42 Questions
What is the definition of hypertension?
Sustained systolic blood pressure of greater than 140 mm Hg
What are the potential consequences of sustained arterial hypertension?
Increased risk of heart failure
What is the purpose of effective pharmacologic lowering of blood pressure?
To prevent damage to blood vessels
Why is knowledge of antihypertensive mechanisms and sites of action important?
To accurately predict efficacy and toxicity
What is the primary benefit of Dihydropyridines in treating hypertension?
Greater affinity for vascular calcium channels
Which class of calcium channel blockers has a higher incidence of adverse effects such as constipation?
Diphenylalkylamines (Verapamil)
Why should high doses of short-acting calcium channel blockers be avoided?
Increased risk of myocardial infarction
Which class of calcium channel blockers is particularly beneficial in treating hypertension?
Dihydropyridines
What is the primary mechanism through which β-Blockers reduce blood pressure?
Decreasing cardiac output
Which calcium channel blocker should be avoided in patients with congestive heart failure or atrioventricular block?
Verapamil (Diphenylalkylamines)
What is the purpose of adding beta-blockers after improving the treatment with ACE inhibitors or ARBs?
To achieve optimal cardiac output
What is the next step if a patient continues to experience symptoms despite optimal doses of ACE inhibitors and beta-blockers?
Adding spironolactone/eplerenone
When should sacubitril/valsartan be considered in the treatment process?
After starting on ACE inhibitors or optimal dose
What are the final medications added to achieve symptomatic benefit in patients undergoing optimal pharmacologic therapy for high frequency?
Digoxin and ivabradine
What is the purpose of adding mineralocorticoid receptor antagonists (spironolactone/eplerenone) in patients with persistent symptoms?
To achieve further symptomatic improvement
When should diuretics be added in the treatment process for patients with persistent symptoms?
Once symptoms persist despite ACE inhibitors and ARBs
What is the reason for starting aldosterone antagonists in patients with continuing symptoms despite optimal doses of ACE inhibitors and beta-blockers?
To improve exercise tolerance
When would sacubitril/valsartan be considered as a replacement for ACE inhibitors or ARBs?
Once symptoms persist despite optimal therapy
Which class of drugs blocks the conversion of angiotensin I to angiotensin II?
ACE inhibitors
Which ACE inhibitor does not undergo hepatic conversion and is preferred in severe hepatic impairment?
Fosinopril
Which class of drugs blocks the effects of angiotensin II on the body?
ARBs (Angiotensin II Receptor Blockers)
Which class of drugs is fetotoxic?
ARBs (Angiotensin II Receptor Blockers)
Which class of drugs is contraindicated during pregnancy?
Renin Inhibitors
Which ACE inhibitor does not require dose adjustment in patients with renal impairment?
Fosinopril
What is the first-line treatment for hypertension recommended for patients with a history of coronary disease, diabetes, stroke, heart failure, myocardial infarction, or chronic kidney disease?
ACE inhibitors
What is the primary action of ACE inhibitors in the body?
Decreasing sodium and water retention
Which medication class affects both cardiac preload and afterload, reducing cardiac work?
Beta-blockers
What is a common side effect of ACE inhibitors?
Dry cough
Which medication class is recommended for treating hypertension based on evidence from placebo-controlled studies that they reduce cardiovascular events?
ARBs
What is the primary action of ARBs in the body?
Blocking the action of angiotensin II
Which medication class is recommended for patients with a history of coronary disease, diabetes, stroke, heart failure, myocardial infarction, or chronic kidney disease based on the text?
ACE inhibitors
Which medication class is known to cause hypotension in hypovolemic states as a common side effect?
ACE inhibitors
For which condition are beta-blockers recommended as a first-line treatment according to the text?
Heart failure
Which class of medication is primarily beneficial in hypertensive patients with heart disease, including supraventricular tachyarrhythmia, previous myocardial infarction, angina pectoris, and chronic heart failure?
β-blockers
Which type of medication undergoes extensive first-pass metabolism, is orally active, and takes several weeks to develop its full effects?
β-blockers
Which class of medication blocks α1 adrenoceptors, decreasing peripheral vascular resistance and lowering arterial blood pressure?
α-adrenoreceptor–blocking agents
Which class of medication relaxes smooth muscle, decreasing peripheral vascular resistance and increasing cardiac output?
Direct-acting vasodilators
What medication is initiated for relief of volume overload symptoms in the classification of heart failure stages?
Loop diuretics
Which medication can replace ACE inhibitors or ARBs for symptomatic benefit in patients who remain symptomatic despite optimal doses of these medications?
Sacubitril/valsartan
What medication is added for symptomatic benefit only in patients already on optimal heart failure pharmacotherapy?
Digoxin
What is a common adverse effect of β-blockers?
Hypotension
What is a common adverse effect of α-adrenoreceptor–blocking agents?
Hypotension
Study Notes
- The primary therapeutic benefits of β-blockers are in hypertensive patients with heart disease, including supraventricular tachyarrhythmia, previous myocardial infarction, angina pectoris, and chronic heart failure.
- β-blockers undergo extensive first-pass metabolism, are orally active, and take several weeks to develop their full effects.
- Common adverse effects of β-blockers include bradycardia, CNS side effects (fatigue, lethargy, insomnia, hallucinations), and hypotension.
- α-adrenoreceptor–blocking agents like prazosin, doxazosin, and terazosin block α1 adrenoceptors, decreasing peripheral vascular resistance and lowering arterial blood pressure.
- Direct-acting vasodilators such as hydralazine and minoxidil relax smooth muscle, decreasing peripheral vascular resistance and increasing cardiac output.
- Heart failure can be classified into four stages; as it progresses, polytherapy is initiated, starting with loop diuretics for relief of volume overload symptoms.
- ACE inhibitors or ARBs are added after diuretic optimization, followed by β-blockers, aldosterone antagonists, and hydralazine/isosorbide dinitrate.
- Sacubitril/valsartan can replace ACE inhibitors or ARBs for symptomatic benefit in patients who remain symptomatic despite optimal doses of these medications.
- Digoxin and ivabradine are added for symptomatic benefit only in patients already on optimal heart failure pharmacotherapy.
Test your knowledge about calcium-channel blockers, a recommended treatment option in hypertensive patients with diabetes or angina. Learn about the classes of calcium-channel blockers and their potential risks and benefits.
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