Question

The following pharmacological agents are useful to reduce blood pressure in congestive heart failure patients (so the heart doesn’t have to work that hard to pump) except:

	An ACE inhibitor.
	A direct renin inhibitor.
	An alpha-1 norepinephrine receptor agonist (mimic the action of norepinephrine).
	An antidiuretic hormone receptor blocker.
	An AT II receptor blocker.
	A renin agonist (mimic the action of norepinephrine).
	C and F

Answer 1

Answer : An alpha-1 norepinephrine receptor agonist and renin agonist

EXPLANATION :
The kidneys function to keep our blood pressure within normal range through renin angiotensin aldosterone system. Kidneys produce renin in response to low blood pressure which stimulates production of angiotensin ll. Angiotensin ll acts on adrenal gland and pituitary to release aldosterone and ADH. Aldosterone results in increase reabsorption of sodium and water and vasoconstriction. ADH increases water retention from renal tubules. This results in increased blood pressure.
An alpha-1 norepinephrine receptor agonist will mimic the action of norepinephrine and thus increase the sympathetic activity. This results in increased blood pressure.
A renin agonist which mimic the action of norepinephrine also increases blood pressure by activating renin angiotensin aldosterone system.
So an ACE inhibitor which will prevent conversion of angiotensinogen to angiotensin ll will reduce blood pressure.
Similarly renin inhibitor will inhibit renin production and thus reduce blood pressure.
An antidiuretic hormone (ADH) receptor blocker will also reduce blood pressure by suppressing action of ADH.
An AT ll (angiotensin ll) receptor blocker will inhibit the action of angiotensin ll and thus reduce blood pressure.