60 Questions
What is the primary mechanism of action of calcium channel blockers?
Block calcium channels
What is a common side effect of thiazide diuretics?
Hypokalemia
Which type of diuretic can cause hyperkalemia?
Potassium-sparing diuretics
What is a common side effect of beta blockers?
Bradycardia
Which type of calcium channel blocker is more selective to the heart?
Non-Dihydropyridine
What is a common interaction between verapamil and other medications?
Increased toxicity with lidocaine
What is the primary mechanism of action of beta blockers?
Block β1-receptors
Which type of diuretic is Frusemide an example of?
Loop diuretic
What is a common side effect of calcium channel blockers?
Ankle swelling
Which type of alpha blocker is Prazosin an example of?
α1-adrenergic blocker
What is the primary mechanism of action of Angiotensin Converting Enzyme Inhibitors (ACEIs) on blood pressure regulation?
Inhibit Angiotensin II to prevent vasoconstriction
Which of the following is a characteristic of Angiotensin Converting Enzyme Inhibitors (ACEIs) that makes them safe to use in patients with ischemic heart disease?
They do not cause reflex tachycardia
What is the primary mechanism of action of Diuretics on blood pressure regulation?
Decrease blood volume by increasing urine output
Which of the following is a common adverse effect of Angiotensin Converting Enzyme Inhibitors (ACEIs)?
Dry cough
Which of the following is a characteristic of Angiotensin Receptor Blockers (ARBs)?
They block the action of angiotensin II on AT1 receptors
Which of the following antihypertensive drugs is classified as a first-line or primary drug?
Angiotensin Converting Enzyme Inhibitors (ACEIs)
What is the effect of Angiotensin Converting Enzyme Inhibitors (ACEIs) on bradykinin?
Increase bradykinin
Which of the following is a contraindication for the use of Angiotensin Converting Enzyme Inhibitors (ACEIs)?
Pregnancy
What is the effect of Angiotensin Converting Enzyme Inhibitors (ACEIs) on peripheral resistance?
Decrease peripheral resistance
Which of the following is a mechanism of action of Angiotensin Converting Enzyme Inhibitors (ACEIs) on blood pressure regulation?
Inhibit the conversion of angiotensin I to angiotensin II
What is the primary mechanism of action of organic nitrates?
Generation of NO leading to vasorelaxation
Which type of adrenergic drug is clonidine?
α2- agonist
What is the effect of arteriodilators on cardiac work?
Decrease O2 demand
What is the main aim of treating heart failure?
Decrease symptoms
Which type of drug is used to treat pregnant hypertensive patients?
α-Methyldopa
What is the common side effect of β-blockers?
Dizziness, weakness, headache, impotence
What is the effect of Ca++ channel blockers on cardiac oxygen demand?
Decrease cardiac oxygen demand
What is the effect of venodilators on cardiac work?
Decrease cardiac work
Which type of drug is used to treat variant angina?
Ca++ channel blocker
What is the common side effect of Ca++ channel blockers?
Arterial dilation → headache, flushing, dizziness & ankle edema
What is the primary mechanism of action of Angiotensin Converting Enzyme Inhibitors (ACEIs) that helps reduce blood pressure?
Increase bradykinin levels
Which of the following is a characteristic of Angiotensin Receptor Blockers (ARBs)?
They are classified as first-line or primary drugs
What is the effect of Diuretics on blood pressure regulation?
Decrease blood volume
What is a common adverse effect of Angiotensin Converting Enzyme Inhibitors (ACEIs)?
All of the above
Which of the following is a contraindication for the use of Angiotensin Converting Enzyme Inhibitors (ACEIs)?
Pregnancy
What is the effect of Angiotensin Converting Enzyme Inhibitors (ACEIs) on peripheral resistance?
Decrease peripheral resistance
What is the primary mechanism of action of Diuretics?
Decrease blood volume
What is the effect of Angiotensin Converting Enzyme Inhibitors (ACEIs) on cardiac output?
No effect on cardiac output
Which of the following is a classification of Antihypertensive Drugs?
Diuretics, RAAS Inhibitors, Calcium Channel Blockers, and Sympatholytic Drugs
What is the primary mechanism of action of Angiotensin Converting Enzyme Inhibitors (ACEIs) on blood pressure regulation?
Inhibit angiotensin II, increase bradykinin, and inhibit aldosterone
What is the primary mechanism of action of thiazide diuretics?
Not mentioned in the text
What is the effect of calcium channel blockers on heart rate?
Decrease heart rate
Which of the following is a side effect of verapamil?
Both A and B
What is the primary mechanism of action of beta blockers?
Blocking beta receptors
What is the effect of calcium channel blockers on peripheral resistance?
Decrease peripheral resistance
Which of the following is a side effect of frusemide?
Hypokalemia
What is the primary mechanism of action of alpha blockers?
Blocking alpha receptors
What is the effect of beta blockers on cardiac work?
Decrease cardiac work
Which of the following is a side effect of amlodipine?
Ankle swelling
What is the primary mechanism of action of spironolactone?
Sparing potassium
What is the primary mechanism of action of organic nitrates?
Generation of NO leading to vasorelaxation
Which type of drug is used to treat benign prostate hyperplasia (BPH)?
ɑ1a-blocker, such as Tamsulosin
What is the effect of arteriodilators on cardiac work?
Decrease cardiac work
Which type of drug is used to treat variant angina?
Calcium Channel Blocker, such as Nifedipine
What is the effect of venodilators on cardiac work?
Decrease cardiac work
What is the primary mechanism of action of β-blockers in reducing anginal pain?
Blockade of β1 receptors
What is the effect of Ca++ channel blockers on cardiac oxygen demand?
Decrease cardiac oxygen demand
Which type of drug is used to treat pregnant hypertensive patients?
Methyldopa, an ɑ2-agonist
What is the main aim of treating heart failure?
Decrease the symptoms
Which type of drug is used to treat hypertension?
Centrally acting adrenergic drug, such as Clonidine
Study Notes
Classification of Antihypertensive Drugs
- Diuretics
- Renin-Angiotensin-Aldosterone (RAAS) System Inhibitors:
- Angiotensin Converting Enzyme Inhibitors (ACEI)
- Angiotensin Receptor Blockers (ARB)
- Renin inhibitors (e.g., aliskiren)
- Calcium Channel Blockers (CCBs)
- Sympatholytic Drugs
- Direct Vasodilators (DVD)
First-Line and Second-Line Antihypertensive Drugs
- First-line (primary) drugs:
- Angiotensin Converting Enzyme Inhibitors (ACEIs)
- Angiotensin Receptor Blockers (ARBs)
- Calcium Channel Blockers (CCBs)
- Diuretics
- Second-line (alternative) drugs:
- Alpha blockers
- Beta Blockers
- Central α2 agonists
- Vasodilators
ACE Inhibitors and Angiotensin Receptor Blockers (ARBs)
- Mechanism of action:
- Inhibit Angiotensin II, preventing vasoconstriction
- Increase bradykinin, causing vasodilation
- Diuresis, inhibiting aldosterone
- Decrease BP by decreasing PR, without affecting CO or HR
- Unlike direct vasodilators, they do not cause reflex tachycardia
- Examples:
- ACE-inhibitors: Enalapril, Ramipril, and Captopril
- AT1 receptor antagonists (ARBs): Losartan and Valsartan
- Pharmacokinetics: Eliminated primarily by the kidneys; adjust dose in renal insufficiency
- Adverse effects:
- Dry cough (5-30%)
- Angioedema
- Hyperkalemia
- Teratogenic (not used in pregnancy)
Diuretics
- Mechanism of action:
- Diuretic action decreases blood volume
- Decrease cardiac output
- Decrease blood pressure
- Classification:
- Thiazide diuretics: Hydrochlorothiazide
- Loop diuretics: Frusemide
- Potassium-sparing diuretics: Spironolactone, Triamterene
- Adverse effects:
- Hypokalemia
- Hypomagnesemia
- Hyperkalemia (in case of potassium-sparing diuretics)
- Hyponatremia and hypercalcemia (Thiazide)
- Hyperurecemia
- Hyperglycemia
Calcium Channel Blockers (CCBs)
- Mechanism of action:
- Block calcium channels
- Decrease heart rate and contractility in the heart
- Vasodilation in blood vessels
- Examples:
- Non-Dihydropyridine: Diltiazem and Verapamil (more selective to the heart)
- Dihydropyridine: Nifidipine and Amlodipine (more selective to blood vessels)
- Adverse effects:
- Flushing, headache, and tachycardia
- Ankle swelling (edema) is common
- Negative inotropic effect of verapamil (can worsen heart failure)
- Constipation is common with verapamil
Beta Blockers
- Mechanism of action:
- Act mainly by blocking β1 receptors
- Decrease heart rate
- Examples:
- Non-selective β-blockers: Propranolol and Carvedilol
- Selective β1-blockers: Atenolol and Bisoprolol
- Adverse effects:
- Bradycardia
- Fatigue
- Cold extremities
- Erectile dysfunction
- Bronchospasm (especially with non-selective β-blockers)
Alpha Adrenergic Blockers
- Examples: Prazosin, Doxazosin, Terazosin
- Produce a competitive block of α1-adrenoceptors
- Tamsulosin, an α1a-blocker, is used in the treatment of benign prostate hyperplasia (BPH)
Centrally Acting Adrenergic Drugs
- α2-agonist: Clonidine
- α-Methyldopa: specially valuable in treating pregnant hypertensive patients
Direct Vasodilators
- Arteriodilators: Hydralazine, Minoxidil, Diazoxide
- Venodilators: Nitroglycerine (IV infusion in hypertensive emergencies)
- Arteriovenodilators: Sodium Nitroprusside
Anti-Angina Drugs
- Nitrites and Nitrates
- Calcium Channel Blockers (CCBs)
- Beta Blockers
- Adjuvant drugs:
- Anti-Platelet: Aspirin, Clopidogrel, and Ticlopidine
- Drug treatment of risk and precipitating factors (e.g., Anxiolytic, Antihypertensive, Anti-hyperlipidemic, Anti-diabetic, etc.)
Organic Nitrates
- Mechanism of action:
- Generation of NO leading to vasorelaxation
- Cardiovascular effects:
- Increase O2 supply and decrease cardiac work (decrease O2 demand) by VD
- Side effects:
- Venodilation → Postural hypotension, reflex tachycardia, dizziness, and syncope
- Arteriodilation → Throbbing headache and flushing
- Tolerance
Classification of Antihypertensive Drugs
- Diuretics
- Renin-Angiotensin-Aldosterone (RAAS) System Inhibitors:
- Angiotensin Converting Enzyme Inhibitors (ACEI)
- Angiotensin Receptor Blockers (ARB)
- Renin inhibitors (e.g., aliskiren)
- Calcium Channel Blockers (CCBs)
- Sympatholytic Drugs
- Direct Vasodilators (DVD)
First-Line and Second-Line Antihypertensive Drugs
- First-line (primary) drugs:
- Angiotensin Converting Enzyme Inhibitors (ACEIs)
- Angiotensin Receptor Blockers (ARBs)
- Calcium Channel Blockers (CCBs)
- Diuretics
- Second-line (alternative) drugs:
- Alpha blockers
- Beta Blockers
- Central α2 agonists
- Vasodilators
ACE Inhibitors and Angiotensin Receptor Blockers (ARBs)
- Mechanism of action:
- Inhibit Angiotensin II, preventing vasoconstriction
- Increase bradykinin, causing vasodilation
- Diuresis, inhibiting aldosterone
- Decrease BP by decreasing PR, without affecting CO or HR
- Unlike direct vasodilators, they do not cause reflex tachycardia
- Examples:
- ACE-inhibitors: Enalapril, Ramipril, and Captopril
- AT1 receptor antagonists (ARBs): Losartan and Valsartan
- Pharmacokinetics: Eliminated primarily by the kidneys; adjust dose in renal insufficiency
- Adverse effects:
- Dry cough (5-30%)
- Angioedema
- Hyperkalemia
- Teratogenic (not used in pregnancy)
Diuretics
- Mechanism of action:
- Diuretic action decreases blood volume
- Decrease cardiac output
- Decrease blood pressure
- Classification:
- Thiazide diuretics: Hydrochlorothiazide
- Loop diuretics: Frusemide
- Potassium-sparing diuretics: Spironolactone, Triamterene
- Adverse effects:
- Hypokalemia
- Hypomagnesemia
- Hyperkalemia (in case of potassium-sparing diuretics)
- Hyponatremia and hypercalcemia (Thiazide)
- Hyperurecemia
- Hyperglycemia
Calcium Channel Blockers (CCBs)
- Mechanism of action:
- Block calcium channels
- Decrease heart rate and contractility in the heart
- Vasodilation in blood vessels
- Examples:
- Non-Dihydropyridine: Diltiazem and Verapamil (more selective to the heart)
- Dihydropyridine: Nifidipine and Amlodipine (more selective to blood vessels)
- Adverse effects:
- Flushing, headache, and tachycardia
- Ankle swelling (edema) is common
- Negative inotropic effect of verapamil (can worsen heart failure)
- Constipation is common with verapamil
Beta Blockers
- Mechanism of action:
- Act mainly by blocking β1 receptors
- Decrease heart rate
- Examples:
- Non-selective β-blockers: Propranolol and Carvedilol
- Selective β1-blockers: Atenolol and Bisoprolol
- Adverse effects:
- Bradycardia
- Fatigue
- Cold extremities
- Erectile dysfunction
- Bronchospasm (especially with non-selective β-blockers)
Alpha Adrenergic Blockers
- Examples: Prazosin, Doxazosin, Terazosin
- Produce a competitive block of α1-adrenoceptors
- Tamsulosin, an α1a-blocker, is used in the treatment of benign prostate hyperplasia (BPH)
Centrally Acting Adrenergic Drugs
- α2-agonist: Clonidine
- α-Methyldopa: specially valuable in treating pregnant hypertensive patients
Direct Vasodilators
- Arteriodilators: Hydralazine, Minoxidil, Diazoxide
- Venodilators: Nitroglycerine (IV infusion in hypertensive emergencies)
- Arteriovenodilators: Sodium Nitroprusside
Anti-Angina Drugs
- Nitrites and Nitrates
- Calcium Channel Blockers (CCBs)
- Beta Blockers
- Adjuvant drugs:
- Anti-Platelet: Aspirin, Clopidogrel, and Ticlopidine
- Drug treatment of risk and precipitating factors (e.g., Anxiolytic, Antihypertensive, Anti-hyperlipidemic, Anti-diabetic, etc.)
Organic Nitrates
- Mechanism of action:
- Generation of NO leading to vasorelaxation
- Cardiovascular effects:
- Increase O2 supply and decrease cardiac work (decrease O2 demand) by VD
- Side effects:
- Venodilation → Postural hypotension, reflex tachycardia, dizziness, and syncope
- Arteriodilation → Throbbing headache and flushing
- Tolerance
This quiz covers the classification of antihypertensive drugs, including diuretics, RAAS inhibitors, calcium channel blockers, sympatholytic drugs, and direct vasodilators.
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