[PCOL] Part 3.1.2 - Cardiovascular Drugs - Drugs for Hypertension - Sympathoplegics, Vasodilators, Angiotensin Antagonist Drugs

e. None

Sympthoplegics classification used for hypertension except:

a. Beta Blockers

b. Alpha Blockers

c. Ganglionic Blockers

d. Adrenergic Neuronal Blockers

e. None

f. All

Act as vasodilators by increasing cAMP through release of nitric oxide.

a. Hydralazine

b. Nitroprusside

c. Nitrates

d. a and b

e. b and c

f. All

c. Opening of L-type calcium channels

Mechanism of vasodilators for treatment of hypertension:

a) Release of nitric oxide increasing cAMP

b) Opening of potassium channels and hyperpolarization

c) BLOCKADE of L-type calcium channels in the heart and arteries

d) Activation of dopamine 1 receptors

Mechanism of vasodilators for treatment of hypertension except:

a. Release of nitric oxide increasing cAMP

b. Opening of potassium channels and hyperpolarization

c. Opening of L-type calcium channels in the heart and arteries

d. Activation of dopamine 1 receptors

e. None

e. b and c

Act as vasodilators by opening of potassium channels and hyperpolarization.

a. Calcium channel blockers

b. Minoxidil sulfate

c. Diazoxide

d. a and b

e. b and c

f. All

a. Calcium channel blockers

Act as vasodilators by blocking L-type calcium channels.

a. Calcium channel blockers

b. Minoxidil sulfate

c. Diazoxide

d. a and b

e. b and c

f. All

c. Fenoldopam

Act as vasodilators by activation of dopamine 1 receptors.

a. Calcium channel blockers

b. Minoxidil sulfate

c. Fenoldopam

d. a and b

e. b and c

f. All

a. I, II, III, IV

Direct Arteriolar Dilators.

I. Dilates only arteries

II. Combine with other agents to reduce adverse effects

III. Include Minoxidil, Diazoxide, and Hydralazine

IV. Common side effects are reflex tachycardia and peripheral edema

a. I, II, III, IV

b. I, II, III

c. II, III, IV

d. I, II

e. III, IV

Hydralazine

Minoxidil

Diazoxide

Direct Arteriolar Dilators drugs

e. a and b

Side effects of direct arteriolar dilators.

a. Reflex tachycardia

b. Peripheral edema

c. Bradycardia

d. Cebrebral edema

e. a and b

f. c and d

b. Diuretics

To counteract peripheral edema adverse effect of direct arteriolar dilators, it should be co-administer with

a. Beta-blockers

b. Diuretics

c. Vasopressin agonist

d. ADH antagonist

a. Beta-blockers

To counteract reflex tachycardia adverse effect of direct arteriolar dilators, it should be co-administer with

a. Beta-blockers

b. Diuretics

c. Alpha-blockers

d. ADH antagonist

d. a and b

Alternative for hypertensive crisis.

a. Minoxidil

b. Diazoxide

c. Hydralazine

d. a and b

e. b and c

f. All

a. Minoxidil

Direct arteriolar vasodilators that can cause hirsutism.

a. Minoxidil

b. Diazoxide

c. Hydralazine

d. a and b

e. b and c

f. All

Diazoxide

Direct arteriolar vasodilators that can cause hyperglycemia.

Hydralazine

Mgt of hypertensive emergency in pregnancy and Mgt of CHF.

Hydralazine

Direct arteriolar vasodilators that can cause systemic Lupus like syndrome (SLE).

Isosorbide dinitrate (ISDN)

Hydralazine when used for mgt of CHF is combined with?

f. All

Hydralazine.

a. For CHF

b. Combined with ISDN

c. African-Americans are more prone to its adverse effects

d. a and b

e. b and c

f. All

c. Both

Mixed Vasodilators.

a. Relaxes both arteries and veins

b. Include sodium nitroprusside

c. Both

d. None

b. Sodium Nitroprusside

1st line in the management of hypertensive emergency.

a. Minoxidil

b. Sodium Nitroprusside

c. Diazoxide

d. Hydralazine

f. All

Sodium Nitroprusside

a. Contains 1 nitro group increasing NO levels which is responsible for its MOA as antihypertensive

b. Contains 5 cyanide groups which may accumulate lead to toxicity

c. Should not be used long term

d. a and b

e. b and c

f. All

a. True

Most dangerous side effect of sodium nitroprusside is accumulation of CN.

a. True

b. False

f. All

Calcium channel blockers:

a. Inhibit L-type Ca channel in the heart and/or in arteriolar smooth muscles

b. Can cause cardiac depression

c. Can cause arteriolar smooth muscles vasodilation

d. a and b

e. b and c

f. All

c. Both

Calcium channel blockers.

a. Can be Non-Dihydropyridine or Dihydropyridine

b. Can be Intrinsically Short Acting, Intrinsically Long Acting, or Modified Long Acting

c. Both

d. None

Verapamil

Diltiazem

Non-Dihydropyridines (Non-DHP) drugs

“-dipines”

Lecarnidipine

Lacidipine

Amlodipine

Dihydropyridines (DHP) drugs

a. Non-Dihydropyridines

Cardio selective.

a. Non-Dihydropyridines

b. Dihydropyridine

b. Dihydropyridine

Vasoselective; arteries only.

a. Non-Dihydropyridines

b. Dihydropyridine

Verapamil

Most cardioselective CCB

b. Diltiazem

Has intermediate effect both in heart and arteries.

a. Verapamil

b. Diltiazem

c. Lercanidipine

d. Amlodipine

e. Lacidipine

b. I, II, VI

Intrinsically Short Acting CCB.

I. Verapamil

II. Diltiazem

III. Lercanidipine

IV. Amlodipine

V. Lacidipine

VI. All other DHPs

a. I, II, III, IV, V, VI

b. I, II, VI

c. III, IV, V

d. I, II, V

e. I, IV, V

[LAL]: Lercanidipine, Amlodipine, Lacidipine

Intrinsically Long-Acting CCB Long

a. True

Modified Long Acting CCBs are intrinsically Short Acting, but have been made available as MR.

a. True

b. False

Verapamil SR - it is modified release intrinsically short acting

Modified Long-Acting CCB

a. I, II, III, IV, V, VI

Clinical use of CCBs.

I. 1st line in the management of hypertension, with ACEis/ARBs

II. Mgt of Migraine Headache

III. Mgt of Angina Pectoris

IV. Mgt of Arrhythmia

V. Mgt of Raynaud's Syndrome

VI. For Pre-term labor

a. I, II, III, IV, V, VI

b. I, II, VI

c. III, IV, V

d. I, II, V

e. I, IV, V

c. CCBs

1st line in the management of hypertension used with ACEIs/ARBs.

a. Direct Arteriolar Dilators

b. Mixed Vasodilator

c. CCBs

d. a and b

e. b and c

f. All

c. CCBs

Mgt of Raynaud's Syndrome.

a. Direct Arteriolar Dilators

b. Mixed Vasodilator

c. CCBs

d. a and b

e. b and c

f. All

a. I, II, III, IV, V, VI, VII

Adverse effects of CCBs

I. Bradycardia

II. CHF (Atrioventricular Block)

III. Constipation

IV. Pretibial Edema

V. Dizziness, N & V

VI. Allergies

VII. Flushing, Fatigue, Confusion

a. I, II, III, IV, V, VI, VII

b. I, II, III, IV, V, VI

c. II, III, IV, V, VI, VII

d. I, II, III, IV,

e. IV, V, VI, VII

f. I, III, V, VII

f. All

Angiotensin Antagonist classifications.

a. Angiotensin-converting enzyme inhibitors (ACEIs)

b. Angiotensin receptor blockers (ARBs)

c. Renin inhibitor

d. a and b

e. b and c

f. All

a. I, II, III, IV

ACE Inhibitors.

I. Inhibit synthesis of Angiotensin II

II. Decrease Angiotensin II

III .Increase Bradykinin leading to dry cough

IV. Include the "- pril" drugs

a. I, II, III, IV

b. II, III, IV

c. I, II, III

d. I, II

e. III, IV

a. I, II, III, IV

ARBs:

I. Inhibit the action of Angiotensin II

II. Do not have a direct effect in lowering Angiotensin II, but they competitively block binding of the compound to its receptor

III. Do not alter Bradykinin level having no effect of dry cough

IV. Include the "-sartan" drugs

a. I, II, III, IV

b. II, III, IV

c. I, II, III

d. I, II

e. III, IV

f. All

Clinical Uses of Angiotensin Antagonist.

a. Mgt of mild to moderate hypertension

b. Mgt of CHF → Base treatment components for CHF

c. Mgt of Chronic Kidney Disease with or without Diabetes Miletus

d. a and b

e. a and c

f. All

d. a and b

Mgt of Chronic Kidney Disease with or without Diabetes Miletus.

a. ACEIs

b. ARBs

c. CCB

d. a and b

e. b and c

f. All

a. I, II

Adverse effects of ACEI only.

I. Angioedema

II. Dry Cough

III. Hyperkalemia

IV. Hypotension

V. Interstitial Nephritis

a. I, II

b. III, IV, V

c. II, III, IV, V

d. I, II, III

e. I, II, III, IV, V

b. III, IV, V

Adverse effects of both ACEIs and ARBs.

I. Angioedema

II. Dry Cough

III. Hyperkalemia

IV. Hypotension

V. Interstitial Nephritis

a. I, II

b. III, IV, V

c. II, III, IV, V

d. I, II, III

e. I, II, III, IV, V

e. b and c

Contraindications of angiotensin antagonists.

a) SBP

Contraindications of angiotensin antagonists.

a. SBP

a. Renal dysgenesis

Angiotensin antagonists are teratogenic which can cause:

a. Renal dysgenesis

b. Phocomelia

c. Fetal hydantoin syndrome

d. Retardation

e. Nasal hypoplasia

a. Hyperkalemia and metabolic acidosis

Electrolyte and acid-base disturbances caused by excess aldosterone activity.

a. Hyperkalemia and metabolic acidosis

b. Hypokalemia and metabolic alkalosis

c. Hypernatremia and respiratory acidosis

d. Hyponatremia and respiratory alkalosis

c. Renal parenchymal disease

Most common underlying cause of secondary hypertension.

a. Pheochromocytoma

b. Primary hyperaldosteronism

c. Renal parenchymal disease

d. Coarctation of the aorta

b. Pheochromocytoma

Adrenal medulla tumor causing hypertension via marked epinephrine and norepinephrine release.

a. Neuroblastoma

b. Pheochromocytoma

c. Glucagonoma

d. Aldosteronoma

b. IV Nicardipine

Intravenous agent of choice for managing acute hypertensive emergencies.

a. Oral Captopril

b. IV Nicardipine

c. Oral Labetalol

d. Sublingual Nifedipine

b. Proximal Convoluted Tubule (PCT)

Primary nephron site responsible for roughly two-thirds (2/3) of solute and water reabsorption.

a. Loop of Henle

b. Proximal Convoluted Tubule (PCT)

c. Distal Convoluted Tubule (DCT)

d. Collecting Duct

b. Glaucoma

Ocular therapeutic indications for Carbonic Anhydrase Inhibitors.

a. Cataract and macular degeneration

b. Glaucoma

c. Diabetic retinopathy and optic neuritis

d. Dry eye syndrome and conjunctivitis

b. Lactulose

Laxative used to trap NH3 as NH4+ in cirrhotic patients with hepatic encephalopathy.

a. Bisacodyl

b. Lactulose

c. Senna

d. Docusate sodium

b. Ethacrynic acid

Phenoxyacetate-derivative loop diuretic suitable for patients with severe sulfa allergy.

a. Furosemide

b. Ethacrynic acid

c. Torsemide

d. Bumetanide

a. Hyperglycemia, Hyperuricemia, Hypercholesterolemia

Metabolic side effects common to both Loop Diuretics and Thiazides.

a. Hyperglycemia, Hyperuricemia, Hypercholesterolemia

b. Hyperkalemia, Hypercalcemia, Hypernatremia

c. Hyperbilirubinemia, Hypermagnesemia, Hyperphosphatemia

d. Hyperammonemia, Hyperglycemia, Hypercalcemia

a. Metolazone, Indapamide, Chlorthalidone

Thiazide-like diuretic agents.

a. Metolazone, Indapamide, Chlorthalidone

b. Hydrochlorothiazide, Chlorothiazide, Methyclothiazide

c. Amiloride, Triamterene, Spironolactone

d. Acetazolamide, Methazolamide, Dichlorphenamide

b. Indapamide

Thiazide-like diuretic with direct vascular vasodilator action ("diuretic breaking").

a. Metolazone

b. Indapamide

c. Chlorthalidone

d. Hydrochlorothiazide

a. Reduces polyuria by concentrating urine via paradoxical antidiuretic effect

Indication of Thiazide diuretics in nephrogenic diabetes insipidus.

a. Reduces polyuria by concentrating urine via paradoxical antidiuretic effect

b. Direct activation of V2 vasopressin receptors

c. Increases glomerular filtration rate by 50%

d. Enhances free water excretion in the collecting duct

b. Eplerenone

Selective Aldosterone antagonist that does not cause gynecomastia.

a. Spironolactone

b. Eplerenone

c. Amiloride

d. Triamterene

b. 25 mg OD

Low-dose Spironolactone prescription proven to decrease mortality in Congestive Heart Failure.

a. 100 mg OD

b. 25 mg OD

c. 50 mg OD

d. 10 mg OD

b. Amiloride

Direct epithelial sodium channel (ENaC) blocker used in Liddle syndrome.

a. Triamterene

b. Amiloride

c. Spironolactone

d. Eplerenone

b. Nephrolithiasis

Adverse effect associated with Triamterene therapy.

a. Gynecomastia

b. Nephrolithiasis

c. Ototoxicity

d. Pulmonary edema

b. Hypovolemia and Hypernatremia

Major toxicities associated with Mannitol usage.

a. Hypokalemia and metabolic alkalosis

b. Hypovolemia and Hypernatremia

c. Ototoxicity and nephrolithiasis

d. Gynecomastia and hyperkalemia