Anti-HTN drugs

Question 1

3 factors that determine BP

Answer 1

CO, SVR, blood volume

Question 2

overall diuretic mech

Answer 2

inhibit reuptake of Na+ and thus water- water follows sodium

Question 3

targets for the three main diuretics

Answer 3

loop- loop of henle
thiazides- distal tubule
K+ sparing- collecting duct

Question 4

loop diuretics moa

Answer 4

inhibit Na/K/2Cl transporter in loop of henle, reduce Na reuptake (also K+ reuptake)

Question 5

loop examples

Answer 5

furosemide, torsemide

Question 6

loop adverse effects

Answer 6

hypokalemia and alkalosis- extracellular Na+ is traded for intracellular H+ downstream of targeted transporter, more Na+ w/ diuretic effect

Question 7

thiazide moa

Answer 7

inhibit Na/Cl symporter in DCT

Question 8

thiazide examples and adverse effects

Answer 8

hydrochlorothiazide, chlortalidone

hypokalemia and alkalois (same mech as loop)

Question 9

K+ sparing moa

Answer 9

inhibit ENaC (epithelial Na channel) in collecting duct either directly (triamterene) or indirectly thru antagonizing aldosterone receptor (spironolacotne and eplerenone) which normally upregulates ENaC

Question 10

K+ sparing adverse effects

Answer 10

gynecomastia- male breast enlargement in spironolactone (similar to estradiol) but not with eplerenone

Question 11

interaction of diuretics and NSAIDs

Answer 11

NSAIDs inhibit glucoronidation of aldosterone (more ENaC) and thus more water retention, and inhibit PGE2 vasodilation

NSAIDs raise blood pressure, can blunt the effects of diuretics

Question 12

why hypokalemia in loop/thiazide diuretics?

Answer 12

increased extracellular Na+from upstream drives loss of K+ in collecting duct

Question 13

hypokalemia CV relevance

Answer 13

can cause hyperpolarization and delayed repolarization (long QT) which can cause arrhythmias

Question 14

types of vasodilator drugs

Answer 14

hydralazine, K+ channel opening (diazoxide), Ca++ blockers (amlodipine, etc)

Question 15

differentiate DHP and non-DHP Ca++ blockers

Answer 15

DHP (amlodipine and nifedipine) act mainly on vascular smooth muscle (SVR) while non DHP act on both vascular SM and cardiac tissue (verapamil and diltiazem)

Question 16

Ca blockers moa

Answer 16

inhibit Ca influx channels, reduce strength of SM contraciton

Question 17

Ca blockers adverse effects

Answer 17

drug-induced gingival enlargement

Question 18

Ca blockers and pregnancy

Answer 18

nifedipine is drug of choice from this class

Question 19

goal of anti-angiotensin drugs

Answer 19

reduce vasoconstriction and water retention

Question 20

ACE inhib moa

Answer 20

inhibit ACE, conversion of angiotensin I to angiotensin II

ACE also breaks down bradykinin, these drugs cause accumulation

Question 21

ARB inhib moa

Answer 21

inhibit angiotensin receptor at vessels and kidneys (prevent constriction and aldo release)

Question 22

ACE inhib examples

Answer 22

captopril, lisinopril

Question 23

ARB examples

Answer 23

losartan, valsartan

Question 24

toxicities of ACEi and ARBs

Answer 24

dry cough, angioedema (from excess bradykinin causing endothelial leakage, worse in african americans)

hyperkalemia and risk of arrhythmias

Question 25

ACEi and ARBs in pregnancy

Answer 25

teratogenic in first trimester, cause fetal hypotension and renal failure in second 2 trimesters

Question 26

goal of sympatholytics

Answer 26

reduce BP by inhibiting SNS

Question 27

why prefer B blockers to vasodilators?

Answer 27

B blockers less likely to induce reflex tachycardia

Question 28

a2 agonist example and moa

Answer 28

clonidine and methyldopa- inhibit SNS from the CNS, reinforcing NE negative feedback loop on the presynaptic receptor

Question 29

Beta blockers moa

Answer 29

inhibit B1 receptors- reduce HR and contractility

Question 30

a1 inhibs moa

Answer 30

block a1 and inhibit VSM contraction

Question 31

B blockers for HF?

Answer 31

yes, documented to decrease mortality

Question 32

B blocker toxicities

Answer 32

can both raise and lower blood sugar (careful with diabetics) exacerbate asthma/COPD (when non selective for B1)

Question 33

a1 examples

Answer 33

prazosin, terazosin, doxazosin

Question 34

a1 toxicities

Answer 34

fist dose causes orthostatic Hypotension (esp w/ prazosin)

Question 35

HTN drug of choice during pregnancy?

Answer 35

methyldopa, a2 agonist

Question 36

which drugs for HTN and angina?

Answer 36

B blockers and Ca blockers

Question 37

drugs for HTN and diabetes/nephropathy?

Answer 37

ACEi or ARBs

Question 38

drugs for HTN and HF

Answer 38

diuretics, ACEi/ARBs, B blockers, hydralazine and nitrates

Question 39

drugs for HTN and BPH?

Answer 39

a1 antagonists

Question 40

threshold for HTN tx?

Answer 40

greater than or equal to 140/90 or 130/80 and CVD, CKD, DM, high CVD risk

Question 41

first line HTN agents

Answer 41

thiazides, Ca blockers, ARBs, ACEi can combine any except ACEi and ARBs