10/22

Question 1

pharm therapy

Answer 1

1st line: thiazides, ACE/ARB/renin inhibitors, CCBs
2nd line: loops, K sparing diuretics, BB, vasodilators (hydrazaline), alpha blockers
initial selection: potentially favorable effects in other disease states

Question 2

diuretics

Answer 2

• roles in managing fluid: correct underlying disease state, restrict Na intake, administration
• most pts require >2 agents: a thiazide duiretic may be 1 unless CI, combo regimens often include a diuretic, resistant HTN: failure to achieve BP goal on full doses of 3 drug regimen including a diuretic

Question 3

diuretics clinical indication

Answer 3

HTN, edema, CHF, CKD, hypercalcemia, diabetes insipidus

may slow osteoporosis

Question 4

thiazide diuretics historically..

Answer 4

first line for most HTN pts

more effective than loops unless CrCl

Question 5

thiazide AEs

Answer 5

hypokalemia, hypomagnesemia, hypercalcemia, hyperuricemia, hyperglycemia, hyperlipidemia, sexual dysfunction
lithium toxicity w concurrent admin
CI: sulfa allergy

Question 6

thiazide examples

Answer 6

HCTZ, chlorthalidone, chlorothiazide, indipamide, metolazone

Question 7

loop diuretics

Answer 7

dose in AM or afternoon to avoid nocturnal diuresis, higher doses may be needed in pts w severely dcreased GFR or HF (use in place of thiazides when CrCl

Question 8

loop diuretics AEs

Answer 8

hypokalemia, hypomagnesemia, hypocalcemia, hyperuricemia, ototoxicity
CI: sulfa allergy (except ethacrynic acid)

Question 9

K sparing diuretic examples

Answer 9

amiloride, triamterene

Question 10

K sparing diuretics

Answer 10

weak diuretics, generally used in combo w thiazide to minimize hypokalemia

Question 11

K sparing diuretics AE

Answer 11

hyperkalemia (especially w ACE/ARB or K supplements), avoid in pts w CKD or DM

Question 12

aldosterone antagonists examples

Answer 12

spironolactone, eplerenone

Question 13

aldosterone antagonists CI

Answer 13

due to inc hyperkalemia, eplerenone is CrCl

Question 14

aldosterone antagonists AE

Answer 14

hyperkalemia (especially w ACE/ARB or K supplements
avoid in CKD or DM
gynecomastia: up to 10% of patients taking spironolactone

Question 15

ACE clinical indications

Answer 15

HTN, left ventricular systolic dysfuction, MI, diabetic nephropathy, renal artery stenosis (degree of stenosis)

Question 16

ARBs clinical indications

Answer 16

HTN (only approved use), CHF, progressive renal impairment (diabetes)

Question 17

renin inhibitors clinical indications

Answer 17

HTN

Question 18

angiotensin compelling indications

Answer 18

DM w proteinuria, HF, post MI w systolic dysfunction

Question 19

favorable effects of angiotensin inhibitors

Answer 19

DM type 1 and 2, renal insufficiency (use)

Question 20

angiotensin inhibtors CI

Answer 20

pregnancy, nursing, hx of angioedema, bilateral renal artery stenosis, hyperkalemia

Question 21

ACEI overview

Answer 21

“prils”

• 1st line option; strongly emphasized for CKD
• block Ang I -> Ang II
• prevent or regress left ventricular hypertrophy (LVH) by reducing ang II myocardial stimulation

Question 22

ACEi monitoring

Answer 22

serum K+ and SCr within 4 weeks of initiation or dose increase

Question 23

ACE AE

Answer 23

dry cough, angioedema, hyperkalemia (esp in pts with CKD or DM)

Question 24

ARB overview

Answer 24

“sartans”

-inhibit Ang II from all pathways (directly block AT1 receptor)

Question 25

ARB AE

Answer 25

othostatic hypotension, renal insufficiency, hyperkalemia

Question 26

ACE/ARB warning

Answer 26

• reduce starting dose by 50% in some patients due to hypotension risk
• may cause hyperkalemia in CKD patients and patients on K sparing medications
• can cause acute kidney failure in certain patients (severe bilateral renal artery stenosis)
• CI in pregnancy

Question 27

direct renin inhibitor

Answer 27

aliskiren

-inhibits angiotensinogen -> Ang I

Question 28

renin inhibitor dosing

Answer 28

start: 150 mg po qd
main: 150 - 300 mg PO QD
max: 300 mg PO QD

Question 29

renin inhibitor adverse events

Answer 29

orthostatic hypotension, hyperkalemia, diarrhea

Question 30

monitoring for angiotensin inhibitors

Answer 30

SCr, K+, angioedema, dizziness, cough