Hypertension Drugs: RAAS and SNS targeting

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Questions and Answers

A patient with hypertension and a history of asthma requires a beta-blocker. Which of the following would be the MOST appropriate choice?

  • Carvedilol
  • Atenolol (correct)
  • Propranolol
  • Labetalol

Which of the following antihypertensive medications requires monitoring of liver function?

  • Captopril
  • Losartan (correct)
  • Aliskiren
  • Eplerenone

A patient taking nifedipine reports experiencing facial flushing. Which of the following is the BEST explanation for this side effect?

  • Stimulation of aldosterone release.
  • Inhibition of calcium channels leading to vasodilation. (correct)
  • Increased sympathetic nervous system activity.
  • Increased renin production.

Which class of antihypertensive medications is MOST likely to cause angioedema as a potential side effect?

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

A patient is prescribed doxazosin for hypertension. What is the MOST important instruction to provide regarding the timing of administration?

<p>Take it at night before bedtime. (D)</p> Signup and view all the answers

Which of the following antihypertensive medications is contraindicated in patients with serum potassium levels greater than 5.0 mEq/L?

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

A patient with hypertension and type 2 diabetes mellitus is prescribed aliskiren. Which of the following is the MOST appropriate action?

<p>Contact the prescriber to question the order; aliskiren is contraindicated in patients with diabetes. (D)</p> Signup and view all the answers

A patient has been taking atenolol for hypertension for several months. They abruptly discontinue the medication. Which of the following is the MOST likely consequence?

<p>Rebound hypertension and increased heart rate (C)</p> Signup and view all the answers

Which of the following antihypertensive medications provides kidney protection in patients with diabetes mellitus?

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

A patient prescribed losartan for hypertension also has significant renal artery stenosis. Which of the following is the MOST appropriate course of action?

<p>Discontinue the losartan; it is contraindicated in patients with renal artery stenosis. (A)</p> Signup and view all the answers

A patient taking eplerenone reports experiencing gastrointestinal upset. Which of the following is the BEST recommendation?

<p>Take the medication with food to reduce gastrointestinal irritation. (A)</p> Signup and view all the answers

A patient is started on captopril for hypertension. What potential adverse effect should the patient be educated about that may manifest as a persistent dry cough?

<p>Bradykinin accumulation (A)</p> Signup and view all the answers

Which of the following medications is contraindicated with grapefruit juice consumption?

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

Which of the following adverse effects is MOST associated with alpha-1 blockers like doxazosin?

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

What is the primary mechanism of action of ACE inhibitors in managing hypertension?

<p>Suppressing the renin-angiotensin-aldosterone system (RAAS) (A)</p> Signup and view all the answers

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Flashcards

ACE Inhibitor (e.g., Captopril)

Blocks the conversion of angiotensin I to angiotensin II, suppressing the RAAS system.

Angiotensin II Receptor Blocker (ARB) (e.g., Losartan)

Blocks angiotensin II receptors, preventing vasoconstriction and aldosterone release, suppressing the RAAS system.

Aldosterone Antagonists (e.g., Eplerenone)

Blocks aldosterone receptors, reducing sodium and water retention, suppressing the RAAS system.

Direct Renin Inhibitors (e.g., Aliskiren)

Directly inhibits renin, the enzyme that starts the RAAS cascade, thus suppressing the system.

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Calcium Channel Blockers (e.g., Nifedipine)

Blocks calcium entry into smooth muscle cells, causing vasodilation.

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Alpha1 Blockers (e.g., Doxazosin)

Blocks alpha1 receptors on blood vessels, leading to vasodilation and reduced blood pressure.

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Beta Blockers (e.g., Atenolol, Metoprolol)

Blocks beta receptors in the heart and blood vessels, reducing heart rate and blood pressure.

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RAAS Suppression

Suppresses the Renin-Angiotensin-Aldosterone System, leading to vasodilation and reduced blood pressure. Examples include ACE inhibitors, ARBs, aldosterone anatagonists and direct renin inhibitors.

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Kidney Protection in DM

Protect diabetic patients from kidney damage. Seen in ACE inhibitors and ARBs.

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Angioedema (ACE Inhibitors)

A rare but serious side effect of ACE inhibitors involving swelling of the face, tongue, and throat.

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Cough (ACE Inhibitors)

A common side effect of ACE inhibitors due to increased bradykinin levels.

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Bone Marrow Suppression

A rare but potentially serious side effect of some hypertension medications that affects blood cell production.

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Gum Hyperplasia (CCBs)

A side effect of calcium channel blockers characterized by excessive growth of gum tissue.

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Orthostatic Hypotension (OH)

A symptom where blood pressure drops when standing, increasing fall risk. Alpha1 Blockers are a common cause

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Hyperkalemia

A dangerous increase in serum potassium levels, a contraindication for aldosterone antagonists and direct renin inhibitors if levels are above 5.0.

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Study Notes

  • Hypertension drugs target RAAS and SNS to reduce blood pressure

ACE Inhibitors

  • Captopril is an example of an ACE inhibitor
  • Suppresses the Renin-Angiotensin-Aldosterone System (RAAS)
  • Protects kidneys in patients with diabetes mellitus (DM)
  • Protects against heart failure (HF)
  • Prevents myocardial infarction (MI)
  • Potential side effects include: angioedema, cough, and bone marrow suppression

Angiotensin II Receptor Blockers (ARBs)

  • Losartan is an example of an ARB
  • Suppresses the RAAS
  • Protects kidneys in patients with DM
  • Contraindicated (No) if creatinine clearance is low or patient is under 6 years old, signals kidney issues or stenosis
  • Liver damage is a potential side effect

Aldosterone Antagonists

  • Eplerenone is an example of an aldosterone antagonist
  • Suppresses the RAAS
  • Contraindicated (CI) in hyperkalemia if potassium is greater than 5.0
  • Gastrointestinal (GI) issues are a potential side effect
  • Contraindicated in patients with type 2 diabetes mellitus (DM2)

Direct Renin Inhibitors

  • Aliskiren is an example of a direct renin inhibitor
  • Suppresses the RAAS
  • GI issues are a potential side effect
  • Contraindicated in hyperkalemia if potassium is greater than 5.0
  • Contraindicated in patients with DM2

Calcium Channel Blockers

  • Nifedipine is an example of a calcium channel blocker
  • Blocks calcium channels
  • Facial flushing and gum hyperplasia are potential side effects
  • Avoid grapefruit consumption

Alpha1 Blockers

  • Doxazosin is an example of an Alpha 1 blocker
  • Suppresses the Sympathetic Nervous System (SNS)
  • Administer at night due to risk of orthostatic hypotension (OH) and falls
  • Use caution with erectile dysfunction (ED) drugs

Beta Blockers

  • Atenolol and Metoprolol are examples of Beta Blockers
  • Suppresses the SNS
  • Bronchodilation is not impaired; suitable for asthma and COPD patients
  • Do not discontinue suddenly due to risk of rebound increase in cardiac output
  • Contraindicated in children

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