Anti-hypertensives

Question 1

Initial therapy for pts with chronic kidney disease (2)

Answer 1

1. ACE inhibitors

2. ARBS (Ang receptor blockers)

Question 2

Initial treatments for black pts (2)

Answer 2

1. Thiazide diuretics

2. CCB

Question 3

Initial treatments for non black pts (4)

Answer 3

1. Thaizide diuretics
2. ACE inhibitor
3. ARB
4. CCB

Question 4

Carbonic Anhydrase Inhibitors MOA

Answer 4

inhibits the membrane-bound and cytoplasmic forms of carbonic anhydrase

Question 5

Carbonic Anhydrase Inhibitors changes in blood urine pH

Answer 5

urine pH - increases
body pH - decreases
–> results in acidosis

Question 6

Carbonic Anhydrase Inhibitors results in (4)

Answer 6

1. decrease in H formation inside the cell
2. decreased Na/H anti-port
3. Increased Na and HCO3 inside the lumen (urine)
4. increased dieresis

Question 7

Drug class: -zolamide

Answer 7

Carbonic Anhydrase Inhibitors

Question 8

Adverse effects: Carbonic Anhydrase Inhibitors (5)

Answer 8

1. sulfonamide hypersensitivity
2. acidosis,
3. hypokalemia,
4. renal stones,
5. paresthesias

Question 9

Use: Carbonic Anhydrase Inhibitors (3)

Answer 9

1. glaucoma,
2. acute mountain sickness,
3. metabolic alkalosis

Question 10

Drug class: ethacrynic acid

Answer 10

Loop Diuretics

Question 11

MOA: Loop Diuretics

Answer 11

inhibit the luminal Na+/K+/2Cl- cotransporter (NKCC2) in the TAL of the loop of Henle

Question 12

Adverse Effects of Loop Diuretics: (7)

Answer 12

1. hypokalemia,
2. alkalosis,
3. hypocalcemia,
4. hypomagnesemia,
5. hyperuricemia,
6. ototoxicity,
7. sulfonamide hypersensitivity

Question 13

Uses of Loop Diuretics: (7)

Answer 13

1. hypokalemia,
2. alkalosis,
3. hypocalcemia,
4. hypomagnesemia,
5. hyperuricemia,
6. ototoxicity,
7. sulfonamide hypersensitivity

Question 14

Thiazide Diuretics MOA:

Answer 14

cause inhibition of the Na+/Cl- cotransporter (NCC) and block NaCl reabsorption in the DCT

Question 15

_______enhance the reabsorption of ____ in both DCT and PCT

Answer 15

Thiazide Diuretics

Ca2+

Question 16

_____ should be used with caution in patients with DM

Answer 16

Thiazide Diuretics

Question 17

Thiazide Diuretics adverse effects (7) first 2 important!

Answer 17

1. hyperglycemia,
2. hyperlipidemia,
3. hypercalcemia,
4. hyperuricemia,
5. hypokalemia
6. alkalosis,
7. sulfonamide hypersensitivity

Question 18

Adverse effects of ENaC inhibitors (2)

Answer 18

Hyperkalemia, acidosis

Question 19

Adverse effects of Mineral corticoid receptor antagonists (2)

Answer 19

hyperkalemia, acidosis, and antiandrogenic effects

Question 20

The mineralocorticoid receptor is also know as the _____ and in a ______ receptor

Answer 20

• aldosterone receptor

- nuclear hormone receptor

Question 21

These two antihypertensive agents increase body pH and cause alkalosis

Answer 21

1. loop agents

2. Thiazides

Question 22

These two antihypertensive agents decrease body pH and cause acidosis

Answer 22

1. Carbonic anhydrase inhibitors

2. K+ sparing agents

Question 23

Ang II effects on the kidney

Answer 23

Na retention

H2O retention

Question 24

Ang II effects on the Brain

Answer 24

stimulate thirst

Question 25

Ang II effects on Adrenal gland

Answer 25

aldosterone

Question 26

Ang II effects on vessels

Answer 26

vasoconstriction --> increased BP

Question 27

What 3 drug classes are contraindicated in Pregnancy?

Answer 27

1. ACE inhibitors 2. ARBS 3. Renin inhibitors

Question 28

ACE inhibitor MOA

Answer 28

- prevent the conversion of ang I to ang II | - prevent the degradation of bradykinin (vasodilator)

Question 29

ACE inhibitor clinical indications (5)

Answer 29

1. HTN 2. Heart failure 3. Left ventricular dysfunction 4. prevent CV events (MI, Stroke) 5. Nephropathy (+/- diabetes)

Question 30

Adverse effects of Ace inhibitors (4)

Answer 30

1. Cough 2. Angioedema 3. hyperkalemial 4. acute renal failure

Question 31

____ prevent/delay the progression of renal disease in ______ and patients with __________.

Answer 31

- ACEIs - type I diabetics - non-diabetic nephroapathies

Question 32

ACEIs vasodilate ____ > ______ arterioles.

Answer 32

efferent over afferent

Question 33

ACEIs usually improve renal blood flow adn Na excretion rate n ____

Answer 33

CHF