Antihypertensive Drug Classes Quiz

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59 Questions

What is the therapeutic window for lithium?

0.6 - 1.4 meq/L

Which drug may act through increasing GABA levels?

Valproic Acid

What percentage of bipolar patients do not respond to lithium?

30-40%

Which anticonvulsant has a wider therapeutic window and faster onset than lithium?

Valproic Acid

What is a common side effect of Valproic Acid?

Alopecia (hair loss)

Which drug can be used as a potentiating agent for antidepressants?

Valproic Acid

What is a potential deadly syndrome associated with the use of Valproic Acid?

Steven Johnson Syndrome

Which drug doubles the concentration of lamotrigine?

Valproic Acid

Which diuretic is usually the first choice for mild and moderate hypertension?

Thiazide diuretics

Which diuretic is effective in renal failure?

Furosemide

Which calcium channel blocker has additional uses in arrhythmias?

Verapamil

Which calcium channel blocker is relatively selective for smooth muscle?

Nifedipine

Which receptor do antipsychotic drugs primarily block?

Dopamine D2 receptor

Which of the following is a typical antipsychotic with a relatively 'clean' D2 antagonist profile?

Haloperidol

Which atypical antipsychotic is more efficacious but can cause dangerous blood dyscrasias in about 2% of patients?

Clozapine

Which drug is a partial dopamine agonist and is effective in treating schizophrenia and depression with a low incidence of side effects?

Aripiprazole

Which atypical antipsychotics are associated with significant side effects including metabolic syndrome and weight gain?

Olanzapine and clozapine

Which of the following is becoming the standard against which other atypical antipsychotics are judged?

Lithium carbonate

Which receptor does lithium carbonate bind with modest affinity?

Dopamine D2

What adverse effect is associated with lithium carbonate use?

Tremor

What combination can result in adverse effects such as mild cognitive impairment, edema, and weight gain?

Antipsychotic drugs and mood stabilizers

What should be carefully monitored when using antipsychotic drugs and mood stabilizers?

Electrolyte levels

What can atypical antipsychotics and mood stabilizers cause due to their narrow therapeutic window?

Acute side effects

What neurotransmitter systems can lithium carbonate have effects on?

GABA and glutamate

Which drug is approved for class II and III heart failure, resulting in decreased hospitalizations and all-cause mortality?

Carvedilol

Which adverse effect is common initially with beta-blockade use?

Symptomatic hypotension

Which drug inhibits aldosterone effects on the collecting ducts and promotes hyperkalemia?

Spironolactone

What is the mechanism of action of cardiac glycosides like digoxin?

Inhibits cell membrane Na/K-ATPase

What are the oral mechanical effects of glycosides on the heart?

Increased myocardial contractile force

What are the GI symptoms associated with digitalis intoxication?

Diarrhea

Which drug may have to be increased in the presence of fluid retention caused by beta-blockade?

Spironolactone

What is the effect of elevated lab values in heart failure patients?

Increased BNP levels

What is the primary electrical effect of glycosides on the AV node?

Shortening of the PR interval

Which drug is a nonselective beta-blocker with alpha1 blocking effect?

Carvedilol

Which drug leads to enhanced Ca++ inside the cell by inhibiting the Na/K-ATPase?

Digoxin

Which drug has recently demonstrated improvement in mortality and morbidity in patients with severe (Class IV) heart failure?

Spironolactone

Which of the following drugs is contraindicated in pregnancy?

Lisinopril

Which drug is associated with drug-induced lupus syndrome?

Hydralazine

Which combination has been shown to decrease mortality in heart failure?

Hydralazine and isosorbide dinitrate

Which drug is rapidly hydrolyzed to nitric oxide and cyanide?

Sodium nitroprusside

Which diuretic may be added if resistance occurs to loop diuretics in heart failure?

Metolazone

Which drug is particularly important to monitor for hypokalemia in heart failure patients taking cardiac glycosides?

Furosemide

Which drug is useful in slowing the remodeling of the heart when heart failure is under control?

Beta-blocker

Which drug class is known to elevate bradykinin and cause cough?

Angiotensin II Blockers

Which drug class is most effective when combined with venodilators?

Organic nitrates

Which drug is used intravenously in acute heart failure to decrease ventricular filling pressures?

Nitroglycerin

Which drug is associated with a significant danger of reducing cardiac output to intolerable levels in acute, decompensated stages of heart failure?

Beta-blocker

Which drug combination is approved for heart failure patients who are intolerant of ACE inhibitors?

Candesartan and losartan

Which drug class works by blocking post-synaptic alpha1 receptors, leading to decreased sympathetic nervous system effects on vasculature?

Alpha1 blockers

Which drug class is being replaced by tamsulosin due to side effects such as increased risk for heart failure, first-dose hypotension, and fatigue?

Beta blockers

Which drug class has advantages such as being cheap and efficacious but is contraindicated in asthma and acute decompensated heart failure?

Non-selective beta-blockers

Which drug class blocks the renin-angiotensin-aldosterone system, leading to decreased preload and afterload and reduced blood pressure, with predictable and mild side effects but the potential for cough, skin rashes, and acute renal failure?

ACE inhibitors

Which drug class dilates arterioles, decreases systemic vascular resistance, and may cause hypotension and side effects such as palpitations and headaches?

Arteriolar vasodilators

Which drug is an arterial dilator and can cause excessive hypotension and cyanide/thiocyanate toxicity?

Nitroprusside

Which drug class reduces sympathetic outflow, with one causing dry mouth, sedation, fatigue, depression, and sexual dysfunction, and the other causing drowsiness and rebound hypertension?

Central acting drugs

Which drug class has effects on morbidity, relieving dyspnea and prolonging exercise tolerance, and mortality, decreasing the risk of death due to slowing of cardiac remodeling and disease progression?

ACE inhibitors

Which drug class is generally used in all patients with left ventricular (LV) systolic dysfunction, including those with no symptoms, and their improvement may take weeks to months?

ACE inhibitors

Which drug class has adverse effects like dry, persistent cough, severe hypotension in hypovolemic patients, acute renal failure, and hyperkalemia?

ACE inhibitors

Which drug class is generally not used in acute heart failure?

ACE inhibitors

Study Notes

Antihypertensive Drug Classes and Specific Drugs

  • Alpha1 blockers like prazosin work by blocking post-synaptic alpha1 receptors, leading to decreased sympathetic nervous system (SNS) effects on vasculature, reducing preload and afterload, and decreasing blood pressure.
  • Beta blockers, not first-line drugs, are used in combination with other classes and are useful in benign prostatic hyperplasia (BPH), although they are being replaced by tamsulosin due to side effects such as increased risk for heart failure, first-dose hypotension, and fatigue.
  • Non-selective beta-blockers like propranolol have advantages such as being cheap and efficacious but are contraindicated in asthma and acute decompensated heart failure and have adverse effects on glycogenolysis and recovery from hypoglycemia.
  • ACE inhibitors like enalapril and ARBs like losartan block the renin-angiotensin-aldosterone system, leading to decreased preload and afterload and reduced blood pressure, with predictable and mild side effects but the potential for cough, skin rashes, and acute renal failure.
  • Arteriolar vasodilators like hydralazine dilate arterioles, decrease systemic vascular resistance, and may cause hypotension and side effects such as palpitations and headaches.
  • Minoxidil and nitroprusside are arterial dilators, while nitroglycerin and reserpine are venodilators; nitroprusside can cause excessive hypotension and cyanide/thiocyanate toxicity.
  • Central acting drugs like methyldopa and clonidine reduce sympathetic outflow, with methyldopa causing dry mouth, sedation, fatigue, depression, and sexual dysfunction, while clonidine can cause drowsiness and rebound hypertension.
  • ACE inhibitors and ARBs reduce the production of angiotensin II, leading to vasodilation, decreased response to sympathetics, and reduced preload, afterload, and mortality, and are used in heart failure to relieve dyspnea and prolong exercise tolerance, with adverse effects including dry cough, severe hypotension, and hyperkalemia.
  • ACE inhibitors and ARBs also have effects on morbidity, relieving dyspnea and prolonging exercise tolerance, and mortality, decreasing the risk of death due to slowing of cardiac remodeling and disease progression.
  • ACE inhibitors and ARBs are generally used in all patients with left ventricular (LV) systolic dysfunction, including those with no symptoms, and their improvement may take weeks to months.
  • ACE inhibitors and ARBs have adverse effects like dry, persistent cough, severe hypotension in hypovolemic patients, acute renal failure, and hyperkalemia.
  • ACE inhibitors and ARBs are generally not used in acute heart failure.

Test your knowledge of antihypertensive drug classes and specific drugs with this quiz. Explore the mechanisms of action, uses, and potential side effects of alpha1 blockers, beta blockers, ACE inhibitors, ARBs, arteriolar vasodilators, arterial and venodilators, and central acting drugs.

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