Anti-hypertensives

Question 1

what qualifies as HTN stage 1? stage 2?

Answer 1

sys>140 or dias>90. sys>=160 or dias>=100. between stage 1 and normal is prehypertensive

Question 2

how do we Rx pre HTN

Answer 2

lifestyle modification and close follow up

Question 3

how much can Na+ restriction lower BP

Answer 3

2-8 mmHG

Question 4

How do you calculate Blood volume?

Answer 4

Total Body Water (TBW)=60% of weight
Extracellular Water (ECV)= 1/3 of TBW
Plasma Water=1/4 of ECV
Blood volume=Plasma Water/(1-Hct)
**About 9%**

Question 5

What are some Thiazide diuretics? Where do they work and what do they do?

Answer 5

Hydrochlorothiazide (HCTZ), chlorthalidone, metolazone. Inhibit the Na-Cl symporter in the DCT

Question 6

side effects of Thiazide diuretics

Answer 6

hypokalemia, hyponatremia, hypercalcemia.

Question 7

What are some Loop Diuretics and where do they act?

Answer 7

Furosemide, torsemide, bumetanide. Inhibit the Na-K-Cl symporter in the TALH

Question 8

What are some side effects of loop diuretics

Answer 8

electrolyte imbalances, ototoxicity, hyperglycemia

Question 9

What are some K+ sparing diuretics and how do they work

Answer 9

Trimteren, Amiloride, SPIRONOLACTONE, eplerenone. First two inhibit renal epithelial Na+ channels in DCT and CD. Second two antagonize mineralcorticoid receptor in DCT and CD.

Question 10

Side effects of K+ sparing diuretics

Answer 10

Hyperkalemia, gynecomastia (spironolactone)

Question 11

What are some Centrally acting agents and how do they work?

Answer 11

Methyldopa inhibits central adrenergic outflow. Clonidine stimulates cenral alpha2 receptors

Question 12

Side effects central acting sympatholytics

Answer 12

sedation, dry mouth, depression. Little interaction with other drugs

Question 13

when should methyldopa be given special consideration

Answer 13

in pregnancy

Question 14

what are some alpha1 receptor blockers

Answer 14

prazosin, terazosin, doxazsin

Question 15

side effects of alpha1 blockers

Answer 15

first dose phenomenon of orthostatic HTN. CHF if given alone

Question 16

What are some beta blockers

Answer 16

Beta1- Atenolol, metoprolol

Beta 1 and 2-Propanolol, timolol

Question 17

Action of beta 1 receptor blockers

Answer 17

decrease HR, decrease contractility, decreased renin

Question 18

Action of beta 2 receptor blockers

Answer 18

vasoconstriction (slight increase in peripheral resistance)

Question 19

what is the overall effect of beta blockers on peripheral resistance

Answer 19

none or slight decrease

Question 20

what is unique about labetolol and carvedilol

Answer 20

beta blockers with some alpha blocking activity

Question 21

what are some side effects of beta blockers

Answer 21

bradycardia, fatigue

Question 22

what are some ACEI? ARB?

Answer 22

-pril, -sartan

Question 23

what three major things does angiotensin do?

Answer 23

sympathetic activation, vasoconstriction (esp efferent arteriole of glomerulus), Na/H2O retention

Question 24

side effects of ACEIs and ARBs

Answer 24

hyperkalemia, renal failure, fetal toxicity. Cough and angioedema w/ ACE-I’s

Question 25

what are some calcium channel blockers

Answer 25

verapamil, diltiazem, dihydropyridines (nifedipine, amlodipine, felodipine)

Question 26

what is different about the actions of dihyrdos and diltiazem/verapamil

Answer 26

dihydros have a big neg affect on peripheral resistance. Nondihydros decrease CO and decrease peripheral resistance to lesser degree

Question 27

side effects of CCBs

Answer 27

GERD, peripheral edema, metabolized by CYP’s

Question 28

what are some peripheral vasodilators

Answer 28

hydralazine, minoxidil, sodium nitroprusside

Question 29

when do you use peripheral vasodilators

Answer 29

stage 2 htn or emergency. Thiazides are usally the first line.

Question 30

What is aliskiren

Answer 30

direct renin inhibitor