ANP, Renal Prostaglandins, ADH

Question 1

What are the three forms of natriuretic peptides?

Answer 1

ANP
BNP
CNP

Question 2

When are the natriuretic peptides released?

Answer 2

Under control of stretch receptors in the right atrium and ventricles

Question 3

What are the potency of natriuretic peptides from greatest to least?

Answer 3

ANP > BNP > CNP

Question 4

Which natriuretic peptides are better vasodilators?

Answer 4

CNP

Question 5

Which natriuretic peptides are more effective natriuretics?

Answer 5

ANP

BNP

Question 6

What cleaves ANP, BNP, CNP in the plasma?

Answer 6

Neprilysin (neutral endopeptidases/metalloprotease)

Question 7

What does ANP C receptor do?

Answer 7

Binds the natriuretic peptides and internalizes them into the cell

Question 8

What does inhibition of neprilysin cause?

Answer 8

Natriuresis

Question 9

What is Sacubitril?

Answer 9

A prodrug converted by esterases to an inhibitor of metalloproteases

Question 10

What are metalloproteases?

Answer 10

Neutral endopeptidases

Question 11

What do neutral endopeptidases do?

Answer 11

Breaksdown endothelin, A2, ANP

Question 12

What does Sacubitril do?

Answer 12

Inhibits neutral endopeptidases/metalloproteases

Question 13

What is Sacubitril used to treat?

Answer 13

In combination with valsartan (A2 antagonist) for CHF

Question 14

What are the three natriuretic peptide receptors?

Answer 14

A B and C

Question 15

What do A and B natriuretic peptide receptors do?

Answer 15

Have physiological actions

Question 16

What does natriuretic C peptide receptor do?

Answer 16

Gets rid of ANP, internalizes receptor with peptide bound to it

Question 17

What is a marker for heart failure/LV dysfunction?

Answer 17

BNP levels (higher levels is worse)

Question 18

Where is BNP released from?

Answer 18

Left ventricle

Question 19

What drug is essentially BNP in a bottle?

Answer 19

Neseritide

Question 20

What is Neseritide used for?

Answer 20

Patients on the maximum amount of diuretic that still need help via natriuresis

Question 21

What is a potential side effect of Neseritide?

Answer 21

Depletion of patients plasma sodium

Question 22

Which endothelin has pathological involvement in pulmonary HTN?

Answer 22

ET-1

Question 23

What causes release of endothelin?

Answer 23

Low shear stress on vascular endothelium

Question 24

Three ET receptors and what each do?

Answer 24

ETa: vascular smooth muscle contraction
ETb: vascular smooth muscle contraction
ETb: endothelium vasodilation via NO and prostacyclin release

Question 25

What is Bosentan?

Answer 25

Non-selective (ETa, ETb, ETc) antagonist

Question 26

What is Ambrisentan?

Answer 26

Selective ETa receptor antagonist

Question 27

When would you give Ambrisentan?

Answer 27

For blocking ETa in pulmonary hypertension

Question 28

Where is vasopressin made?

Answer 28

Supraoptic and paraventricular nuclei

Question 29

Where is vasopressin released from?

Answer 29

Posterior pituitary

Question 30

What triggers release of vasopressin?

Answer 30

In response to changes in plasma hyperosmolality (controlled by drugs too)

Question 31

V2 vasopressin receptor:

Answer 31

Gs: adenylate cyclase to form cAMP causing increased permeability

Question 32

V1/V3 vasopressin receptor:

Answer 32

Gq: DAG and IP3 to activate Ca2+ release causing vasoconstriction

Question 33

What does vasopressin cause in the uterus?

Answer 33

Oxytocin receptor stimulation

Question 34

What does vasopressin work on?

Answer 34

DCT | CD

Question 35

What are V2 receptor sensitizers used for?

Answer 35

Used for patients with V2 receptor or porin channel genetic defects

Question 36

What do V2 receptor sensitizers do?

Answer 36

Makes V2 receptor more sensitive to ADH/Vasopressin

Question 37

What drug is a V2 sensitizer?

Answer 37

Chlorpropamide

Question 38

What drug is a V2 receptor antagonist?

Answer 38

Demeclocycline (tetracycline antibiotic)

Question 39

What are ADH peptide substitutes?

Answer 39

Lypressin | Desmopressin (drug of choice)

Question 40

What two drugs are non-peptide V1, V2 antagonists?

Answer 40

Conivaptan (IV only) | Tolvaptan (oral)

Question 41

What do mesangial cells produce?

Answer 41

Vasodilatory prostaglandins

Question 42

What triggers mesangial cells to produce prostaglandins?

Answer 42

Increased BP Increased bradykinin Increased A-II Increased endothelin

Question 43

What affect do PGI2 and PGE2 have?

Answer 43

Decrease BP Decrease afferent arteriolar resistance Decreased glomerular filtration pressure Decreased albuminuria

Question 44

What affect do prostacyclins have on the nephron?

Answer 44

Decreased Na+ reabsorption in ascending loop of Henle | Reduced ADH efficacy in CD

Question 45

What is Bartter's Syndrome?

Answer 45

NKCC2 deficiency

Question 46

Bartter's Syndrome treatment?

Answer 46

NSAIDs + ACE inhibitors

Question 47

What is Gitelman's Syndrome?

Answer 47

NCC deficiency

Question 48

Final results of Bartter syndrome?

Answer 48

Severe dehydration Severe hypokalemia Polyuria

Question 49

Final results of Gitelman syndrome?

Answer 49

Dehydration Hypokalemia Polyuria