HTN 2 Drugs 1

Question 1

Blood pressure is determined by the product of

Answer 1

BP = CO x PVR

Question 2

CO=cardiac output which is equal to

Answer 2

SV X HR

Question 3

The Primary physiologic factors that determine blood pressure are

Answer 3

Renin-angiotensin-aldosterone system
Sympathetic nervous system
Plasma volume (largely mediated by kidneys)

Question 4

CO will Increase

Answer 4

Increase venous constriction:
Sympathetic nervous system overactivity
Excess stimulation of Renin-angiotensin aldosterone system

Question 5

Increase in cardiac preload include

Answer 5

Increased Fluid volume from excess Na

Question 6

PVR increase by these factors

Answer 6

Increasing vascular constriction and hypertrophy
Excess stimulation of RAAS
SNS overactivity
Endothelial dysfunction due to decreases Nitric Oxide and increases endothelial

Question 7

Most pts with essential HTN have a normal CO but increased

Answer 7

peripheral resistance

Question 8

Peripheral resistance is determined by small arterioles

Answer 8

responsible for blood flow distribution to organs

Question 9

Arteriole walls contain layers of

Answer 9

endothelial cells

Question 10

Vasodilator

Answer 10

Nitrico oxide

Question 11

Vasoconstrictor are

Answer 11

ENDOTHELIUM and ANGIOTENSIN 2

Question 12

When there is damage in endothelial

Answer 12

blood starts to aggregate in the damage part and become plaque

Question 13

Angiotensin 2 positive and negative effects

Answer 13

The postive effects if angiotensin 2 are it plays the major part homeostasis, decrease thrombosis, decrease platelet aggregation but when endothilial is damage it does the oppsite cause thrombosis, platelet agregation and plaque.

Question 14

Excess stimulation of Renin angiotensin-aldosterone

system (RAAS) can lead to:

Answer 14

Increased sympathetic activity
Increased PVR (arteriolar vasoconstriction)
Water / salt retention
Lead to elevated BP

Question 15

Inhibiting RAAS leads to

Answer 15

lowering BP

Question 16

ACE INHIBITOR MOA

Answer 16

block conversion of angiotensin 1 to angiotensin 2

Question 17

The ace inhibitor also inhibits and break down

Answer 17

BRADYKININ

which means the bredykinin level increase

Question 18

The inhibition of Bradykinin by ACE-1 leads to

Answer 18

Cough, hperkalemia and Angioedema

Question 19

ACE inhibitor meds are

Answer 19

Lisinopril (Prinivil, Zestril) 10 – 40MG Daily

Enalapril (Vasotec) 5 – 40MG 1-2 times daily

Question 20

The ACE inhibitor is also considered

Answer 20

First-line therapy in HTN guidelines (without compelling indication)

Question 21

When someone already has a heart attack and they are established. what ACE will do

Answer 21

improves their chance of second heart attack and reduces hospitalization.

Question 22

Compelling use of an ACE inhibitor

Answer 22

Post-MI & HFrEF
renal protection for patients with protein-related DM DKD or CKD
Elevated UACR (> 30mg/g)
eGFR < 60

It helps patients with post-MIT, hfref AND protects kidney

When they already have it then we use it but we cannot use to prevent it from happening.

Question 23

When not to use ACE

Answer 23

HTN: less efficacy as monotherapy in Black patients, consider combo therapy when used (need adequate dose!)
Contraindicated in pregnancy Especially in the 2nd and 3rd trimester
Pt with Bilateral Renal Artery Stenosis

Question 24

ARB Angiotensin Receptor Blocker MOA

Answer 24

Block the activity of Angiotensin 2 at the Type 1 receptor

Question 25

Stimulation of AT1 ________ Inhibiton of At1 _________

Answer 25

Vasoconstriction, Vasodilation

Question 26

ARB does not cause what side effect

Answer 26

Bradykinin

Question 27

ARB meds are

Answer 27

Irbesartan (Avapro) 150 – 300 Daily Lorsartan (Cozaar) 50 – 100 1-2 times daily Valsartan (Diovan) 80 – 320 Daily

Question 28

Special compelling for ARB are

Answer 28

``` Compelling use in Post-MI & HF •Compelling use in renal protection for patients with protein-related DM DKD or CKD •Elevated UACR •eGFR < 60 ```

Question 29

ARB has ONE extra advantage and why

Answer 29

•Consider losartan in pts with PMH of gout due to increased urinary uric acid excretion

Question 30

ACEI / ARB Adverse Drug Events (ADE)

Answer 30

Slight rise in SCr at initiation (<30% rise from baseline acceptable) • Hyperkalemia have Increased risk in pt with CKD Dry Cough* (Can be DELAYED) --> Asian Americans have a higher incidence of ACE inhibitor–induced cough. Angioedema* (Rare: <1%)

Question 31

Contraindicated: of ACEI / ARB are

Answer 31

Pregnancy Category D & Bilateral Renal | Artery Stenosis

Question 32

cough and angioedema are less common with _____ but have a chance of happening

Answer 32

ARBs

Question 33

Lisinopril-induced cough will not be effected by cough suppressant the solution is

Answer 33

Change to ARB.

Question 34

Lisinopril-induced angioedema can be cure by

Answer 34

changing to ARB means wait 6 week wash out period. | than change to ARB

Question 35

ACE/ARB Drug Interactions are

Answer 35

Effect k+ so not use with K+ sparing dieuretics or supplements

Question 36

ACE/ARB monitoring include

Answer 36

B.P. SCr, BUN, K+, angioedema and cough | Asses blood test for electorlytes and renal function 2 to 4 weeks after initiating therapy

Question 37

Direct Renin Inhibitor MOA

Answer 37

Block RAAS at its initial point of activation and prevent formation of ATI AND ATII

Question 38

Direct Renin drug (cousin of ARB/ACE) name is

Answer 38

Aliskirn

Question 39

One imporant thing about Direct Renin Inhibitor is

Answer 39

Do not use with ARB/ACE as it will increase K+ level

Question 40

ALDOSTERONE Antagonist MOA

Answer 40

Inhibit aldosterone receptor in distal tubule, and increasing NaCl & H20 excretion while conserving K+. Block effect of aldosterone on arteriolar smooth muscle (Work on fluid balance and smooth muscle)

Question 41

Aldosterone Antagonists are

Answer 41

Spironolactone (Aldactone) 25 – 100mg/day 1-2times/day

Question 42

Aldosterone antagonist should be avoided in

Answer 42

someone has elevated K+ | or less kidney fuction

Question 43

Alodosterone antagonist is effective in

Answer 43

Heart failure with reduce ejection fraction Primary aldostronsim ( elevated eldostrone) Resistant HTN

Question 44

Spironolactone adverse effect are

Answer 44

``` Hyperkalemia Hyponaterima Gynecomastia ( main issue in males) impotence Hpotension ```

Question 45

Excess stimulation of Renin-angiotensinaldosterone system (RAAS) can lead to

Answer 45

Increased sympathetic activity Increased PVR (arteriolar vasoconstriction) Water / salt retention Lead to elevated BP

Question 46

Inhibiting RAAS lead s to

Answer 46

Leads to lowering BP

Question 47

Adverse effects specific to Aldosteron antagonist are

Answer 47

Hyponaterima | Gynecomastia ( main issue in males)