PHRM 1203 Exam Questions With
Correct Solution
renin-angiotensin-aldosterone system - ANSWER - System for controlling blood volume
and pressure
- Renin is released from kidneys when [Na+] decreases OR hypotension
- Renin produces angiotensin I (converted to angiotensin II by ACEi)
- Angiotensin II (a vasoconstricting hormone) stimulates secretion of aldosterone which
increases Na+ reabsorption, thus increasing fluid retention and decreasing urine
output.
- Angiotensin II also causes vasoconstriction of smooth muscle, increasing peripheral
vascular resistance, increasing venous return, therefore increasing BP and blood
volume
Test - ANSWER
ACEi - ANSWER Name: Angiotensin converting enzyme (ACE) inhibitor (ACEi) (-pril)
Indication:
- Management of HTN
- Management of chronic heart failure
- Pt's with MI
Mechanism of action:
- ACEi block conversion of angiotensin I to angiotensin II, a vasoconstrictor
- More Na and Cl is excreted in urine due to reduced aldosterone secretion, leading to
reduced blood volume, thus lower BP.
- Prevents bradykinin breakdown (a vasodilator)
Examples:
- Ramipril
- Lisinopril
- Perindopril
,- Trandolapril
Adverse effects:
- Hypotension
- Cough
- Nausea
- Hyperkalaemia
- Diarrhoea
- Dizziness
- Headache
Contraindications:
- History of hypersensitivity to ACEi
- History of angioedema (and angioedema associated with ACEi use)
- Bilateral OR unilaternal renal artery stenosis
- Pregnancy
Pregnancy/breastfeeding:
- Enalapril, captopril SAFE in breastfeeding
- ALL ACEi NOT SAFE in pregnancy - use alternative
ARA OR sartans - ANSWER Name: Angiotensin receptor antagonist (ARA) (-sartan)
Indication:
- HTN
- Heart failure
Mechanism of action:
- Similar to ACEi, but different because they bind to angiotensin II receptors to block the
effect of angiotenin II, rather than blocking the conversion of angiotensin I->II
Examples:
- Valsartan
,- Irbesartan
- Candesartan
- Eprosartan
- Losartan
- Olmesartan
- Telmisartan
Contraindications:
- Pregnancy and breastfeeding
- Similar to ACEi
Considerations when starting ACEi or sartans - ANSWER - Stop K+ supplements and
potassium-sparing dieuretics
- Review NSAID use
- Low dose when starting
- Check and review renal function and eletrolytes
- Work the best 4-6 weeks after starting treatment
CCB's (mostly are -pine) - ANSWER Name: Calcium channel blockers (CCB's)
Indication:
- Hypertension
- Angina
Mechanism of action:
- Block inward movement of calcium into the heart and vascular smooth muscle (L-type
calcium channels)
Types:
1. Dyhydropyridines
2. Non-dihydropyridines
Contraindications:
- Do not use in patients with heart failure with reduced ejection fraction. Verapamil and
diltiazem contraindicated.
, Pregnancy
- Need specialist advice
Breastfeeding:
- Most appear safe but lack safety data
Dyhydropyridines (-pine) - ANSWER *preferred treatment for HTN*
Mechanism of action:
- Causes vasodilation in peripheral blood vessels, helping to lower BP
Examples:
- Amlodipine
- Clevidipine
- Felodipine
- Lercanidipine
- Nifedipine
- Nimodipine
Adverse effects:
1. Vasodilatory effects
- Headache, dizziness flushing
- Peripheral oedema (not improved by loop diuretics)
- Dose dependent
2. Reflex cardiac events
- Palpitations, tachycardia, chest pain
- Associated with BP lowering and short acting CCB's
Non-dihydropyridines - ANSWER Mechanism of action:
- Reduce HR and contractility, while having a lower peripheral vasodilation effect
Benzothiazipine
- Diltiazem
- Large vasodilation effect, less reduced in HR and contractility
Correct Solution
renin-angiotensin-aldosterone system - ANSWER - System for controlling blood volume
and pressure
- Renin is released from kidneys when [Na+] decreases OR hypotension
- Renin produces angiotensin I (converted to angiotensin II by ACEi)
- Angiotensin II (a vasoconstricting hormone) stimulates secretion of aldosterone which
increases Na+ reabsorption, thus increasing fluid retention and decreasing urine
output.
- Angiotensin II also causes vasoconstriction of smooth muscle, increasing peripheral
vascular resistance, increasing venous return, therefore increasing BP and blood
volume
Test - ANSWER
ACEi - ANSWER Name: Angiotensin converting enzyme (ACE) inhibitor (ACEi) (-pril)
Indication:
- Management of HTN
- Management of chronic heart failure
- Pt's with MI
Mechanism of action:
- ACEi block conversion of angiotensin I to angiotensin II, a vasoconstrictor
- More Na and Cl is excreted in urine due to reduced aldosterone secretion, leading to
reduced blood volume, thus lower BP.
- Prevents bradykinin breakdown (a vasodilator)
Examples:
- Ramipril
- Lisinopril
- Perindopril
,- Trandolapril
Adverse effects:
- Hypotension
- Cough
- Nausea
- Hyperkalaemia
- Diarrhoea
- Dizziness
- Headache
Contraindications:
- History of hypersensitivity to ACEi
- History of angioedema (and angioedema associated with ACEi use)
- Bilateral OR unilaternal renal artery stenosis
- Pregnancy
Pregnancy/breastfeeding:
- Enalapril, captopril SAFE in breastfeeding
- ALL ACEi NOT SAFE in pregnancy - use alternative
ARA OR sartans - ANSWER Name: Angiotensin receptor antagonist (ARA) (-sartan)
Indication:
- HTN
- Heart failure
Mechanism of action:
- Similar to ACEi, but different because they bind to angiotensin II receptors to block the
effect of angiotenin II, rather than blocking the conversion of angiotensin I->II
Examples:
- Valsartan
,- Irbesartan
- Candesartan
- Eprosartan
- Losartan
- Olmesartan
- Telmisartan
Contraindications:
- Pregnancy and breastfeeding
- Similar to ACEi
Considerations when starting ACEi or sartans - ANSWER - Stop K+ supplements and
potassium-sparing dieuretics
- Review NSAID use
- Low dose when starting
- Check and review renal function and eletrolytes
- Work the best 4-6 weeks after starting treatment
CCB's (mostly are -pine) - ANSWER Name: Calcium channel blockers (CCB's)
Indication:
- Hypertension
- Angina
Mechanism of action:
- Block inward movement of calcium into the heart and vascular smooth muscle (L-type
calcium channels)
Types:
1. Dyhydropyridines
2. Non-dihydropyridines
Contraindications:
- Do not use in patients with heart failure with reduced ejection fraction. Verapamil and
diltiazem contraindicated.
, Pregnancy
- Need specialist advice
Breastfeeding:
- Most appear safe but lack safety data
Dyhydropyridines (-pine) - ANSWER *preferred treatment for HTN*
Mechanism of action:
- Causes vasodilation in peripheral blood vessels, helping to lower BP
Examples:
- Amlodipine
- Clevidipine
- Felodipine
- Lercanidipine
- Nifedipine
- Nimodipine
Adverse effects:
1. Vasodilatory effects
- Headache, dizziness flushing
- Peripheral oedema (not improved by loop diuretics)
- Dose dependent
2. Reflex cardiac events
- Palpitations, tachycardia, chest pain
- Associated with BP lowering and short acting CCB's
Non-dihydropyridines - ANSWER Mechanism of action:
- Reduce HR and contractility, while having a lower peripheral vasodilation effect
Benzothiazipine
- Diltiazem
- Large vasodilation effect, less reduced in HR and contractility
