Hypertension

Question 1

What are the BP ranges for the three stages of hypertension?

Answer 1

Stage 1: 140-159/90’s
Stage 2: 160-179/100-109
Stage 3: =>180/110

Question 2

What is the JNC 8 recommendation for those aged over 60?

Answer 2

Treat if over 150/90 (either sys or dia) with a goal to be below those numbers.

Question 3

What is the JNC 8 recommendation for those aged below 60?

Answer 3

Treat a systolic above 140. (expert opinion)

Question 4

What are the four major types of antihypertensives?

Answer 4

Diuretics
Beta-blockers
ACE-I/ARB
CCBs

Question 5

Which of the four major types of antihypertensives is slightly less effective than the rest?

Answer 5

Beta-blocker

Question 6

What describes a substance that promotes the excretion of urine?

Answer 6

Diuretic

Question 7

What describes a substance that promotes the renal excretion of Na+?

Answer 7

Natriuretic

Question 8

What is the site of action for osmotic diuretics?

Answer 8

Proximal tubule and thin descending limb of Henle

Question 9

What is the site of action for Carbonic anhydrase inhibitors?

Answer 9

Proximal tubule

Question 10

What is the site of action for Thiazides?

Answer 10

Distal convoluted tubule

Question 11

What is the site of action for loop diuretics?

Answer 11

Thick ascending limb of Henle

Question 12

What is the site of action for Na+ channel blockers and spironolactone?

Answer 12

Cortical collecting duct

Question 13

What is the MOA for Thiazide diuretics?

Answer 13

Inhibits Na+ and Cl- transporter in distal convoluted tubules.
Increases excretion of Na+, Cl-, K+, Mg2+
Decrease Ca2+ excretion

Question 14

How are thiazides administered and absorbed?

Answer 14

Orally, poorly absorbed

Question 15

How long is the onset of action for thiazides and what is their t1/2?

Answer 15

1-2 hours (BP effects take several days)

Wide range of t1/2 for different thiazides (generally longer than diuretics)

Question 16

What the two major side effects to worry about with thiazides?

Answer 16

Hypokalemia and hyponatremia

Question 17

What are four commonly used thiazides?

Answer 17

Chlorothiazide
Hydrochlorothiazide
Chlorthalidone
Metolazone

Question 18

What are four common loop diuretics?

Answer 18

Furosemide
Bumetanide
Torsemide
Ethacrynic acid

Question 19

What is the MOA of loop diuretics?

Answer 19

Inhibit apical Na-K-2Cl transporter in thick ascending loop of henle
Competes with Cl- binding site
Enhanced excretion of Mg2+, Ca2+, K+, and H+
Inhibits reabsorption of glomerular filtrate

Question 20

How are loop diuretics administered and absorbed?

Answer 20

Orally, rapid absorption

Question 21

What is the onset of action for loop diuretics?

Answer 21

Rapid for both diuresis and BP effects

Question 22

What are the toxicity concerns with loop diuretics?

Answer 22

They cause retention of lithium, also has additive toxicity with ototoxic drugs at IV doses

Question 23

What decreases the potency of loop diuretics?

Answer 23

Inhibitors of organic acid ion transport (NSAIDs)

Question 24

What are the two main side effects to worry about with loop diuretics?

Answer 24

Hypokalemia and hyponatremia

Question 25

What antihypertensive drugs are the best tolerated?

Answer 25

Renin-Angiotensin Inhibitors (RAS) and ARBs.

Question 26

What are four common Angiotensin Converting Enzyme Inhibitors (ACE-Is)?

Answer 26

Lisinopril Enalapril Captopril Ramipril

Question 27

What are four common Angiotensin Receptor Blockers (ARB)?

Answer 27

Losartan Irbesartan Valsartan Candesartan

Question 28

What is the most common side effect of ACE-I's?

Answer 28

A dry cough (more common in black and asian patients)(can replace with ARB)

Question 29

What are the side effects of ACE-I's?

Answer 29

Dry cough Angioedema Hyperkalemia Kidney function reduction

Question 30

What are the three types of CCBs?

Answer 30

Phenylalkylamines Benzothiazepines 1, 4-dihydropryidines

Question 31

Two of the three CCB types work mostly through decreased cardiac output. Which one works by causing vasodilation?

Answer 31

Dihydropyradines

Question 32

What is the principal side effect of dihydropyridines?

Answer 32

Ankle edema

Question 33

What is the MOA of beta-blockers?

Answer 33

``` Competitive antagonism (non-selective for both beta 1 and 2 receptors) Antagonize effects of catecholamines on the heart. ```

Question 34

What is the difference between cardioselective and non-cardioselective beta-blockers?

Answer 34

Cardioselective prefer B1 receptors (except at high doses. Theoretically cause less bronchoconstriction and peripheral vasodilation

Question 35

What are some of the important adverse effects of beta blockers?

Answer 35

CNS effects (sedation, depression, hallucinations) Worsening of heart failure when initiated (start low dose) Bronchospasm Hypoglycemia unawareness in diabetes Impotence