Classification of Antihypertensive Drugs

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Questions and Answers

What is the primary mechanism of action of calcium channel blockers?

  • Block potassium channels
  • Block calcium channels (correct)
  • Increase heart rate and contractility
  • Increase peripheral resistance

What is a common side effect of thiazide diuretics?

  • Hyperkalemia
  • Hypercalcemia
  • Hypokalemia (correct)
  • Hypermagnesemia

Which type of diuretic can cause hyperkalemia?

  • Osmotic diuretics
  • Thiazide diuretics
  • Potassium-sparing diuretics (correct)
  • Loop diuretics

What is a common side effect of beta blockers?

<p>Bradycardia (D)</p> Signup and view all the answers

Which type of calcium channel blocker is more selective to the heart?

<p>Non-Dihydropyridine (B)</p> Signup and view all the answers

What is a common interaction between verapamil and other medications?

<p>Increased toxicity with lidocaine (A)</p> Signup and view all the answers

What is the primary mechanism of action of beta blockers?

<p>Block β1-receptors (D)</p> Signup and view all the answers

Which type of diuretic is Frusemide an example of?

<p>Loop diuretic (A)</p> Signup and view all the answers

What is a common side effect of calcium channel blockers?

<p>Ankle swelling (B)</p> Signup and view all the answers

Which type of alpha blocker is Prazosin an example of?

<p>α1-adrenergic blocker (C)</p> Signup and view all the answers

What is the primary mechanism of action of Angiotensin Converting Enzyme Inhibitors (ACEIs) on blood pressure regulation?

<p>Inhibit Angiotensin II to prevent vasoconstriction (B)</p> Signup and view all the answers

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?

<p>They do not cause reflex tachycardia (B)</p> Signup and view all the answers

What is the primary mechanism of action of Diuretics on blood pressure regulation?

<p>Decrease blood volume by increasing urine output (B)</p> Signup and view all the answers

Which of the following is a common adverse effect of Angiotensin Converting Enzyme Inhibitors (ACEIs)?

<p>Dry cough (A)</p> Signup and view all the answers

Which of the following is a characteristic of Angiotensin Receptor Blockers (ARBs)?

<p>They block the action of angiotensin II on AT1 receptors (C)</p> Signup and view all the answers

Which of the following antihypertensive drugs is classified as a first-line or primary drug?

<p>Angiotensin Converting Enzyme Inhibitors (ACEIs) (C)</p> Signup and view all the answers

What is the effect of Angiotensin Converting Enzyme Inhibitors (ACEIs) on bradykinin?

<p>Increase bradykinin (D)</p> Signup and view all the answers

Which of the following is a contraindication for the use of Angiotensin Converting Enzyme Inhibitors (ACEIs)?

<p>Pregnancy (C)</p> Signup and view all the answers

What is the effect of Angiotensin Converting Enzyme Inhibitors (ACEIs) on peripheral resistance?

<p>Decrease peripheral resistance (B)</p> Signup and view all the answers

Which of the following is a mechanism of action of Angiotensin Converting Enzyme Inhibitors (ACEIs) on blood pressure regulation?

<p>Inhibit the conversion of angiotensin I to angiotensin II (C)</p> Signup and view all the answers

What is the primary mechanism of action of organic nitrates?

<p>Generation of NO leading to vasorelaxation (C)</p> Signup and view all the answers

Which type of adrenergic drug is clonidine?

<p>α2- agonist (A)</p> Signup and view all the answers

What is the effect of arteriodilators on cardiac work?

<p>Decrease O2 demand (D)</p> Signup and view all the answers

What is the main aim of treating heart failure?

<p>Decrease symptoms (A)</p> Signup and view all the answers

Which type of drug is used to treat pregnant hypertensive patients?

<p>α-Methyldopa (C)</p> Signup and view all the answers

What is the common side effect of β-blockers?

<p>Dizziness, weakness, headache, impotence (D)</p> Signup and view all the answers

What is the effect of Ca++ channel blockers on cardiac oxygen demand?

<p>Decrease cardiac oxygen demand (A)</p> Signup and view all the answers

What is the effect of venodilators on cardiac work?

<p>Decrease cardiac work (D)</p> Signup and view all the answers

Which type of drug is used to treat variant angina?

<p>Ca++ channel blocker (C)</p> Signup and view all the answers

What is the common side effect of Ca++ channel blockers?

<p>Arterial dilation → headache, flushing, dizziness &amp; ankle edema (B)</p> Signup and view all the answers

What is the primary mechanism of action of Angiotensin Converting Enzyme Inhibitors (ACEIs) that helps reduce blood pressure?

<p>Increase bradykinin levels (B)</p> Signup and view all the answers

Which of the following is a characteristic of Angiotensin Receptor Blockers (ARBs)?

<p>They are classified as first-line or primary drugs (B)</p> Signup and view all the answers

What is the effect of Diuretics on blood pressure regulation?

<p>Decrease blood volume (C)</p> Signup and view all the answers

What is a common adverse effect of Angiotensin Converting Enzyme Inhibitors (ACEIs)?

<p>All of the above (D)</p> Signup and view all the answers

Which of the following is a contraindication for the use of Angiotensin Converting Enzyme Inhibitors (ACEIs)?

<p>Pregnancy (B)</p> Signup and view all the answers

What is the effect of Angiotensin Converting Enzyme Inhibitors (ACEIs) on peripheral resistance?

<p>Decrease peripheral resistance (D)</p> Signup and view all the answers

What is the primary mechanism of action of Diuretics?

<p>Decrease blood volume (A)</p> Signup and view all the answers

What is the effect of Angiotensin Converting Enzyme Inhibitors (ACEIs) on cardiac output?

<p>No effect on cardiac output (A)</p> Signup and view all the answers

Which of the following is a classification of Antihypertensive Drugs?

<p>Diuretics, RAAS Inhibitors, Calcium Channel Blockers, and Sympatholytic Drugs (D)</p> Signup and view all the answers

What is the primary mechanism of action of Angiotensin Converting Enzyme Inhibitors (ACEIs) on blood pressure regulation?

<p>Inhibit angiotensin II, increase bradykinin, and inhibit aldosterone (C)</p> Signup and view all the answers

What is the primary mechanism of action of thiazide diuretics?

<p>Not mentioned in the text (A)</p> Signup and view all the answers

What is the effect of calcium channel blockers on heart rate?

<p>Decrease heart rate (D)</p> Signup and view all the answers

Which of the following is a side effect of verapamil?

<p>Both A and B (B)</p> Signup and view all the answers

What is the primary mechanism of action of beta blockers?

<p>Blocking beta receptors (B)</p> Signup and view all the answers

What is the effect of calcium channel blockers on peripheral resistance?

<p>Decrease peripheral resistance (C)</p> Signup and view all the answers

Which of the following is a side effect of frusemide?

<p>Hypokalemia (D)</p> Signup and view all the answers

What is the primary mechanism of action of alpha blockers?

<p>Blocking alpha receptors (B)</p> Signup and view all the answers

What is the effect of beta blockers on cardiac work?

<p>Decrease cardiac work (A)</p> Signup and view all the answers

Which of the following is a side effect of amlodipine?

<p>Ankle swelling (B)</p> Signup and view all the answers

What is the primary mechanism of action of spironolactone?

<p>Sparing potassium (B)</p> Signup and view all the answers

What is the primary mechanism of action of organic nitrates?

<p>Generation of NO leading to vasorelaxation (C)</p> Signup and view all the answers

Which type of drug is used to treat benign prostate hyperplasia (BPH)?

<p>É‘1a-blocker, such as Tamsulosin (B)</p> Signup and view all the answers

What is the effect of arteriodilators on cardiac work?

<p>Decrease cardiac work (C)</p> Signup and view all the answers

Which type of drug is used to treat variant angina?

<p>Calcium Channel Blocker, such as Nifedipine (C)</p> Signup and view all the answers

What is the effect of venodilators on cardiac work?

<p>Decrease cardiac work (C)</p> Signup and view all the answers

What is the primary mechanism of action of β-blockers in reducing anginal pain?

<p>Blockade of β1 receptors (B)</p> Signup and view all the answers

What is the effect of Ca++ channel blockers on cardiac oxygen demand?

<p>Decrease cardiac oxygen demand (D)</p> Signup and view all the answers

Which type of drug is used to treat pregnant hypertensive patients?

<p>Methyldopa, an É‘2-agonist (B)</p> Signup and view all the answers

What is the main aim of treating heart failure?

<p>Decrease the symptoms (D)</p> Signup and view all the answers

Which type of drug is used to treat hypertension?

<p>Centrally acting adrenergic drug, such as Clonidine (B)</p> Signup and view all the answers

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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

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