HTN 4

Question 1

Which two meds are Aldosterone Antagonists?

Answer 1

1. Spironolactone

2. eplerenone

Question 2

Mechanism of which group of diuretics?

–Blocks aldosterone receptor in distal convoluted renal tubule inhibiting sodium and water retention, and inhibiting vasoconstriction.

Answer 2

Aldosterone Antagonists

Question 3

Which Aldosterone antagonist is more specific with little affinity for androgen or progesterone receptors—HTN and HF

Answer 3

Eplerenone

Question 4

What are the 7 side effects of Aldosterone antagonists (Spironolactone, eplerenone)

Answer 4

1. *Hyperkalemia,
2. *hyponatremia
3. *Gynecomastia
4. *Menstrual irregularities
5. *decreased libido
6. *impotence
7. GI disturbances

Question 5

Efficacy/monitoring of which group of meds:

1. *Modest diuresis
2. *Often used in combo with thiazides and loop diuretics which can counteract the K+ loss
3. *Monitor K+ levels
   
   • Eplerenone greater risk so avoid in DM with microalbuminuria, CrCl <50ml/min or elevated serum creatinine

Answer 5

Aldosterone Antagonists

Question 6

**When should you adjust dosage of Spironolactone?**

Answer 6

**Adjust in renal impairment**

Question 7

The drug interactions of thiazides and loops are similar to that of which group of diuretics?

Answer 7

Aldosterone antagonists

Question 8

What are aldosterone antagonists used for in pediatrics?

Answer 8

**HTN and Diuretic**

Question 9

Which medication is used in the treatment of female acne and hirsutism?**

Answer 9

Aldosterone antagonists

Question 10

What is the 1 ADE of Amiloride

Answer 10

**Hyperkalemia**

Question 11

Amiloride (a K+ sparing diuretic) is usually used in combination with which group of diuretics?

Answer 11

Thiazides (b/c of excessive potassium loss)

Question 12

Mechanism of which group of meds:

–Blocks the epithelial Na+ channel action proximal to the distal convoluted tubule

• results in cessation of K+ secretion.

Answer 12

Potassium sparing Diuretics (amiloride, triamterene)

Question 13

What is the side effect of potassium sparing diuretics (amiloride, triamterene)?

Answer 13

**Hyperkalemia**

Question 14

What disease are potassium sparing diuretics (amiloride, triamterene) contraindicated in?

Answer 14

renal failure

Question 15

When should you avoid giving potassium sparing diuretics (amiloride, triamterene)?

Answer 15

Avoid in patients also treated w/ ACE-I

Question 16

Efficacy/monitoring of ________ diuretics

–*Diuretic effect is modest

–*Monitor K+

Answer 16

Potassium sparing diuretics (amiloride, triamterene)

Question 17

When should you avoid giving Triamterene (a K sparing diuretic)

Answer 17

**Avoid use in CrCl <10ml/min**

Question 18

When should you adjust the dosage of Amiloride (a K sparing diuretic)?

Answer 18

Adjust in renal impairment

Question 19

Potassium sparing diuretics (amiloride, triamterene) decrease the levels/effect of which 2 things?**

Answer 19

1. Cardiac glycoside**
2. quinidine

Question 20

Which group of diuretics have the following drug interaction:

**Decrease levels/effects of diuretic

• NSAIDS**

Answer 20

Potassium sparing Diuretics (amiloride, triamterene)

Question 21

**Rarely is ______ prescribed without HCTZ**

Answer 21

**triamterene**

(a potassium sparing diuretic)

Question 22

Which group of diuretics has the most amount of NaCl in the urine

Answer 22

Loop Diuretics

Question 23

Which of the diuretics has a low amount of K in the urine?

Answer 23

K sparing diuretics

Question 24

What is the common ending of all ACE-Inhibitors?

Answer 24

-opril

Question 25

Mechanism of which group of meds? ## Footnote **–\*\*Action reduces angiotensin II mediated vasoconstriction and aldosterone secretion\*\*** **–Bradykinin accumulation—additive vasodilation by releasing nitric oxide** **–\*\*Reduces direct stimulation by angiotensin II on myocardial cells to help prevent or regress LVH\*\***

Answer 25

ACE inhibitors ("-prils")

Question 26

Mechanism of which group of meds? ## Footnote –Directly inhibit angiotensin-converting enzyme and block the conversion of angiotensin I to angiotensin II –Stimulate synthesis of vasodilating prostaglandins –Sometimes reduces SNS activity \*these were not bolded on the slide

Answer 26

ACE-I ("-prils")

Question 27

Mechanism of which group of meds? ## Footnote **–Angiotensin receptor blocker—net result is same as ACE inhibitor**

Answer 27

ARB ("-sartans")

Question 28

The following are adverse effects of which 2 groups of meds? 1. Hypotension in patients w/ bilateral renal artery 2. **Modest increase in Sr Cr ~35% or absolute increase of less than 1mg/dL do not warrant changes-vasoconstriction of efferent arterioles** 3. **\*\*Hyperkalemia\*\*** 4. HA, dizziness, fatigue, nausea, taste disturbances, 5. \<1%--Neutropenia and agranulocytosis, proteinuria, glomerulonephritis and acute kidney failure

Answer 28

ACE and ARBs

Question 29

What are 3 side effects of just ACE inhibitors (NOT ARBs)

Answer 29

**1. Dry cough\*** **2. Angioedema\*** 3. Rash (ACEs also cause Hyperkalemia like ARBs)

Question 30

Efficacy/monitoring of which two groups of meds? ## Footnote –Single therapy can control about 40-50% of patients, combo with diuretic or CCB is potent -\*\***Choice in DM**-delay progression of kidney disease, adjunct in CHF-afterload reduction, LV dysfunction after MI

Answer 30

ACEI and ARB

Question 31

What patient population are ACEI and ARBs **most effective in?\*\***

Answer 31

**\*\*young white patients\*\***

Question 32

What patient population are ACEI and ARBs **_least_ effective in?\*\***

Answer 32

1. blacks 2. older persons 3. predominantly systolic HTN

Question 33

What 6 things are important to monitor in patients taking ACE/ARBs?

Answer 33

1. BUN 2. **\*\*serum creatinine** 3. renal function 4. WBC 5. **\*\*K+** 6. CBC with diff in collagen vascular disease and/or renal impairment

Question 34

**\*\*What antihypertensives are the choice in DM?\*\***

Answer 34

ACEI and ARBs

Question 35

What are 5 drug interactions of ACEs and ARBs?

Answer 35

1. Other antihypertensives 2. Potassium supplements 3. Potassium sparing diuretics 4. **NSAIDs** 5. **\*\*\*PDE5—may increase levels of ACEI and ARB**

Question 36

T/F: you are able to take ACE/ARBs in pregnancy?

Answer 36

FASE ## Footnote **\*\*ACE/ARBs are absolutely contraindicated in pregnancy\*\***

Question 37

\*\*What is the **US Boxed warning** for aliskiren (DRI)\*\*

Answer 37

Not to be used in pregnant patients (injury and possible death of developing fetus)

Question 38

What is aliskiren (DRI) a synergist with?

Answer 38

–Synergistic with diuretics, ACEIs ARBs (avoid if CrCl \<60ml/min)

Question 39

What 4 types of patients should ACEI, ARBs and direct rening inhibitors be avoided?

Answer 39

- hyperkalemia - pulmonary (cough) - pregnant - CKD

Question 40

Review of ANS: What are the 4 SNS receptors and what do they do?

Answer 40

* α1 vasoconstriction of arterioles and venules * α2 regulation of α1 * β1 increase HR, contractility and renin release (heart and kidney) * β2 vasodilation of arterioles and venules; bronchodilation and vasodilation (lung, liver, pancreas, and arteriolar smooth muscle), gluconeogenesis

Question 41

Review of ANS: What is the PNS receptor and what does it act on? ## Footnote •M1-5 –CNS –Heart--decrease rate –Smooth muscle –Peripheral nerves –Glands

Answer 41

M1-5 * CNS * Heart--decrease rate * Smooth muscle * Peripheral nerves * Glands