Paper I
2018 February (2010 Scheme) · 40 marks · 120 min

Question

Classify antihypertensive drugs. Describe the mechanism of action, uses and adverse effects of angiotensin converting enzyme (ACE) inhibitors. (2+2+1+1)

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Answer

Classification of antihypertensive drugs

  • Diuretics: Hydrochlorothiazide
  • Beta blockers: Atenolol
  • ACE inhibitors: Enalapril
  • Angiotensin receptor blockers: Losartan
  • Calcium channel blockers: Amlodipine
  • Centrally acting: Methyldopa

Mechanism of action of ACE inhibitors

  • Inhibit angiotensin-converting enzyme, blocking conversion of angiotensin I to angiotensin II
  • Reduces vasoconstriction (↓afterload) and aldosterone-mediated Na⁺/water retention (↓preload)
  • Prevents bradykinin breakdown, contributing to efficacy and the characteristic dry cough

Uses

  • Hypertension
  • Congestive cardiac failure (improves survival)
  • Post-MI (reduces remodelling)
  • Diabetic nephropathy (renoprotective)

Adverse effects

  • Dry cough
  • Hyperkalaemia
  • First-dose hypotension
  • Angioedema
  • Teratogenic (contraindicated in pregnancy)
  • Acute renal failure in bilateral renal artery stenosis

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