30 Questions
Which of the following is a type of hypertension characterized by a disorder of unknown origin affecting the Blood Pressure regulating mechanisms?
Essential hypertension
Which of the following is responsible for intrarenal redistribution of pressure and increased absorption of salt and water in response to reduced renal pressure?
Renin production
What is the physiological equation for blood pressure?
Blood Pressure = Cardiac output X Resistance to passage of blood through precapillary arterioles
What is the primary effect of angiotensin II in regulating blood volume and blood pressure?
Direct constriction of renal arterioles
What is the long-term control mechanism for blood pressure by controlling blood volume?
Renal response
What is the mechanism of action of diuretics?
Increase excretion of Na and H2O, decrease in blood volume, and decreased BP
Which drug is a K+ sparing diuretic?
Spironolactone
What is the main adverse effect of ACE inhibitors?
Cough
Which drug acts on central α2A receptors to decrease sympathetic outflow and lead to a fall in blood pressure?
Clonidine
What is the MOA of calcium channel blockers?
Blocks influx of Ca++ in smooth muscle cells, relaxation of SMCs, decrease BP
Which drug acts as a prodrug and is a precursor of dopamine and noradrenaline?
Alpha-Methyldopa
Which drug is an imidazoline derivative and a partial agonist of central alpha-2 receptor?
Clonidine
Which type of angina is due to obstruction of coronaries by atheroma?
Exertional Angina
Which drug class blocks calcium entry in myocardium and vascular smooth muscles, causing a decrease in myocardium contractility & oxygen requirement?
Calcium Channel Blockers
What is the biggest problem associated with antiarrhythmic drugs?
They can cause arrhythmia
Which receptors do sympathomimetic agents activate to increase the force of myocardial contraction?
Cardiac β-receptors
What is the initial drug of choice for treating mild heart failure?
ACE inhibitor
What is the effect of acute administration of β-blockers on myocardial contractility in heart failure?
Reduces myocardial contractility
Which class of drugs reduces mortality in stable patients with heart failure when given with an ACE inhibitor and diuretic for approximately 1 year?
β-Receptor Antagonists (β Blockers)
What is the main goal of reducing elevated plasma cholesterol level in the treatment of hyperlipidemia?
Decrease the rate of progression of atherosclerotic disease
Which class of antiarrhythmic drugs causes strong Phase 0 depression with no effect on depolarization or action potential duration?
Class I, Subclass IC
Which antiarrhythmic drug is an oral lidocaine derivative with similar activity to lidocaine?
Mexiletine
Which drug, developed initially to treat hypertension, suppresses ventricular fibrillation?
Bretylium
Which antiarrhythmic drug blocks Na+ channels mostly in ventricular cells and is also used as a local anesthetic?
Lidocaine
Which class of drugs is particularly indicated for patients with atrial fibrillation and increases the contractile force of the heart?
Inotropic drugs like Digoxin
What is the primary mechanism of action of ACE inhibitors in the management of hypertension?
Inhibiting the conversion of angiotensin I to angiotensin II
Which medication is a competitive antagonist and inverse agonist of AT1 receptors?
Losartan
Why are cardioselective beta-blockers preferred over non-selective ones in certain patients?
Due to fewer side effects in asthma, diabetes mellitus, peripheral vascular disease, and in young non-obese patients
What is the primary effect of calcium channel blockers (CCBs) on the heart?
Negative chronotropic effect
Which medication is often used for hypertensive emergencies and promotes hair growth in alopecia?
Hydralazine
Study Notes
- Rashes, urticaria, and certain medical conditions are contraindications for the use of ACE inhibitors and ARBs in hypertension management.
- ACE inhibitors are used to manage hypertension, congestive heart failure, myocardial infarction, and high CVS risk subjects. They work by inhibiting the conversion of angiotensin I to angiotensin II and thus blocking vasoconstriction and aldosterone release.
- ARBs, such as losartan, are competitive antagonists and inverse agonists of AT1 receptors. They block all the actions of angiotensin II without interfering with other receptors, except for TXA2.
- ARBs have fewer foetopathic effects compared to ACE inhibitors but can cause rare first-dose hypotension.
- Beta-blockers, both non-selective and cardioselective, are used to manage hypertension and reduce cardiac output. They work by blocking beta-adrenergic receptors and decreasing renin release from the kidney, NA release, and central sympathetic outflow.
- Cardioselective beta-blockers are preferred over non-selective ones due to fewer side effects in asthma, diabetes mellitus, peripheral vascular disease, and in young non-obese patients.
- Alpha-adrenergic blockers, particularly prazosin, are used to reduce total peripheral resistance and mean blood pressure, as well as venomotor tone and pooling of blood. They are not used as first-line agents in chronic essential hypertension.
- Calcium channel blockers (CCBs) block L-type calcium channels, leading to smooth muscle relaxation, negative chronotropic, ionotropic, and chronotropic effects in the heart, and diuretic action.
- Vasodilators, such as hydralazine and minoxidil, work by directly acting on the endothelium of arterioles, releasing NO, and relaxing vascular smooth muscle. Hydralazine is often used for hypertensive emergencies and promotes hair growth in alopecia. Sodium nitroprusside is a rapidly acting vasodilator used for hypertensive emergencies and infused with caution due to its cyanide release.
Test your knowledge of centrally acting drugs with this quiz. Explore the mechanism of action, indications, and adverse effects of alpha-methyldopa and clonidine.
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