Podcast
Questions and Answers
What is the diastolic blood pressure range for Stage 2 hypertension?
What is the diastolic blood pressure range for Stage 2 hypertension?
- 80 - 89 mmHg
- 100 - 109 mmHg (correct)
- > 110 mmHg
- 90 - 99 mmHg
Which class of antihypertensive drugs primarily works by blocking CNS output?
Which class of antihypertensive drugs primarily works by blocking CNS output?
- Sympathoplegics (correct)
- Calcium channel blockers
- Diuretics
- ACE inhibitors
Which of the following drugs is classified as a loop diuretic?
Which of the following drugs is classified as a loop diuretic?
- Metoprolol
- Hydrochlorothiazide
- Furosemide (correct)
- Spironolactone
In what scenario is polydrug therapy required?
In what scenario is polydrug therapy required?
Which of the following is NOT categorized as a beta adrenoceptor blocker?
Which of the following is NOT categorized as a beta adrenoceptor blocker?
What mechanism do ACE inhibitors use to lower blood pressure?
What mechanism do ACE inhibitors use to lower blood pressure?
What is the primary effect of alpha 2 agonists like clonidine and methyldopa on sympathetic outflow?
What is the primary effect of alpha 2 agonists like clonidine and methyldopa on sympathetic outflow?
How does methyldopa function as a prodrug in the treatment of hypertension?
How does methyldopa function as a prodrug in the treatment of hypertension?
Which side effect is commonly associated with the use of methyldopa?
Which side effect is commonly associated with the use of methyldopa?
What is the mechanism of action of clonidine in the treatment of hypertension?
What is the mechanism of action of clonidine in the treatment of hypertension?
What does the drug reserpine do in the context of sympathetic nervous system function?
What does the drug reserpine do in the context of sympathetic nervous system function?
What effect does activation of presynaptic alpha 2 receptors have on norepinephrine release?
What effect does activation of presynaptic alpha 2 receptors have on norepinephrine release?
Which of the following is NOT a characteristic of centrally acting antihypertensive agents like clonidine?
Which of the following is NOT a characteristic of centrally acting antihypertensive agents like clonidine?
Which of the following describes the mechanism of action of hydralazine?
Which of the following describes the mechanism of action of hydralazine?
What is a potential side effect of using hydralazine in high doses?
What is a potential side effect of using hydralazine in high doses?
How does minoxidil exert its therapeutic effects?
How does minoxidil exert its therapeutic effects?
What is a notable characteristic of calcium channel blockers (CCBs) in their action?
What is a notable characteristic of calcium channel blockers (CCBs) in their action?
What is the primary action of nitroprusside in managing hypertension?
What is the primary action of nitroprusside in managing hypertension?
Which of the following compounds is a dopamine D1 receptor agonist used for hypertensive crisis?
Which of the following compounds is a dopamine D1 receptor agonist used for hypertensive crisis?
Captopril and enalapril are classified as which type of antihypertensive agents?
Captopril and enalapril are classified as which type of antihypertensive agents?
What is the metabolite of nitroprusside that is cleared by the kidneys?
What is the metabolite of nitroprusside that is cleared by the kidneys?
What role does renin play in the renin-angiotensin system?
What role does renin play in the renin-angiotensin system?
What is a key difference between ACE inhibitors and Angiotensin II receptor blockers?
What is a key difference between ACE inhibitors and Angiotensin II receptor blockers?
Which of the following correctly describes the effects of Angiotensin II?
Which of the following correctly describes the effects of Angiotensin II?
What is a common side effect of ACE inhibitors experienced by some patients?
What is a common side effect of ACE inhibitors experienced by some patients?
Which statement is true regarding the safety of ACE inhibitors during pregnancy?
Which statement is true regarding the safety of ACE inhibitors during pregnancy?
What is the primary clinical effect of angiotensin II receptor blockers (ARBs)?
What is the primary clinical effect of angiotensin II receptor blockers (ARBs)?
What is the function of aminopeptidase in relation to Angiotensin II?
What is the function of aminopeptidase in relation to Angiotensin II?
Which of the following drugs is considered an ACE inhibitor?
Which of the following drugs is considered an ACE inhibitor?
What is the primary role of Atrial natriuretic peptide (ANP)?
What is the primary role of Atrial natriuretic peptide (ANP)?
What does BNP specifically target to achieve its effects?
What does BNP specifically target to achieve its effects?
Which of the following is true about BiDil®?
Which of the following is true about BiDil®?
How does isosorbide enhance its cardiovascular effects?
How does isosorbide enhance its cardiovascular effects?
What genetic factor contributes to the differences in medication efficacy between African American patients and whites regarding ACE inhibitors?
What genetic factor contributes to the differences in medication efficacy between African American patients and whites regarding ACE inhibitors?
Which of the following statements correctly characterizes the renin-angiotensin-aldosterone system's effect?
Which of the following statements correctly characterizes the renin-angiotensin-aldosterone system's effect?
What is a primary reason for noncompliance among patients taking antihypertensives?
What is a primary reason for noncompliance among patients taking antihypertensives?
What term describes when a patient correctly takes medication only for five days prior to a doctor's appointment?
What term describes when a patient correctly takes medication only for five days prior to a doctor's appointment?
Which of the following best describes the '1/6th Rule' related to patient adherence?
Which of the following best describes the '1/6th Rule' related to patient adherence?
According to the survey of patients, which of these was reported as a reason for not filling prescriptions?
According to the survey of patients, which of these was reported as a reason for not filling prescriptions?
What is the mechanism of action (MOA) of enalapril?
What is the mechanism of action (MOA) of enalapril?
What is the mechanism of action (MOA) of losartan?
What is the mechanism of action (MOA) of losartan?
What role does aldosterone play in the renin-angiotensin system's control of blood pressure?
What role does aldosterone play in the renin-angiotensin system's control of blood pressure?
Which of the following is an aim of drug treatment for hypertension? (Select all that apply)
Which of the following is an aim of drug treatment for hypertension? (Select all that apply)
What do diuretics do?
What do diuretics do?
Which drugs alter water and sodium concentrations?
Which drugs alter water and sodium concentrations?
Which of the following drugs alter sympathetic outflow? (Select all that apply)
Which of the following drugs alter sympathetic outflow? (Select all that apply)
What drugs are adrenergic neuron-blocking drugs? (Select all that apply)
What drugs are adrenergic neuron-blocking drugs? (Select all that apply)
Which drug is an adrenoceptor antagonist (alpha 1 blocker)?
Which drug is an adrenoceptor antagonist (alpha 1 blocker)?
Which drugs are calcium channel blockers? (Select all that apply)
Which drugs are calcium channel blockers? (Select all that apply)
Which drugs are ACE inhibitors? (Select all that apply)
Which drugs are ACE inhibitors? (Select all that apply)
What is the stem for Angiotensin II blockers?
What is the stem for Angiotensin II blockers?
Which of the following is an example of a thiazide?
Which of the following is an example of a thiazide?
Which drug blocks norepinephrine (NE) stores from being released?
Which drug blocks norepinephrine (NE) stores from being released?
Guanethidine crosses the blood-brain barrier (BBB).
Guanethidine crosses the blood-brain barrier (BBB).
What is the major adverse drug reaction (ADR) of reserpine?
What is the major adverse drug reaction (ADR) of reserpine?
What are the two primary actions of beta blocker drugs?
What are the two primary actions of beta blocker drugs?
Which of the following are oral vasodilators? (Select all that apply)
Which of the following are oral vasodilators? (Select all that apply)
Which of the following drugs are parenteral vasodilators?
Which of the following drugs are parenteral vasodilators?
Which of the following are actions of vasodilators? (Select all that apply)
Which of the following are actions of vasodilators? (Select all that apply)
Describe the Renin, ACE, angiotensin pathway?
Describe the Renin, ACE, angiotensin pathway?
Which class of drugs should never be used in pregnancy?
Which class of drugs should never be used in pregnancy?
What does Losartan do?
What does Losartan do?
What is primary hypertension?
What is primary hypertension?
What is secondary hypertension?
What is secondary hypertension?
Which drug is used to lower blood pressure in pregnancy?
Which drug is used to lower blood pressure in pregnancy?
What does Labetalol do and what does it treat?
What does Labetalol do and what does it treat?
How is esmolol administered?
How is esmolol administered?
What is a common adverse drug reaction (ADR) of hydralazine?
What is a common adverse drug reaction (ADR) of hydralazine?
What is an ADR of minoxidil (potassium channel enhancer)?
What is an ADR of minoxidil (potassium channel enhancer)?
Flashcards
Staging of Hypertension
Staging of Hypertension
Classifying high blood pressure into stages based on diastolic blood pressure (DBP) values.
Stage 1 Hypertension
Stage 1 Hypertension
High blood pressure with a diastolic blood pressure (DBP) between 90 and 99 mmHg.
Antihypertensive Drugs
Antihypertensive Drugs
Medications used to lower high blood pressure.
Diuretics (Antihypertensives)
Diuretics (Antihypertensives)
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Polydrug Therapy
Polydrug Therapy
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ACE Inhibitors
ACE Inhibitors
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Thiazide Diuretics
Thiazide Diuretics
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Loop Diuretics
Loop Diuretics
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Methyldopa mechanism
Methyldopa mechanism
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Clonidine's action
Clonidine's action
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Alpha-2 receptor effect
Alpha-2 receptor effect
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Sympathetic outflow reduction
Sympathetic outflow reduction
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Methyldopa side effects
Methyldopa side effects
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Reserpine's function
Reserpine's function
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Guanethidine's action
Guanethidine's action
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Postganglionic Sympathetic Blockers
Postganglionic Sympathetic Blockers
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Renin-Angiotensin System
Renin-Angiotensin System
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Angiotensin II
Angiotensin II
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Hydralazine mechanism of action
Hydralazine mechanism of action
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Minoxidil mechanism
Minoxidil mechanism
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Calcium Channel Blockers (CCBs)
Calcium Channel Blockers (CCBs)
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What are ACE inhibitors used for?
What are ACE inhibitors used for?
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Side effect of ACE inhibitors
Side effect of ACE inhibitors
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Nitroprusside mechanism
Nitroprusside mechanism
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Angiotensin Receptor Blockers (ARBs)
Angiotensin Receptor Blockers (ARBs)
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Nitroprusside use
Nitroprusside use
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Fenoldopam function
Fenoldopam function
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What are ARBs used for?
What are ARBs used for?
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BNP Agonist
BNP Agonist
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ACE Inhibitors actions
ACE Inhibitors actions
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CCB action in muscle
CCB action in muscle
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ANP
ANP
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BNP
BNP
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How do ANP and BNP work?
How do ANP and BNP work?
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Nesiritide (Natrecor®)
Nesiritide (Natrecor®)
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BiDil®
BiDil®
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Isosorbide
Isosorbide
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Hydralazine
Hydralazine
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Why is BiDil effective for African Americans?
Why is BiDil effective for African Americans?
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Patient Compliance
Patient Compliance
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Adherence Rates
Adherence Rates
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Electronic Medication Monitor
Electronic Medication Monitor
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White-coat Adherence
White-coat Adherence
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The 1/6th Rule
The 1/6th Rule
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Patient Noncompliance Reasons
Patient Noncompliance Reasons
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Hydralazine's Action
Hydralazine's Action
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Study Notes
Pharmacology I - Chapter 11: Antihypertensives
- A 35-year-old male patient, with a blood pressure of 150/95 mmHg, drinks alcohol, is sedentary, and does not smoke. He has a family history of hypertension and is moderately obese. His total cholesterol is 220 mg/dL, HDL is 40 mg/dL, and FBS is 105 mg/dL. Treatment needs to be considered.
Case Study Treatment Recommendations
- Treat first with behavioral changes: diet, exercise, and reduced alcohol consumption.
- Initiate low-dose thiazide diuretic.
- Monitor for a few months. If needed, add a second drug such as a calcium channel blocker or an ACE inhibitor.
Hypertension Staging
- Normal blood pressure is defined as 120/80 mmHg.
- Hypertension is diagnosed when blood pressure is 140/90 mmHg or higher.
- DBP (diastolic blood pressure) is used to stage hypertension.
- Mild: DBP 90-104 mmHg
- Moderate: DBP 105-114 mmHg
- Severe: DBP > 115 mmHg
Antihypertensive Agents
- Drugs target various sites in the body to lower blood pressure. The figure illustrates different targets.
Types of Hypertension
- Primary hypertension (essential): accounts for over 95% of all cases. Cause is unknown. Approximately 27% of the US population has high blood pressure.
- Secondary hypertension: accounts for less than 5% of cases. Caused by specific disorders affecting control mechanisms, including the renin system or tumors.
Aims of Drug Treatment
- Lower blood volume: diuretics restrict dietary sodium intake and reduce blood volume.
- Reduce peripheral resistance: sympatholytics reduce peripheral resistance.
- Relax smooth muscle: direct vasodilators relax smooth muscle.
- Block or decrease Angiotensin II production: drugs target the renin-angiotensin system.
Blood Pressure Monitoring
- Using home blood pressure monitors helps eliminate "white coat" hypertension in some patients.
- Approximately 20% of patients with elevated blood pressure have "white coat" hypertension.
Staging Primary Hypertension
- Stage 1: diastolic BP 90-99
- Stage 2: diastolic BP 100-109
- Stage 3: diastolic BP >110
- Reducing diastolic blood pressure by 5-6 mmHg decreases the risk of stroke by 40%, risk of coronary disease by 16%, and risk of death from any cardiovascular cause by 20%.
Antihypertensive Drug Classes
- Diuretics: lower blood volume.
- Sympatholytics: block CNS output, reduce peripheral resistance.
- Direct vasodilators: relax smooth muscles, induce vasodilation.
- Block Angiotensin: decrease Angiotensin II production.
Drug Treatment of Hypertension
- Drug treatment lowers systolic blood pressure by 10-15%.
- Monotherapy is effective in approximately 50% of patients.
- Using multiple drugs at lower doses may produce fewer side effects than using a single drug at high doses.
- Patients with stage 2 and 3 hypertension often require poly-drug therapy.
List of Drugs
- Alter water and sodium: diuretics
- Alter sympathetic outflow: methyldopa, clonidine
- Adrenergic neuron blockers: guanethidine, reserpine
- Alpha blockers: prazosin
- Beta blockers: metoprolol, propranolol, bisoprolol
- Calcium channel blockers: verapamil, diltiazem, nifedipine
- ACE inhibitors: captopril, enalapril, benazepril
- ANG II receptor blockers: losartan, valsartan, candesartan
- Vasodilators: hydralazine, minoxidil, nitroprusside, fenoldopam
- BNP agonist: nesiritide
- BiDil: isosorbide/hydralazine
Vasodilators
- Drugs that dilate blood vessels through different mechanisms.
- Some examples are hydralazine, minoxidil, nitroprusside, and fenoldopam.
Calcium Channel Blockers (CCBs)
- Block voltage-gated L-type calcium channels in cardiac and smooth muscle.
- Calcium influx is blocked, preventing muscle contraction, causing vasodilation.
Nitroprusside
- Releases NO, stimulates guanylyl cyclase which increases cGMP, leading to myosin light chain dephosphorylation, and muscle relaxation.
- Used as an IV drug in emergencies to lower blood pressure.
Dopamine D1 Receptor Agonist
- Fenoldopam results in arterial vasodilation.
- IV administration is typically used for hypertensive crisis.
ACE Inhibitors
- Captopril, enalapril block ACE (angiotensin-converting enzyme), reducing Angiotensin II levels and aldosterone levels.
ACE Inhibitors Mechanism of Action
- Reduced renal arterial pressure releases renin from the kidney.
- Renin converts angiotensinogen to angiotensin I.
- ACE converts angiotensin I to angiotensin II.
- Angiotensin II is a potent vasoconstrictor.
- Aminopeptidase converts angiotensin II to inactive fragments.
Angiotensin Antagonists - ACE Inhibitors
- Block the formation of angiotensin II.
- A second class of drugs that directly act on the renin-angiotensin system.
Angiotensin II Receptor Blockers (ARBs)
- Block the receptor for angiotensin II.
- Similar clinical effects to ACE inhibitors but with lower incidence of cough.
- Still may cause fetal kidney damage and should not be used in pregnancy.
BNP Agonists
- Brain natriuretic peptide (BNP) and Atrial natriuretic peptide (ANP) act to counter-balance the renin-angiotensin-aldosterone system (RAAS).
- Nesiritide (Natrecor®) is a BNP agonist used as a slow IV drip to lower blood pressure.
BiDil
- First drug FDA approved for a specific ethnic group.
- A combination of isosorbide dinitrate and hydralazine.
- Both drugs were already widely used and available.
- Data from clinical trials supported its use in African Americans.
- Hydralazine acts by releasing NO from endothelial cells.
Patient Compliance
- Adherence to medication is crucial for efficacy.
- Rates of adherence vary depending on the condition. Some patients have higher adherence rates for acute conditions than chronic ones, but chronic patients typically show adherence rates between 43 and 78%.
- Poor compliance is also a major cost driver related to hospital admissions, estimated at $100 billion annually in the US.
- Methods to measure or increase compliance include direct observation, indirect measures such as counting pills, medication monitoring devices, patient diaries, and support from family or nurses.
- Factors like forgetting to take medication, or adverse effects, and high cost are among the reasons that patients cite for poor compliance.
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Description
This quiz covers the key concepts from Chapter 11 of Pharmacology I, focusing on antihypertensive treatments and guidelines. Explore the classification and management strategies for hypertension, along with the pharmacological agents used in treatment. Test your knowledge on dietary changes, medication options, and staging of hypertension.
