Which of the following is NOT an advantage of beta-adrenergic blockers?

Reduction in blood pressure initially Signup and view all the answers

Which of the following is a side effect of beta-adrenergic blockers?

Impotence Signup and view all the answers

Which of the following is a preferred patient population for beta-adrenergic blockers?

Young non-obese patients Signup and view all the answers

Which of the following is a mechanism of action of beta-adrenergic blockers?

Decreased cardiac output Signup and view all the answers

Which of the following is an advantage of cardioselective beta-adrenergic blockers over non-selective ones?

All of the above Signup and view all the answers

Which of the following is an adverse effect associated with prazosin?

Postural hypotension Signup and view all the answers

What is the recommended starting dose of prazosin?

0.5 mg Signup and view all the answers

Which of the following is an advantage of alpha-adrenergic blockers?

Symptomatic improvement in BPH Signup and view all the answers

In which condition is prazosin not used as a first-line agent?

Not a first line agent but used with other conventional drugs Signup and view all the answers

Which class of antihypertensive drugs are non-selective alpha blockers?

Phenoxybenzamine, phentolamine Signup and view all the answers

Which receptors are not inhibited by alpha-adrenergic blockers, leading to the preservation of autoregulation of noradrenaline (NA) release?

Alpha-2 receptors Signup and view all the answers

What is the main adverse effect of prazosin?

Postural hypotension Signup and view all the answers

Which conventional drugs can prazosin be used in addition to, if they are failing?

Diuretic or beta blocker Signup and view all the answers

What is the current status of prazosin in the treatment of hypertension?

Used in addition to other conventional drugs Signup and view all the answers

Which type of calcium channels are present in smooth muscles?

Voltage sensitive, receptor operated and leak channel Signup and view all the answers

What is the mechanism of action of calcium channel blockers (CCBs)?

Inhibition of L-type calcium channels Signup and view all the answers

Which type of calcium channels do CCBs primarily block?

L-Type Signup and view all the answers

What is the main effect of CCBs on the heart?

Negative chronotropic, ionotropic and chronotropic effects Signup and view all the answers

Which type of calcium channel blockers have the highest smooth muscle relaxation and vasodilator action?

DHPs Signup and view all the answers

What is the main advantage of calcium channel blockers over diuretics?

No adverse metabolic effects, can be given in pregnancy Signup and view all the answers

Which condition is a contraindication for the use of calcium channel blockers?

All of the above Signup and view all the answers

What is the preparation and dosage of amlodipine?

2.5, 5 and 10 mg tablets (5-10 mg OD) Signup and view all the answers

Which calcium channel blocker has diuretic action?

DHPs Signup and view all the answers

Which calcium channel blocker can be given in pregnancy without adverse fetal effects?

Amlodipine Signup and view all the answers

Which of the following is the mechanism of action of hydralazine?

Hydralazine molecules combine with receptors in the endothelium of arterioles Signup and view all the answers

Which of the following is a potential adverse effect of hydralazine?

Tachycardia Signup and view all the answers

Which of the following is a use for hydralazine?

All of the above Signup and view all the answers

Which of the following can counter the effects of hydralazine?

Beta blockers and diuretics Signup and view all the answers

Which of the following is a major use of Minoxidil?

Treatment of alopecia Signup and view all the answers

What is the route of administration for Minoxidil in the treatment of alopecia?

Topical lotion/gel Signup and view all the answers

What is the mechanism of action of Minoxidil in promoting hair growth?

All of the above Signup and view all the answers

When is Minoxidil rarely indicated in hypertension?

In life-threatening hypertension Signup and view all the answers

Which of the following is the primary mechanism of action of Sodium Nitroprusside?

Relaxation of resistance vessels Signup and view all the answers

What is the main difference between Sodium Nitroprusside and hydralazine in terms of cardiac work and reflex tachycardia?

Sodium Nitroprusside decreases cardiac work and does not cause reflex tachycardia. Signup and view all the answers

What is the primary use of Sodium Nitroprusside?

Hypertensive Emergencies Signup and view all the answers

What is the main reason for adverse effect of Sodium Nitroprusside?

Release of cyanides Signup and view all the answers

Which receptor does Alpha-Methyldopa act on in the brain?

Alpha-2 receptor Signup and view all the answers

What is the main reason why Clonidine is not frequently used now?

It causes tolerance and withdrawal hypertension Signup and view all the answers

What is the main adverse effect of Alpha-Methyldopa?

All of the above Signup and view all the answers

In which condition is Alpha-Methyldopa still used therapeutically?

Hypertension during pregnancy Signup and view all the answers

Which drug acts on alpha-2 receptors in the brain and causes inhibition of adrenergic discharge in the medulla, resulting in a fall in total peripheral resistance (TPR) and blood pressure (BP)?

Alpha-Methyldopa Signup and view all the answers

Which drug is commonly used for hypertensive emergencies such as cerebrovascular accident or head injury with high BP, left ventricular failure with pulmonary edema due to hypertension, hypertensive encephalopathy, and angina or MI with raised BP?

All of the above Signup and view all the answers

Which drug is useful in reducing cardiac work and is commonly used in cardiac surgery, left ventricular failure (LVF), myocardial infarction (MI), and angina?

Esmolol Signup and view all the answers

What is the goal of antihypertensive therapy?

To use low doses of drugs to effectively lower blood pressure Signup and view all the answers

What is often required to achieve the goal of antihypertensive therapy?

Combinations of drugs with complementary actions Signup and view all the answers

Which drug has dose titration and monitoring for its use?

Sodium Nitroprusside Signup and view all the answers

Which drug is a prodrug that is converted to alpha methyl noradrenaline, which acts on alpha-2 receptors in the brain and causes inhibition of adrenergic discharge in the medulla?

Alpha-Methyldopa Signup and view all the answers

Study Notes

Hypertension Overview

Symptoms of hypertension may include headaches, shortness of breath, and nosebleeds.
Blood pressure is calculated by the equation: BP = Cardiac Output x Peripheral Resistance.
Primary hypertension is of unknown origin, while secondary hypertension has identifiable causes.

Baroreflex and Blood Pressure Regulation

The baroreflex maintains blood pressure homeostasis by adjusting heart rate and vascular resistance.
A reduction in vessel wall stretch decreases baroreceptor activity, leading to increased sympathetic discharge and elevated blood pressure.
Stimulation of baroreceptors from vessel wall stretch reduces sympathetic discharge, promoting vasodilation.

Antihypertensive Medications

Antihypertensive drugs lower blood pressure through various mechanisms, such as vasodilation, decreased blood volume, and reduced cardiac output.
Diuretics increase sodium and water excretion, reducing blood volume and pressure.
Angiotensin-converting enzyme (ACE) inhibitors decrease the synthesis of Angiotensin II, lowering peripheral resistance and blood volume.
Angiotensin receptor blockers (ARBs) inhibit Angiotensin II from binding to its receptors, reducing vasoconstriction.

Specific Antihypertensive Drug Classes

Diuretics (like thiazides) lead to sodium and water loss, reducing blood pressure.
ACE inhibitors (e.g., captopril, enalapril, ramipril) are first-line treatments for hypertension.
Beta-adrenergic blockers decrease heart rate and contractility, lowering blood pressure.
Calcium channel blockers (CCBs) relax vascular smooth muscle, decreasing blood pressure.
Alpha-adrenergic blockers reduce peripheral vascular resistance but may cause adverse effects like reflex tachycardia.

Mechanisms of Action for Specific Drugs

Thiazide diuretics are effective at lowering blood pressure, but may cause hypokalemia as a common adverse effect.
Captopril inhibits the angiotensin-converting enzyme, leading to increased blood flow and reduced blood pressure; it must be taken orally and has adverse effects including cough and taste alterations.
Losartan, an ARB, primarily targets the AT1 receptor for Angiotensin II, leading to vasodilation and reduced blood pressure.

Unique Drug Properties and Effects

Amlodipine, a long-acting CCB, is effective for hypertension and may be used in pregnancy; its dosage is typically 5-10 mg orally.
Minoxidil promotes hair growth for alopecia at low doses but is rarely indicated for treating hypertension due to its strong vasodilating effects.
Sodium Nitroprusside serves as a fast-acting vasodilator primarily used in hypertensive emergencies.
Alpha-Methyldopa acts centrally in the brain to reduce sympathetic outflow and lower blood pressure.

Treatment Considerations

Patients with renal impairment or pregnancy conditions must be carefully monitored regarding selection of antihypertensive medications.
CCBs and ARBs are often preferred due to lower adverse effects compared to traditional ACE inhibitors.
Combination therapy is commonly employed when monotherapy is insufficient to control hypertension effectively.

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Description

Test your knowledge on hypertension and its different types, causes, and symptoms. Learn about essential and secondary hypertension, environmental factors that contribute to high blood pressure, and the importance of symptomatic treatment.