Anti-Hypertensive Drugs

Question 1

Give an example of a loop diuretic

Answer 1

Furosemide

Question 2

Loop diuretics inhibit which transport protein? Where is the transport protein located?

Answer 2

Na+/K+/2Cl- symporter within the loop of henle. THis promotes more sodium and water retention proximally. This sodium then gets reabsorbed and exchanged for hydrogen ions distally. This leads to loss of acid into the tubule.

Question 3

What are adverse effects of loop diuretics?

Answer 3

Hypokalemia (potassium gets excreted), Alkalosis (Hydrogen ions get excreted distally from na/k/cl symporter)

Question 4

Thiazide diuretics inhibit which transport protein? Where is this transport protein located?

Answer 4

Na+/Cl- symporter within the Distal convoluted tubule

Question 5

Give some examples of thiazide diuretics

Answer 5

Chlorthalidone, hydrochlorothiazide

Question 6

What are some adverse effects of thiazide diuretics?

Answer 6

Hypokalemia, alkalosis

Question 7

Potassium sparing diuretics inhibit which protein? Where is this protein located?

Answer 7

Epithelial sodium channels in the collecting ducts

Question 8

Give an example of some potassium sparing diuretics

Answer 8

• Triamterene

Aldosterone receptor antagonists: Spironolactone, eplerenone

Question 9

What are some adverse effects of potassium sparing diuretics?

Answer 9

gynecomastia: Enlargement of breast tissue in men (in spironolactone only as this acts like estradiol)

Question 10

What are some diuretic drug interactions?

Answer 10

• Diuretics+NSAIDS, as NSAIDS inhibit the phase II glucuronidiation of aldosterone, which leads to salt/water retention, increased blood volume, and therefore hypertension
• NSAIDS also inhibit the production of prostaglandin E2, which causes vasodilation. So not having this prostaglandin present could lead to HTN

Question 11

Increased sodium from the __ and __ from diuretics, drives loss of potassium from the __.

Answer 11

Loop of henle and distal convoluted tubule; Collecting duct

Question 12

Hypokalemia can lead to hyperpolarizaiton and delayed repolarization. This could respectively lead to __ and __

Answer 12

various arrhythmias and reentry rhythms

Question 13

When used with pregnancy, furosemide, HCTZ, spironolactone, and triamterene are classified as

Answer 13

Furosemide: Class C (no studies have been done in humans or animals)
HCTZ/spironolactone, triamterene: Class D (evidence of risk to fetus exists but benefits can outweigh cons in some situations)

Question 14

Hydralazine is a vasodilator. What is its mechanism?

Answer 14

It increases cGMP in vascular smooth muscle, inducing relaxation

Question 15

What is the role of diazoxide?

Answer 15

It opens potassium channels, which hyper-polarizes smooth muscle cells, inhibiting contraction, in vascular smooth muscle cells. It is administered parenterally for hypertensive emergencies

Question 16

How do nifedipine, amlodipine, verapamil, and diltiazem reduce blood pressure?

Answer 16

They block L-type calcium channels thus reducing smooth muscle contraction strength.

Question 17

What are some adverse effects of calcium channel blockers?

Answer 17

Drug-induced gingival enlargement

Question 18

What is the calcium channel blocker of choice during pregnancy?

Answer 18

Nifedipine

Question 19

Captopril and lisinopril have what mechanism of action?

Answer 19

They inhibit ACE, which converts angiotensin I to angiotensin II in the RAAS pathway

Question 20

What are the toxicities for ace inhibitors and ARBs?

Answer 20

• Dry cough
• angioedema (face, tongue, larynx, abdomen, arms, and legs. It is life threatening if it compromises airway (3x as likely in AAs as caucasians). Rapidly reversible
• Hyperkalemia (risk of arrhythmias)
• Leads to Bradykinin metabolism, which leads to endothelial leakage in lungs and other capillaries=cough/angioedema

Question 21

ACE inhibitors and ARBs are what classification for pregnancy. Can you use it during pregnancy?

Answer 21

Class D
1st trimester: Teratogenic
2nd trimester: Fetal hypotension and renal failure
3rd trimester: Fetal hypotensionn and renal failure

Question 22

Clonidine is what type of drug, and where does it act?

Answer 22

It is an alpha 2 agonist, and acts on the nucleus of the tractus solitarius of the brain stem. This then leads out to the baroreceptor in the carotid sinus

Question 23

Which are more likely to induce reflex tachycardia, B-blockers or vasodilators?

Answer 23

Vasodilators

Question 24

What are some toxicities for B1 antagonists?

Answer 24

Can increase or decrease blood sugar, so use with caution in diabetics. B1 antagonists block sympathetic nervous system. The blockage of the sympathetic nervous system leads to expression of the parasympathetic nervous system, in which the PS system acts on the beta cells of the pancreas to produce insulin, thus dropping blood sugar

Question 25

What are some toxicities of a1 antagonists?

Answer 25

1st dose postural/orthostatic hypotension, particularly with prazosin which occurs shortly after first dose. Does not typically reoccur with subsequent doses

Question 26

What are the FDA classifications of B-blockers?

Answer 26

1st trimester: Class B and C

2nd and 3rd timester: Class D

Question 27

What FDA class is prazosin?

Answer 27

Class C

Question 28

What FDA class are a2 agonists?

Answer 28

clonidine: Class C
methyldopa: Class B

Question 29

What drugs can be used for angina?

Answer 29

B-blockers and Ca2+ blockers

Question 30

What drugs can be used for DM (nephropathy)

Answer 30

ACEi and ARBs

Question 31

What drugs can be used for heart failure?

Answer 31

• Diuretics
• ACEi and ARBs
• B-blockers
• Hydralazine + Nitrates

Question 32

What drugs can be used for BPH?

Answer 32

alpha 1 antagonists