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Flashcards in Cardio VI Deck (84):
1

What are the three prototypical Thiazide diuretics?

Chlorthalidone
Hydrochlorothiazide
Metolazone
Indapamide

2

What is the MOA of thiazide diuretics like chlorthalidone?

block the Na/Cl cotransporter in the distal collecting ducts

3

What is the effect of thiazide diuretics on Ca?

Increase reabsorption (therefore decreasing excretion)

4

What is the effect of thiazide diuretics on the vasculature? How?

Vasodilation

Increased Ca leads to increase NO synthesis

5

What are the drugs that cause Ca loss? Ca reuptake?

Loss = loop diuretics
Uptake = thiazide diuretics

6

Thiazide diuretics are indicated with edema caused by what?

CHF
Hepatic cirrhosis
Renal disease

7

When are thiazide diuretics contraindicated for edema?

if GFR is less than 30-40 ml/min

8

Why are thiazide diuretics used to treat HTN?

Inexpensive, well tolerated

9

Why are thiazide diuretics used in treating renal stones?

Increase Ca uptake= decrease in urine

10

Why are thiazide diuretics used to treat nephrogenic DI?

reduce urine volume and increase Na reabsorption

11

Do thiazide diuretics cause hypokalemia?

Yes

12

What is the cause of nephrogenic DI?

Loss of aquaporins

13

What are the major adverse effects of thiazide diuretics?

Hypokalemia
Metabolic acidosis

14

How do thiazide diuretics cause hyperglycemia?

Impairment of pancreatic insulin secretion

15

What is the relationship between thiazide diuretics and hyperlipidemia?

increases total serum cholesterol

16

How do thiazide diuretics cause hyponatremia?

increased Na excretion

17

What drug class share cross-reactivity with thiazide diuretics?

sulfa drugs

18

What are the two prototypical inhibitors of renal epithelial Na channels?

Amiloride
Triamterene

19

What is the MOA of amiloride?

Inhibit renal epithelial Na channels in the late distal tubule and collecting duct by competing with Na for the channel

20

What group of diuretic drugs have to be used in combination with another diuretic class?

epithelial Na channel inhibitors

21

True or false: Na channel inhibiting diuretics have only a weak diuretic effect on their own

True

22

How is it that Na channel inhibitors are K sparing diuretics?

If you inhibit the Na channel, K will not flow out of the cell

23

What is the main use of Na channel inhibitors?

used in combination with loop diuretics to prevent hypokalemia

24

What is the MOA of chlorthalidone?

Thiazide diuretic

25

What is the MOA of hydrochlorothiazide?

thiazide diuretic

26

What is the MOA of metolazone?

Thiazide diuretic

27

What is the MOA of indapamide?

Thiazide diuretic

28

What is the MOA of triamterene?

Renal epithelial Na channel inhibitor

29

Which type of diuretic is K sparing?

Inhibitors of renal epithelial Na channels (amiloride/triamterene)

Aldosterone blockers

30

What is the MOA of spironolactone?

Aldosterone receptor antagonist

31

What is the MOA of eplerenone?

Aldosterone receptor antagonist

32

What is the effect of activation of the aldosterone receptor on renal epithelial cells?

Increase Na/K pump on basolateral side, and increased channels on the lumenal side.

Causes increased K excretion, decreased Na excretion

33

What part of the renal tubule are aldosterone receptors found?

distal tubule and collecting duct

34

What happens when you block aldosterone?

Decreased K loss
Increased Na loss
Increased water loss

35

Which type of diuretic does not require access to the tubular lumen to induce diuresis?

Aldosterone receptor antagonists

36

Are spironolactone and Eplerenone competitive or noncompetitive aldosterone receptor antagonists?

Competitive

37

How do aldosterone receptor blockers like spironolactone prevent LV remodeling and cardiac fibrosis?

Inhibit matrix metalloproteases

Inhibit protein kinase C

38

How do aldosterone receptor blockers like spironolactone prevent sudden cardiac death? (3)

-improve HR variability
-Reduce QT dispersion
-Prevent severe hypokalemia

39

What are the hemodynamic effects of aldosterone inhibitors?

BP reduction
Moderate diuresis and natriuresis

40

What are the vascular effects of aldosterone inhibitors?

Decrease vascular NAD(P)H oxidase activity

41

What are the clinical uses of aldosterone inhibitors?

Edema and HTN
heart failure

42

What is the diuretic of choice when treating hepatic cirrhosis?

Aldosterone inhibitors

43

What is the most severe adverse effect of aldosterone inhibitors?

Hyperkalemia

44

What is the diuretic treatment of choice for primary hyperaldosteronism?

Aldosterone antagonists

45

What are the two main mechanisms by which diuretics lower BP?

Decrease TPR and Na/water

46

What is the upper limits of normal BP?

120/80

47

What is the range of high-normal BP?

120-140 /80-90

48

What is the range of BP for stage 1 HTN? What medication should you consider using? How often should you recheck?

140-160 / 90-100
Thiazide
3 months

49

What is the range of BP for stage 2 HTN? What medication should you consider using?

>160 / >100
Thiazide and ACEI
2-4 weeks

50

What is the range of BO to diagnose isolated systolic HTN?

>140 /

51

What are HTN crises?

High blood pressure and/or organ damage

52

What is a HTN urgency?

NO associated end organ damage

Have hours/days to treat

53

What is a HTN emergency?

Markedly elevated BO WITH end organ damage

have minutes/hours to treat

54

What are the four end organs in HTN emergencies?

Kidney
Brain
Heart
Retina

55

What is resistant HTN?

BP that is uncontrolled despite the use of three or more anti-HTN drugs (one of which is a diuretic)

56

What is pseudo-resistant HTN?

Uncontrolled HTN d/t white coat effect or poor adherence to HTN meds

57

Who is more at risk for HTN, females or males? Why?

Females--loss of estrogen

58

Which ethnicity is at higher risk of HTN?

African-americans

59

What is primary HTN?

Idiopathic rise in BP

60

What are the causes of secondary HTN?

Renal disease
Primary aldosteronism

61

What are some of the uncommon causes of secondary HTN?

Pheochromocytoma
Cushing syndrome
Hyperparathyroidism
Coarctation of the aorta

62

What should be you intent when treating HTN?

Treat with the intent of reducing CV events

63

What is the BP goal of treating pts

140/90

64

What is the BP goal of treating pts > 60 yo?

150/90

65

What medication should you consider adding if treating a stage 1 HTN pt for more than 3 months without a significant drop in BP?

Add ACEI

66

What is the diet for HTN?

DASH diet

67

How much EtOH is helpful with HTN?

2 drinks / day

68

True or false: once initiated, HTN is a lifelong disease

True

69

Why is it that there is no baroreceptor reflex in HTN?

Chronic HTN resets the reflex

70

Mean arterial pressure = ?

CO * TPR

71

CO = ?

HR * SV

72

What is the drug that is indicated for HTN secondary to another disease?

ACEI

73

What are the drugs that should be used to treat HTN with coronary artery disease?

Beta blocker
ACEI

74

What is the first line regimen for left ventricular dysfunction?

ACEI
Diuretic
Beta blockers

75

What is the first line regimen for HTN with previous ischemic stroke?

ACEI
Thiazide diuretic (?)

76

What are the drugs that should be added on to HTN w/ DM?

thiazide
Beta blocker
CCB

77

What are the drugs that should be added on to HTN w/ coronary artery disease?

Aldosterone antagonist
CCB
thiazide

78

What are the drugs that should be added on to HTN w/ left ventricular dysfunction?

Aldosterone antagonist
Hydralazine

79

What enzyme is released by the kidneys to cleave angiotensinogen to angiotensin I?

Renin

80

What is the effect of angiotensin II?

Vasoconstriction and aldosterone release

Release vasopressin

81

What is the effect of aldosterone?

Increase Na reuptake
Increase K output

82

What is the enzyme that cleaves angiotensin I to angiotensin II?

ACE

83

What is the effect of increased Na at the tubular macula densa?

Vasoconstriction

84

Which are the three MOA of treating HTN via the angiotensin pathway?

Inhibit renin
Inhibit ACE
Inhibit angiotensin receptor