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Cardio VI Flashcards

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1
Q

What are the three prototypical Thiazide diuretics?

A

Chlorthalidone
Hydrochlorothiazide
Metolazone
Indapamide

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2
Q

What is the MOA of thiazide diuretics like chlorthalidone?

A

block the Na/Cl cotransporter in the distal collecting ducts

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3
Q

What is the effect of thiazide diuretics on Ca?

A

Increase reabsorption (therefore decreasing excretion)

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4
Q

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

A

Vasodilation

Increased Ca leads to increase NO synthesis

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5
Q

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

A 
Loss = loop diuretics
Uptake = thiazide diuretics
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6
Q

Thiazide diuretics are indicated with edema caused by what?

A

CHF
Hepatic cirrhosis
Renal disease

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7
Q

When are thiazide diuretics contraindicated for edema?

A

if GFR is less than 30-40 ml/min

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8
Q

Why are thiazide diuretics used to treat HTN?

A

Inexpensive, well tolerated

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9
Q

Why are thiazide diuretics used in treating renal stones?

A

Increase Ca uptake= decrease in urine

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10
Q

Why are thiazide diuretics used to treat nephrogenic DI?

A

reduce urine volume and increase Na reabsorption

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11
Q

Do thiazide diuretics cause hypokalemia?

A

Yes

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12
Q

What is the cause of nephrogenic DI?

A

Loss of aquaporins

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13
Q

What are the major adverse effects of thiazide diuretics?

A

Hypokalemia

Metabolic acidosis

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14
Q

How do thiazide diuretics cause hyperglycemia?

A

Impairment of pancreatic insulin secretion

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15
Q

What is the relationship between thiazide diuretics and hyperlipidemia?

A

increases total serum cholesterol

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16
Q

How do thiazide diuretics cause hyponatremia?

A

increased Na excretion

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17
Q

What drug class share cross-reactivity with thiazide diuretics?

A

sulfa drugs

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18
Q

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

A

Amiloride

Triamterene

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19
Q

What is the MOA of amiloride?

A

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

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20
Q

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

A

epithelial Na channel inhibitors

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21
Q

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

A

True

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22
Q

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

A

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

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23
Q

What is the main use of Na channel inhibitors?

A

used in combination with loop diuretics to prevent hypokalemia

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24
Q

What is the MOA of chlorthalidone?

A

Thiazide diuretic

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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

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