Antihypertensives - diuretics and vasodilators (exam 3)

Question 1

thiazide diuretics

Answer 1

chlorthalidone
HCTZ (esidrix)
metolazone (zaroxolyn)

Question 2

loop diuretics

Answer 2

bumetanide
furosemide (lasix)
torsemide (demadex)

Question 3

K sparing diuretics

Answer 3

amiloride (midamor)
triamterene (dyrenium)
eplerenone (Inspra)
spironolactone (aldactone)

Question 4

loop diuretic MOA

Answer 4

act on thick ascending limb
inhibits NA/K/2CL carrier in the luminal membrane

Question 5

thiazide diuretics MOA

Answer 5

bind to the Cl site of the Na/Cl co transport system in the distal convoluted tubule
loss of Na and Cl in urine

Question 6

K sparing diuretics MOA (amiloride and triamterene)

Answer 6

excretion of sodium and water while preventing the loss of potassium in the urine

Question 7

direct vasodilators examples

Answer 7

hydralazine (apresoline)
minoxidil (loniten)
nitroprusside (nitropress)

Question 8

direct vasodilators MOA

Answer 8

reduce peripheral resistance directly by relaxing smooth muscle cell layer in arterial vessels

Question 9

dihydropyridines have more effect on __________ and less effect on _____________

Answer 9

vasodilation

heart function

Question 10

non-dihydropyridines have more effect on ____________ and less effect on ________________

Answer 10

heart function

vasodilation

Question 11

ADRs of thiazide diuretics

Answer 11

hyponatremia
hypercalcemia
hypokalemia
metabolic alkalosis (inc pH)
hyperglycemia
hyperuricemia
hyperlipidemia

Question 12

____________ in 1.5-2x more potent at lowering blood pressure compared to ____________ and may be preferred

Answer 12

chlorthalidone

HCTZ

Question 13

K sparing diuretics MOA (eplerenone and spironolactone)

Answer 13

antagonist at aldosterone receptor which reduces Na/K exchange in distal convoluted tubule
leads to increased Na excretion and K reabsorption

Question 14

Hydralazine MOA

Answer 14

directly relaxes arteriolar smooth muscle by reduction in intracellular calcium

Question 15

direct vasodilators ADRs

Answer 15

strong reflex tachycardia
increased fluid retention
peripheral edema

Question 16

Minoxidil MOA

Answer 16

opens K channels causing hyper polarization and arterial relaxation

Question 17

Minoxidil increases

Answer 17

blood flow to skin, skeletal muscle, GI tract and the heart

Question 18

Minoxidil is used to promote

Answer 18

hair growth by increasing nutrient flow to hair follicles

Question 19

Nitroprusside MOA

Answer 19

prodrug that reacts with sulfhydrl groups on RBCs to produce nitric oxide –> vasodilation

Question 20

Nitroprusside is given as an IV infusion when

Answer 20

rapid BP reduction is required (hypertensive crisis, acute decompensated HF)

Question 21

Nitroprusside includes a risk of

Answer 21

cyanide toxicity

Question 22

antidotes for cyanide toxicity from nitroprusside

Answer 22

hydroxocobalamin, sodium nitrate or sodium thiosulfate

Question 23

symptoms of cyanide toxicity

Answer 23

metabolic acidosis
dyspnea
bradycardia
confusion
flushing

Question 24

reflex tachycardia occurs due to

Answer 24

baroreceptors

Question 25

baroreceptors

Answer 25

specialized neurons found in the heart and arteries detects changes in BP activate when BP is high

Question 26

vasodilators decreased blood pressure, leading to

Answer 26

less activation of baroreceptors less suppression of the SNS increased release of NE/E at the heart leading to tachycardia

Question 27

drugs that cause vasodilation can cause ____________ why?

Answer 27

peripheral edema (swelling of lower legs and feet due to fluid accumulation) drugs that vasodilator the arterial system and NOT the venous system do this

Question 28

vasodilation of the arterial system without concurrent venous vasodilation leads to _______________ which leads to ___________________

Answer 28

increased capillary pressure fluid extravasation and edema

Question 29

drugs that cause peripheral edema include

Answer 29

CCBs and direct vasodilators

Question 30

how can peripheral edema be lessened?

Answer 30

add on a ACEI or ARB since they cause venous vasodilation

Question 31

CCB DHPs

Answer 31

block L-type calcium channels on arterial smooth muscle causes vasodilation

Question 32

CCB non-DHPs

Answer 32

verapamil - Ca channels on cardiac tissue (dec HR and contractility) diltiazem - arterial smooth muscle and cardiac tissue

Question 33

ADRs of DHPs

Answer 33

reflex tachycardia peripheral edema dizziness flushing

Question 34

rare ADR of DHPs and non-DHPs

Answer 34

gingival hyperplasia

Question 35

ADRs of verapamil

Answer 35

bradycardia atrioventricular block constipation

Question 36

ADRs of diltiazem

Answer 36

similar to DHPs and verapamil but milder

Question 37

are calcium channel blockers first line agents for HTN?

Answer 37

only DHPs not non-DHPs due to side effects

Question 38

Non-DHPs should be avoided in combination with

Answer 38

beta blockers due to additive bradycardia

Question 39

CCBs absorption/distribution

Answer 39

hepatic first pass metabolism by CYP3A4

Question 40

3A4 inhibitory potential of CCBs

Answer 40

verapamil and diltiazem (moderate inhibitors) > amlodipine > other DHPs

Question 41

amlodipine has a _________ half life and diltiazem and verapamil have a ___________ half life

Answer 41

long shorter

Question 42

about 20% of patients will require

Answer 42

more than 3 medications

Question 43

majority of patients will require ________________ to reach BP goals

Answer 43

more than 1 medication