NURP-424- Exam 3 Questions And Accurate Solution
Agents that Influence BP - Response - Cardiac output
- Peripheral resistance
- Heart rate
- Filling pressure
- Contractility
- Arteriolar tone
- Blood volume
- Venous tone
Blood Pressure Medication Action - Response Lower blood pressure by lowering
cardiac output and peripheral resistance
ACE Inhibitors (-prils) - Response - Block conversion of angiotensin I to angiotensin II
which inhibits aldosterone and in return lowers BP by:
- Reduction of sympathetic nervous system output
- Increased vasodilation of vascular smooth muscle
- Decreased retention of sodium and water (via decreased aldosterone in the system)
- Inhibit breakdown of bradykinin (anti-inflammatory mediator - cause of cough and
angioedema) and increase production of vasodilating prostaglandins
ACE Inhibitor Indications - Answer - HTN: less SE in Caucasian decent
- Hypertensive proteinuric diabetes: helps in renal protection and prevention of
,nephropathy
Angina and ischemic heart disease: reduces peripheral vascular resistance that
reduces cardiac output; reduces thickening of ventricular walls leading to reduced O2
demand
Post-MI: reduce morbidity and mortality by reduction of myocardial injury and
prevention of ventricular remodelling
HF: reduction of remodeling of the heart secondary to HTN
ACE Inhibitor Caution & Contraindications - Answer Avoid in bilateral renal artery
stenosis
Contraindicated in idiopathic and hereditary angioedema
Contraindicated in pregnancy and lactation
Contraindicated concomitant use of ACE-I with ARB or aliskern
Cautious use in renal and hepatic impairment
Limited data for < 6 y.o. for HTN treatment. Approved for > 6 y.o.
ACE Inhibitor Adverse Effects - Answer - Dry cough
Hypotension
Hyperkalemia
Skin rash
Altered taste
Dizziness
,HA
Fatigue
ARBs (-sartans) - Answer - Indications: HTN, hypertensive proteinuric diabetes, angina
and ischemic heart disease, post-MI, HF
- Pharmacodynamics: block angiotensin II receptors and reduce the levels of
aldosterone secretion which reduces the retention of sodium and water
- No effect on bradykinin so less likely to develop a cough or angioedema
ARBs Caution & Contraindications - Answer - Avoid in bilateral renal artery stenosis
Avoid in idiopathic and hereditary angioedema
Avoid concurrent use of ACE-I with ARB or aliskern
Caution with other medications causing hyperkalemia
Caution in renal and hepatic impairment
Approved for > 6 y.o.
ARBs Adverse Drug Effects Answer Dizziness
Hypotension
Hyperkalemia
Fatigue
URI
, For which of the following may the initial dose need to be lower? ARB - Answer In
patients on ARBs, there is no dosage adjustment required based on renal impairment;
initial ARB doses may be lower in patients with impaired hepatic function, however.
Liver function tests should be performed before starting therapy, and the dose
increased based on tolerance.
ACEIs, ARBs, and direct renin inhibitors act on the RAA system to lower blood pressure
and reduce the adverse effects of which disease on the kidney? - Answer ACEIs, ARBs,
and direct renin inhibitors acting on the RAA system lower blood pressure and reduce
the adverse effects of diabetes on the kidney.
Calcium Channel Blockers (Dihydropyridines) - Answer - Nifedipine (Procardia) or
Amlodipine (Norvasc)
- Indications: HTN and angina
- Pharmacodynamics: impede calcium ions across the cell membrane causing profound
reduction of transmembrane calcium content and lasting relaxation of vascular smooth
muscle
- Myocardial oxygen supply is improved and peripheral vascular resistance is reduced
- More powerful vasodilator and slightly suppresses SA and AV conduction
- More useful to the African American population
Calcium Channel Blockers (Dihydropyridines) - Caution and Contraindications - Answer
- Avoid in patients with significant peripheral edema
- Avoid in unstable angina
Agents that Influence BP - Response - Cardiac output
- Peripheral resistance
- Heart rate
- Filling pressure
- Contractility
- Arteriolar tone
- Blood volume
- Venous tone
Blood Pressure Medication Action - Response Lower blood pressure by lowering
cardiac output and peripheral resistance
ACE Inhibitors (-prils) - Response - Block conversion of angiotensin I to angiotensin II
which inhibits aldosterone and in return lowers BP by:
- Reduction of sympathetic nervous system output
- Increased vasodilation of vascular smooth muscle
- Decreased retention of sodium and water (via decreased aldosterone in the system)
- Inhibit breakdown of bradykinin (anti-inflammatory mediator - cause of cough and
angioedema) and increase production of vasodilating prostaglandins
ACE Inhibitor Indications - Answer - HTN: less SE in Caucasian decent
- Hypertensive proteinuric diabetes: helps in renal protection and prevention of
,nephropathy
Angina and ischemic heart disease: reduces peripheral vascular resistance that
reduces cardiac output; reduces thickening of ventricular walls leading to reduced O2
demand
Post-MI: reduce morbidity and mortality by reduction of myocardial injury and
prevention of ventricular remodelling
HF: reduction of remodeling of the heart secondary to HTN
ACE Inhibitor Caution & Contraindications - Answer Avoid in bilateral renal artery
stenosis
Contraindicated in idiopathic and hereditary angioedema
Contraindicated in pregnancy and lactation
Contraindicated concomitant use of ACE-I with ARB or aliskern
Cautious use in renal and hepatic impairment
Limited data for < 6 y.o. for HTN treatment. Approved for > 6 y.o.
ACE Inhibitor Adverse Effects - Answer - Dry cough
Hypotension
Hyperkalemia
Skin rash
Altered taste
Dizziness
,HA
Fatigue
ARBs (-sartans) - Answer - Indications: HTN, hypertensive proteinuric diabetes, angina
and ischemic heart disease, post-MI, HF
- Pharmacodynamics: block angiotensin II receptors and reduce the levels of
aldosterone secretion which reduces the retention of sodium and water
- No effect on bradykinin so less likely to develop a cough or angioedema
ARBs Caution & Contraindications - Answer - Avoid in bilateral renal artery stenosis
Avoid in idiopathic and hereditary angioedema
Avoid concurrent use of ACE-I with ARB or aliskern
Caution with other medications causing hyperkalemia
Caution in renal and hepatic impairment
Approved for > 6 y.o.
ARBs Adverse Drug Effects Answer Dizziness
Hypotension
Hyperkalemia
Fatigue
URI
, For which of the following may the initial dose need to be lower? ARB - Answer In
patients on ARBs, there is no dosage adjustment required based on renal impairment;
initial ARB doses may be lower in patients with impaired hepatic function, however.
Liver function tests should be performed before starting therapy, and the dose
increased based on tolerance.
ACEIs, ARBs, and direct renin inhibitors act on the RAA system to lower blood pressure
and reduce the adverse effects of which disease on the kidney? - Answer ACEIs, ARBs,
and direct renin inhibitors acting on the RAA system lower blood pressure and reduce
the adverse effects of diabetes on the kidney.
Calcium Channel Blockers (Dihydropyridines) - Answer - Nifedipine (Procardia) or
Amlodipine (Norvasc)
- Indications: HTN and angina
- Pharmacodynamics: impede calcium ions across the cell membrane causing profound
reduction of transmembrane calcium content and lasting relaxation of vascular smooth
muscle
- Myocardial oxygen supply is improved and peripheral vascular resistance is reduced
- More powerful vasodilator and slightly suppresses SA and AV conduction
- More useful to the African American population
Calcium Channel Blockers (Dihydropyridines) - Caution and Contraindications - Answer
- Avoid in patients with significant peripheral edema
- Avoid in unstable angina
