Hypertension I

Question 1

BP=

Answer 1

CO X PVR

Question 2

Risk factors for hypertension

Answer 2

Family History, Sex, Diet, Smoking, Diabetes, Hyperlipidemia

Question 3

What is diuresis?

Answer 3

An increase in urine volume

Question 4

What is Natriuresis?

Answer 4

An increase in renal sodium excretion

Question 5

Clinical uses of diuretics?

Answer 5

HTN, Edema, CHF, Kidney Disease, Cirrhosis, Hypercalcemia, Diabetes Insipidus

Question 6

Site of Acetazolamide activity?

Answer 6

Proximal Tubule

Question 7

What does Acetazolamide do?

Answer 7

It is a carbonic anhydrase inhibitor. This prevents the H+/Na+ antiporter from absorbing Na

Question 8

Why is Acetazolamide not super effective?

Answer 8

Na still absorbed in the loop

Question 9

Potential side effect of Acetazolamide to watch for?

Answer 9

Metabolic Acidosis

Question 10

Hemodynamic Effects of long-term diuretic administration

Answer 10

Peripheral resistance decrease
Plasma Volume decreased or unchanged
HR+CO don’t change
Plasma renin activity is increased

Question 11

Name the important loop diuretics

Answer 11

Furosemide
Bumetanide
Ethacrynic Acid

Question 12

Loop diuretics act by…

Answer 12

Inhibiting the Na+-K+2Cl- symporter

Inhibits reabs of Na, Cl, Mg, Ca

Question 13

Clinical use of Loop Diuretics

Answer 13

Edematous Conditions

Acute Pulmonary Edema

Question 14

Loop diuretic toxicities?

Answer 14

Dehydration
Hypokalemic metabolic alkalosis
Ototoxicity
Hyperuricemia
Hypomagnesemia

Question 15

Contraindications for Loop Diuretics?

Answer 15

Sulfa Allergy

Question 16

Thiazides + Loops – who is best for HTN in patients with normal renal fxn

Answer 16

Thiazides

Question 17

How do thiazides work?

Answer 17

Inhibit Na/Cl cotransporters in the distal tubule

Question 18

Thiazide diuretic names

Answer 18

Things that end in thiazide
Chlorthalidone
Indapamide
Metolazone

Question 19

Actions of Thiazide diuretics

Answer 19

Inhibit NaCl reabsorption in DCT
Enhance Ca reabs in the kidney
May open Ca channels –> Vasodilation
Decrease in peripheral resistance from neg. Na balance

Question 20

Clinical uses of Thiazides

Answer 20

Hypertension

Congestive Heart Failure

Question 21

Influence of Thiazides on Ca

Answer 21

Loss of Na in the DCT leads to activtion of the Ca/Na antiporter, causing increase Ca absorption

Question 22

Thiazide toxicities

Answer 22

Hypokalemia/Hypokalemic metabolic alkalosis
Hyperuricemia
Hypercalcemia
Impaired Carb. tolerance
Hyperlipidemia
ED

Question 23

Contraindications for Thiazides?

Answer 23

Sulfa allergies

Question 24

Major type of drugs that act in the collecting tubule…

Answer 24

Na Channel Inhibitors

Question 25

Whats the wording commonly used for Na Channel inhibitors in the collecting tubule?

Answer 25

Potassium Sparing Diuretics | Without NA coming in, no Na/K antiporter action, so K is spared

Question 26

Two examples of Potassium sparing diuretics

Answer 26

Amiloride | Triamterene

Question 27

Clinical uses for Amiloride?

Answer 27

Adjunctive treatment with thiazide or loop diuretic in CHF or HTN Can reduce BP

Question 28

Toxicities of Amiloride and Triamterene?

Answer 28

Hyperkalemia | Hyperchloremic metabolic acidosis

Question 29

Contraindications for prescribing Amiloride?

Answer 29

K+ Supplements | ACE inhibitors

Question 30

Clinical uses for Triamterene?

Answer 30

Edema assoc. with CHF, hepatic cirrhosis, nephrotic syndrome, or hyperaldosteronism Can't lower BP alone

Question 31

Contraindications for Triamterene?

Answer 31

Kidney Stones K+ Supplements ACE Inhibitors

Question 32

How do aldosterone antagonists work

Answer 32

Control Aldosterone expression | Modifies # of Na channels via transcription of proteins and channels that put them in

Question 33

Main aldosterone antagonists to know?

Answer 33

Spironlactone | Eplerenone

Question 34

Actions of Spironlactone

Answer 34

Blocks Aldosterone | Inhibits 5-alpha reductase

Question 35

Clinical uses for Spironlactone in CV Disease

Answer 35

Hypertension or CHF w/ other diuretics

Question 36

Toxicities of Spironlactone?

Answer 36

Hyperkalemia Hyperchloremic metabolic acidosis Gynecomastia + Impotence Benign Prostatic Hyperplasia

Question 37

Contraindications for Spironlactone?

Answer 37

K+ Supplements ACE Inhibitors (Promotes K+ Retention) Chronic Renal Insufficiency

Question 38

Actions of Eplerenone

Answer 38

Selective antagonism of mineralocorticoid receptor in kidney, heart, BV, and brain

Question 39

Clinical use of Eplerenone

Answer 39

Hypertension | Full therapeutic effect within 4 weeks

Question 40

Toxicities and adverse reactions to Eplerenone?

Answer 40

Hyperkalemia | Hypertriglyceridemia

Question 41

Contraindications for Eplerenone?

Answer 41

``` K+ supplements/K+ sparing diuretics ACE inhibitors Chronic Renal Insufficiency Diabetes+microalbuinuria CYP450 3A4 inhibitors (ex. ketoconazole) ```