Diuretics and anti-hypertensives

Question 1

Furosemide

Answer 1

Inhibits NKCC2 pump

Uses: edema, hypercalcemia, hypertension

Toxicity: hypokalemia, ototoxicity

active in thick ascending limb of Henle, rapid onset of action

Question 2

Hydrochlorothiazide

Answer 2

inhibits NCC pump

Uses: congestive heart failure, hypercalciuria, hypertension

hypokalemic metabolic alkalosis

active in distal convuluted tubule, slower onset of action

Question 3

Amiloride

Answer 3

inhibits ENaC Na+ channel

Uses: congestive heart failure, hypertension, hypokalemia

Toxicity: Hyperkalemia

active in corticol collecting duct, K+ sparing diuretic

Question 4

Spironolactone

Answer 4

aldosterone receptor antagonist

Uses: congestive heart failure, hyperaldosteronism, hypertension

Toxicity: hyperkalemia, endocrine effects

active in corticol collecting duct, K+ sparing diuretic

Question 5

Tolvaptan

Answer 5

V2 vasopressin receptor antagonist

Uses: SIADH, hyponatremia

Toxicity: nephrogenic diabetes insipidus, hepatotoxicity

in clinical trials for CHF, polycystic kidney disease

Question 6

RAAS inhibitors

Answer 6

Valsartan - ARB

Lisinopril - ACE inhibitor

Question 7

Adrenergics

Answer 7

Metoprolol - Beta-1 antagonist

Labetolol (carvedilol) - Alpha-1 + Beta-1 antagonist

Doxazosin - Alpha-1 antagonist

Clonidine - Alpha-2 agonist

Question 8

Ca2+ Channel blockers

Answer 8

Verapamil - Cardioselective

Amlodipine (nifedipine) - VSM preferring

Question 9

Diuretics

Answer 9

Hydrochlorothiazide - Inhibits NCC

Furosemide - inhibits NKCC2 in LOH

Question 10

Ambrisentan

Answer 10

Endothelin-A receptor antagonist

Treats: Pulmonary hypertension

Toxicity: hepatic impairment, headache

100x selective for Endothelin A receptor over Endothelin B

Question 11

Hydralazine

Answer 11

vascular smooth muscle K+ channel activator

Uses: hypertensive crisis, pregnancy induced hypertension, heart failure

Toxicity: tachycardia, salt and water retention

MOA not completely understood, can cause lupus like syndrome

Question 12

Sidenafil

Answer 12

Phosphodiesterase 5 inhibitor

Uses: pulmonary hypertension, angina, erectile dysfunction

Toxicity: tachycardia, hypotension, vision disturbances

contraindicated with nitrovasodilators

Question 13

Epoprostenol

Answer 13

Prostacyclin I2 analogue

Uses: pulmonary hypertension, Raynaud’s syndrome

Toxicity: hypotension, flushing, dizziness

contraindicated with nitrovasodilators