ANTI-HYPERTENSIVE MEDICATIONS

Question 1

What is the normal bp

Answer 1

<120/<80

Question 2

120-129 / < 80

Answer 2

Elevated

Question 3

130 - 139 / 80-89

Answer 3

Stage 1 hypertension

Question 4

> 140 / > 90

Answer 4

Stage 2 hypertension

Question 5

What is the mechanism of Diuretics?

Answer 5

• Inhibits Sodium and Water retention (in the kidney)
• Therefore, increasing sodium and water excretion
  As a result:
  ↓ Blood volume
  ↓ Preload
  ↓ SV/CO
  ↓ Blood pressure

**Wherever the sodium goes, the water follows

Question 6

What are the 3 Diuretics Drugs?

Answer 6

(A) Thiazides - DCT
(B) Loop Diuretics - Ascending loop of Henle
(C) Potassium-sparing - DCT

Question 7

MOA of Thiazides

Answer 7

Inhibit Na+ Channels in the DCT, therefore NA+, Cl and water are excreted in urine

Question 8

Indications of Thiazides

Answer 8

• 1st line drugs for the treatment of essential hypertension
• Thus can be used as initial drug therapy for hypertension

Question 9

Adverse effect of Thiazides:

Answer 9

• Hyponatremia
• Hypokalemia
• Metabolic alkalosis
• ↑ uric acid (avoid in patients with gout)

Question 10

What are Thiazides drugs

Answer 10

• Hydrochlorothiazide
• Chlorthalidone
• Chlorothiazide
• Metolazone

Question 11

MOA of loop diuretics

Answer 11

• Blocks (Sodium-potassium-2 chloride transporter; NKCC) in the thick ascending loop of Henle
• Therefore, inhibiting reabsorption of Sodium and water back to the bloodstream and so increasing their excretion

Indication:
Patient who are volume overloaded

Question 12

Loop Diuretics Drugs

Answer 12

Drugs:
- Furosemide (most common)
- Torsemide (better bioavailability and more potent than Furosemide)
- Bumetanide (better bioavailability and more potent than Furosemide)
- Ethacrynic acid (infrequently used due to its adverse effect)

Indication:
NSAIDS can reduce the diuretic action of loop diuretics

Question 13

Therapeutic used of loop diuretics

Answer 13

(a) Edema (acute pulmonary edema)
(b) Hypercalcemia
(C) Hyperkalemia

Question 14

Adverse effect of Loop diuretics

Answer 14

(a) Acute hypovolemia (lead to cardia arrhythmias)
(b) Hypokalemia
(c) Hypomagnesemia
(d) ototoxicity (Ethacrynic acid)
(e) Hyperuricemia (gout)

Question 15

MOA of Potassium-sparing diuretics

Answer 15

Inhibit sodium reabsorption and potassium excretion in the collecting tubule.

↑ SOdium exretion
↓ Potassium secretion

Question 16

What are the aldosterone antagonist drugs

Answer 16

(a) Eplerenone - may cause hyperkalemia; due to inhibition of potassium excretion
(b) Spironolactone - binds to progesterone and lactones. Causes decreased libido and gynecomastia

Question 17

Therapeutic used of Aldosterone receptor antagonist

Answer 17

(a) Edema with secondary hyperaldosteronism (Spironolactone - ascites)

(b) hypokalemia - in partners with other diuretics
(c) Heart Failure - decrease mortality
(d) Resistant hypertension
(e) Polycystic ovary syndrome (spironolactone)

Question 18

What are the Epithelial sodium channel blockers

Answer 18

Triamterene and amiloride

MOA:
block epithelial sodium channels, resulting in a decrease in NA/K exchange in the collecting duct.

Indication:
Used in combination with other diuretics, almost solely for their potassium-sparing properties.