(4.9) HTN DRUGS (HARD QUIZ)
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Questions and Answers

Which class of antihypertensive drugs specifically works by inhibiting the Renin-Angiotensin-Aldosterone System (RAAS)?

  • Calcium-channel blockers
  • ACE inhibitors (correct)
  • Diuretics
  • Alpha-blockers

What is the primary mechanism of action of calcium-channel blockers in the treatment of hypertension?

  • Inhibition of vasopressor hormones
  • Decreased calcium influx into cardiac and vascular smooth muscle (correct)
  • Reduction of peripheral vascular resistance
  • Increased renal sodium excretion

Which of the following adverse effects is most directly related to the mechanism of action of diuretics?

  • Dry cough
  • Electrolyte imbalances (correct)
  • Bradycardia
  • Peripheral edema

How does the physiology of blood pressure relate to the medications used to treat hypertension?

<p>Antihypertensives work by altering fluid volume or vascular tone. (D)</p> Signup and view all the answers

Among the following antihypertensive medications, which one is primarily used in patients with heart failure?

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

Which drug category does amlodipine belong to, and what is its primary clinical indication?

<p>Calcium-channel blockers; hypertension (C)</p> Signup and view all the answers

Which of the following statements about the mechanism of action of antihypertensive drugs is accurate?

<p>Diuretics primarily act on the kidneys to reduce blood volume. (A)</p> Signup and view all the answers

What is the most common use for lisinopril in clinical practice?

<p>Treatment of hypertension and heart failure (A)</p> Signup and view all the answers

Which of the following medication classes directly impacts vascular smooth muscle tone?

<p>Calcium-channel blockers (A)</p> Signup and view all the answers

Which side effect is commonly associated with ACE inhibitors like lisinopril?

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

What is the primary goal of hypertension treatment?

<p>To reduce cardiovascular and renal morbidity and mortality (D)</p> Signup and view all the answers

Which diuretics are considered safe and effective for preventing serious cardiovascular events?

<p>Low-dose diuretics (C)</p> Signup and view all the answers

Which drug is the prototype β-blocker that acts on both β1 and β2 receptors?

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

What are common adverse effects associated with β-blockers?

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

What is the main function of aliskiren in the context of hypertension?

<p>It inhibits renin and reduces the activation of RAAS (B)</p> Signup and view all the answers

Which adverse effect is commonly associated with ACE inhibitors?

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

What is a key advantage of angiotensin receptor blockers (ARBs) compared to ACE inhibitors?

<p>They provide complete blockade of angiotensin II action (A)</p> Signup and view all the answers

Which class of drugs helps to limit intracellular calcium, promoting vasodilation?

<p>Calcium channel blockers (B)</p> Signup and view all the answers

Which patient population is most recommended to receive ACE inhibitors as first-line treatment?

<p>Patients with high coronary disease risk or other specified conditions (B)</p> Signup and view all the answers

Which class of antihypertensive drugs exerts its effects by primarily reducing blood volume?

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

What is a significant physiological effect of calcium-channel blockers in the treatment of hypertension?

<p>Decreased vascular resistance (C)</p> Signup and view all the answers

Which of the following is a likely consequence of excessive renin-angiotensin-aldosterone system (RAAS) activation?

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

What type of adverse effect is frequently associated with calcium-channel blockers?

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

Among the following, which drug class is most likely to cause a persistent cough as a side effect?

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

Which of the following antihypertensive classes primarily prevents calcium from entering vascular smooth muscle cells?

<p>Calcium-channel blockers (A)</p> Signup and view all the answers

What main mechanism of action do beta-blockers use to lower blood pressure?

<p>Decreased heart rate and contractility (A)</p> Signup and view all the answers

Which adverse effect is most commonly linked with diuretics due to their mechanism of action?

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

Which antihypertensive medication class is often used first-line in patients with heart failure?

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

Which medication is a commonly prescribed calcium-channel blocker for hypertension?

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

Which antihypertensive drug class is particularly advantageous for patients who cannot tolerate ACE inhibitors due to adverse effects?

<p>Angiotensin Receptor Blockers (B)</p> Signup and view all the answers

What is a common side effect of β-blockers that can negatively impact patient adherence to treatment?

<p>Decreased heart rate (A)</p> Signup and view all the answers

Which of the following medications lowers blood pressure by specifically inhibiting the enzymatic activity of renin?

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

What is the primary consequence of increased bradykinin levels as related to ACE inhibitors?

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

Which diuretic action leads to a reduction in blood pressure?

<p>Decreased blood volume (B)</p> Signup and view all the answers

In patients with high coronary disease risk, which class of antihypertensive drugs is prioritized in treatment?

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

Which of the following is a potential life-threatening side effect associated with ACE inhibitors?

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

What is the mechanism by which calcium channel blockers lower blood pressure?

<p>Blocking calcium entry into vascular smooth muscle (B)</p> Signup and view all the answers

Which drug class has been observed to potentially cause kidney complications when combined with ACE inhibitors or ARBs?

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

What effect do ARBs exert on aldosterone secretion?

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

Flashcards

Hypertension Pharmacology

Study of drugs used to treat high blood pressure.

Diuretics

Drugs that increase urine output, lowering blood volume.

RAAS inhibitors

Drugs that block the renin-angiotensin-aldosterone system, reducing blood pressure.

Calcium-channel blockers

Drugs that relax blood vessels by blocking calcium entry, lowering blood pressure.

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Amlodipine

A calcium-channel blocker used to treat high blood pressure.

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Lisinopril

An ACE inhibitor used to treat high blood pressure and heart failure.

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ACE inhibitor

Drug that inhibits the angiotensin-converting enzyme, reducing blood pressure.

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Blood Pressure

The force of blood against the walls of blood vessels.

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Vasculature Physiology

The study of how blood vessels function, including flow and pressure.

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Adverse effects

Unwanted side effects of medication.

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Hypertension Goal

The goal of hypertension treatment is to reduce cardiovascular and renal morbidity and mortality, and improve overall patient health.

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First Line Hypertension Treatment

Initial treatment for hypertension often involves monotherapy with a thiazide diuretic, ACE inhibitor, ARB, or calcium channel blocker, if blood pressure is above 130/90.

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Hypertension Progression

If blood pressure remains uncontrolled after initial monotherapy, add an additional drug based on minimizing adverse effects to reach the goal blood pressure.

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Dual Therapy for Hypertension

Patients with blood pressure greater than 160/100 should receive dual therapy with two medications from the beginning.

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Diuretics and Hypertension

Diuretics decrease blood volume, leading to lower blood pressure. They are effective in preventing stroke, myocardial infarction, and heart failure.

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β-Blocker Mechanism

β-blockers reduce blood pressure by lowering cardiac output through selective blockage of beta-adrenergic receptors. They also inhibit renin release and decrease angiotensin II and aldosterone formation.

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ACE Inhibitor Mechanism

ACE inhibitors block the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor.

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ARB Mechanism

ARBs block angiotensin II receptors, preventing its action on blood vessels and leading to vasodilation and reduced aldosterone secretion.

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Calcium Channel Blocker Mechanism

Calcium channel blockers limit intracellular calcium, promoting vasodilation of arterioles by blocking calcium entry into smooth muscle cells.

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Adverse Effects of β-Blockers

β-blockers can cause bradycardia, hypotension, fatigue, lethargy, insomnia, decreased libido, and erectile dysfunction.

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ACE Inhibitor MOA

ACE inhibitors block the conversion of angiotensin I to angiotensin II, a powerful vasoconstrictor, thus reducing blood pressure.

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ARB MOA

ARBs block the angiotensin II receptors, preventing its effect on blood vessels and causing vasodilation. They also reduce aldosterone secretion.

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Calcium Channel Blocker MOA

Calcium channel blockers limit calcium entry into smooth muscle cells of blood vessels, causing vasodilation and lower blood pressure.

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Diuretic MOA

Diuretics increase urine output, reducing blood volume and lowering blood pressure.

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What are the 3 major classes of antihypertensive drugs?

The three major classes of antihypertensive drugs are diuretics, RAAS inhibitors (ACE inhibitors and ARBs), and calcium channel blockers.

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How does the MOA of antihypertensive drugs relate to blood pressure?

Antihypertensive drugs work by targeting specific mechanisms that regulate blood pressure, such as fluid volume, vasoconstriction, and heart rate.

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Why are adverse effects important to consider?

Adverse effects are crucial to consider because they impact the effectiveness and safety of a drug, potentially outweighing their beneficial effects.

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What is the connection between adverse effects and vasculature physiology?

Adverse effects of antihypertensive drugs often arise from their impact on vasculature physiology, causing unwanted changes in blood vessel function.

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Why is Amlodipine frequently prescribed?

Amlodipine, a calcium channel blocker, is commonly prescribed for hypertension because it effectively lowers blood pressure with a long-acting mechanism, making it convenient for patients.

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Why is Lisinopril frequently prescribed?

Lisinopril, an ACE inhibitor, is widely prescribed for hypertension and heart failure due to its effectiveness in lowering blood pressure and reducing the risk of cardiovascular complications

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Thiazide diuretic

A type of diuretic used as first-line treatment for hypertension. They work by removing excess sodium and water from the body, which reduces blood volume and pressure.

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ARB

A drug that blocks angiotensin II receptors, preventing its action on blood vessels and leading to vasodilation and reduced aldosterone secretion.

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ACE inhibitor side effects

ACE inhibitors can cause a persistent dry cough, rash, fever, hypotension, and hyperkalemia. The cough is attributed to elevated bradykinin.

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Angioedema

A rare but life-threatening allergic reaction to ACE inhibitors, characterized by swelling of the face, lips, tongue, and throat. It's a very serious side effect that requires immediate medical attention.

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Hypertension: dual therapy

For patients with uncontrolled blood pressure over 160/100, two medications are prescribed simultaneously to manage hypertension effectively.

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Monitoring for electrolyte imbalances

Patients on diuretics require regular monitoring of serum electrolytes, especially potassium, to detect and address any potential abnormalities.

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Study Notes

Lecture #32: Hypertension Pharmacology

  • Julia Hum, PhD, is the primary course instructor
  • Course meets Monday/Wednesday/Friday, 2:00-2:50 PM
  • Office hours are Monday/Wednesday/Friday, 11:00 AM-12:00 PM (317B or WebEx)
  • Lecture website is marian.edu/medicalschool

L32: Learning Objectives

  • Compare and contrast the mechanism of action (MOA) of the main classes of hypertension drugs (diuretics, RAAS inhibitors, calcium-channel blockers)
  • Relate the MOA of antihypertensive drugs to their effect on blood pressure physiology
  • Connect key adverse effects of antihypertensive drugs to their MOA and vascular physiology

L32: "Take Home Slide"

  • Diagram shows the Renin-Angiotensin-Aldosterone System (RAAS)
  • Angiotensinogen (a₂-globulin in blood) is converted to angiotensin I by the enzyme renin.
  • Angiotensin I is converted to angiotensin II by ACE (Angiotensin-converting enzyme).
  • Angiotensin II increases blood pressure by constricting blood vessels.
  • Renin inhibitors, ACE inhibitors, and ARBs (Angiotensin II receptor blockers) block these steps.
  • Aldosterone receptor antagonists decrease retention of sodium and water, reducing blood pressure.

Top 10 List of Drugs Prescribed in America

  • This is a list of top-prescribed drugs in America.
  • Amlodipine: High blood pressure (Ca++ channel blocker)
  • Alprazolam: Anxiety (xanax, short-acting "benzo")
  • Atorvastatin: High cholesterol ("Statins")
  • Metformin: Type 2 Diabetes (T2D)
  • Gabapentin: Seizures and nerve pain (Neurontin)
  • Lisinopril: Hypertension, heart failure (ACE inhibitor)

Summary of Antihypertensive Drugs

  • Lists various classes of antihypertensive drugs
  • Includes examples of specific drugs within each class

Hypertension: Treatment Strategies

  • Goal: reduce cardiovascular and renal morbidity and mortality
  • Start monotherapy (thiazide diuretic, ACE inhibitor, ARB, or calcium channel blocker) if blood pressure is >130/90
  • Add an additional drug if blood pressure remains uncontrolled to reach a goal blood pressure.
  • Dual therapy (2 drugs) should be started if the blood pressure is > 160/100

Hypertension Management - IRL

  • Includes a decision-tree flow chart describing the management of hypertension

Treatment of hypertension with concomitant diseases

  • Provides a table relating concomitant diseases to indicated drug classes.
  • Presents possible drug combinations for particular conditions.

Hypertension: Diuretics

  • Goal: Decreasing blood volume to lower blood pressure
  • Low-dose diuretics are safe, inexpensive, and effective in preventing stroke, heart attack, and heart failure (HF).
  • Routine serum electrolyte monitoring is needed for those on diuretics

Hypertension: β-Blockers

  • MOA: Reduce blood pressure by decreasing cardiac output, inhibiting the release of renin from kidneys, and decreasing the secretion of aldosterone
  • β-blockers are effective in lowering blood pressure and are commonly used
  • Prototype β-blocker is propranolol (acts on both β1 and β2 receptors)
  • Metoprolol and atenolol are selective β1 blockers

Adverse Effects: β-Blockers

  • Possible side effects such as bradycardia, hypotension, CNS side effects (fatigue, lethargy, and insomnia), and a decreased libido, can lead to erectile dysfunction

Hypertension: Renin Inhibitors

  • Aliskiren is a renin inhibitor
  • Acts earlier in RAAS system to control hypertension, lowering blood pressure equally well as ARBs and ACE inhibitors

Inhibitors of RAAS - Inhibitor of enzymatic activity of renin

  • Aliskiren is the first approved renin inhibitor.
  • Blocks the conversion of angiotensinogen to angiotensin I
  • Metabolized by CYP 3A4 and can interact with other drugs.
  • Effective antihypertensive, and helps slow progression of heart failure

Hypertension: ACE Inhibitors

  • ACE inhibitors are recommended as a first-line treatment for hypertension in certain patient groups (those with high coronary disease, diabetes, stroke, heart failure, myocardial infarction, or chronic kidney disease).

Inhibitors of RAAS - Angiotensin-converting enzyme inhibitors

  • ACE inhibitors prevent the conversion of angiotensin I to angiotensin II.
  • This leads to vasodilation and a decrease in blood pressure
  • Examples of ACE inhibitors include Lisinopril "-pril"

Adverse Effects: ACE Inhibitors

  • Possible side effects include dry cough, rash, fever, hypotension (in hypovolemic states), and hyperkalemia
  • Angioedema is a rare but potentially life-threatening side effect linked to bradykinin.

Hypertension: ARBs

  • MOA: Block the AT1 receptors, decreasing the activation of AT1 receptors by angiotensin II.
  • Similiar to ACE inhibitors; produces arteriolar and venous dilation, blocks aldosterone secretion, lowers blood pressure, and decreases salt and water retention.

Inhibitors of RAAS - Angiotensin Receptor Blockers

  • ARBs are competitive antagonists of the angiotensin II type 1 receptor
  • Examples of ARBs include Valsartan and Losartan ("-sartan")
  • ARBs are substitutes for ACE inhibitors for patients who cannot tolerate ACE inhibitors.
  • They have similar effects and side effects except for the cough side effect.

Calcium Channel Blockers

  • MOA: limit intracellular calcium, promoting vasodilation of arterioles.
  • Block inward calcium movement in heart/peripheral smooth muscle through L-type calcium channels.
  • Triggers calcium release from the SR (sarcoplasmic reticulum) increasing cytosolic calcium.

Calcium Channel Blockers

  • Divided into 3 chemical classes: Diphenylalkylamines (e.g., Verapamil), Benzothiazepines (e.g. Diltiazem), and Dihydropyridines (e.g., Nifedipine).
  • Each class has different pharmacokinetic properties and clinical uses.

Adverse Effects: Calcium Channel Blockers

  • Verapamil and diltiazem should be avoided in patients with heart failure due to possible negative impacts on cardiac function.
  • Possible side effects including dizziness, headache, fatigue, and peripheral edema.

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Med Phys Pharm 551 L32 Hypertension Pharm Lecture Notes PDF

Description

This quiz focuses on Lecture #32 of the hypertension pharmacology course, led by Dr. Julia Hum. Participants will explore the mechanisms of action of various antihypertensive drug classes, their effects on blood pressure physiology, and associated adverse effects. Additionally, it includes key elements of the Renin-Angiotensin-Aldosterone System (RAAS).

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