Anti-hypertensives

Question 1

CVS mortality doubles with each

Answer 1

20/10 mmHg BP increment

Question 2

ACE inhibitor MOA

Answer 2

Prevent conversion of angiotensin 1 to 2. Lowers Angiotensin 2 and increases bradykinin. Overall effect is decreased BP. End in -pril

Question 3

ACE inhibitor clinical uses

Answer 3

HF, CAD, hypertension, and chronic renal disease with proteinuria.

Question 4

ACE inhibitor adverse effects

Answer 4

1.) increases serum K+
2.) Acute renal failure
3.) Pregnancy absolute contraindication
4.) Dry cough due to increased bradykinin and possibly angioedema
5.) hypotension in patients with volume and/or salt depletion

Question 5

Angiotensin 2 receptor blockers (ARBs) MOA

Answer 5

Block the function of angiotensin 2 (less vasoconstriction and less aldosterone secretion) end in -artan

Question 6

ARBs clinical uses

Answer 6

HF, CAD, hypertension, and chronic kidney disease with proteinuria

Question 7

ARBs adverse effects

Answer 7

1.) increased serum K+
2.) Acute renal failure
3.) pregnancy is a contraindication
4.) Hypotension in patients with volume and/or salt depletion

Question 8

Neprilysin inhibitor plus ARBs

Answer 8

Sacubitril/valsartan (entresto) used for HF. Increases natureatic peptides and natural diuretics (ANP and BNP) Adverse effects: hyperkalemia, cough, angioedema, renal function deterioration, hypotension. Use within 36 hours of ACE inhibitor increases risk of angioedema and contraindicated in pregnancy and bilateral kidney artery stenosis

Question 9

Aldosterone antagonists MOA

Answer 9

Prevents sodium and water retention which lowers BP. Ends in -one

Question 10

Aldosterone antagonists clinical uses

Answer 10

hyperaldosteronism, hypertension (resistant HTN), HF, and MI with LV dysfunction

Question 11

Aldosterone antagonists adverse effects

Answer 11

1.) renal dysfunction
2.) hyperkalemia
3.) Endocrine abnormalities
4.) Contraindicated in SCr>2.5 in men and >2.0 in women. and Potassium >5.0

Question 12

Diuretics MOA

Answer 12

Lower BP by: depleting the body of sodium and H2O and reducing blood volume (decreased SV)

Question 13

Loop diuretics MOA

Answer 13

Treat edema by getting rid of excess sodium and water. Also used to lower K+. Sight of action is the ascending Loop of Henle (Furosemide - Lasix)

Question 14

Loop diuretic uses

Answer 14

Treatment and prevention of edematous condition, hyperkalemia, and HTN (2nd line)

Question 15

Loop diuretic adverse effects

Answer 15

1.) Na volume depletion (hypotension and renal insufficiency)
2.) Hypokalemia (arrhythmias), hypocalcemia (tetany), hypomadnesemia (arrhythmias), metabolic alkalosis, and hyperuricemia (gout)
3.) Ototoxicity (tinnitus, deafness, vertigo)

Question 16

Thiazide diuretics MOA

Answer 16

Prevent reabsorption of NaCl which lowers BP

Question 17

Thiazide uses

Answer 17

1.) First-line treatment for hypertension
2.) Less potent than loops but can be combined together

Question 18

Thiazide adverse effects

Answer 18

1.) hypovolemia
2.) hypokalemia (rare without loop use
3.) hyponatremia (common)
4.) hypochloremia, hypomagnesemia
5.) HYPERCALCEMIA (different than loops)
6.) hyperuricemia (gout)
7.) metabolic acidosis