Anti-Hypertensives

Question 1

Loop Diuretic

Answer 1

Furosemide

Question 2

Thiazide Diuretics (2)

Answer 2

Hydrochlorothiazide

Chlortalidone

Question 3

K+ sparing diuretic classes

Answer 3

Aldosterone antagonist

ENaC inhibitor

Question 4

Aldosterone antagonists (2 total)

Answer 4

Spironolactone

Eplerenone

Question 5

ENaC inhibitor

Answer 5

Triamterene

Question 6

Mechanism of action for diuretics

Answer 6

Inhibit the reuptake of Na and H2O (just differ on location and transporters affected)

Question 7

Loop diuretics inhibit ___________ in the Loop of Henle

Answer 7

Na/K/Cl symporter

Question 8

Loop diuretics act on what part of the nephron

Answer 8

Loop of Henle

Question 9

Adverse effects of loop and thiazide diuretics

Answer 9

Hypokalemia

Alkalosis (inc. secretion of H+)

Question 10

How do loop diuretics and thiazide diuretics cause alkalosis?

Answer 10

Inc. urine Na stimulates Na/H antiporters, favoring H+ loss in urine

Question 11

Thiazide diuretics inhibit _____________ in the distal convoluted tubule

Answer 11

Na/Cl symporters

Question 12

Thiazide diuretics act on what part of the nephron

Answer 12

Distal convoluted tubule

Question 13

K+ sparing diuretics inhibit _______ in the collecting duct

Answer 13

Aldosterone or ENaC (Epithelial Na channel)

Question 14

K+ sparing diuretics act on what part of the nephron

Answer 14

Collecting duct

Question 15

enlargement of breast tissue in men

Answer 15

gynecomastia

Question 16

Diuretic that runs the risk of gynecomastia

Answer 16

Spironolactone (Aldosterone antagonist)

Question 17

How do NSAIDs oppose the effects of diuretics?

Answer 17

nhibit prostaglandin (vasodilator)
Promote salt/water retention via breakdown inhibition of aldosterone

Question 18

Increased Na from upstream (LoH, DCT) drives ______________ in collecting duct

Answer 18

the loss of K+

Question 19

Hypokalemia results in…

Answer 19

Hyperpolarization

Delayed repolarization

Question 20

Which diuretic is rarely used for HTN (Loop, Thiazide or K+ sparing)

Answer 20

Loop diuretics

Question 21

Which diuretic is used in patients with arrhythmias or heart failure

Answer 21

K+ sparing

Question 22

Furosemide has what drug risk classification

Answer 22

C

Question 23

Which diuretics have drug risk classification D (evidence of risk for human fetuses, but benefits may outweight risks)

Answer 23

Hydrochlorothiazide
Spironolactone (Aldosterone antagonist)
Triamterene (ENaC inhibitor)

Question 24

Vasodilator with an unknown mechanism; relaxes arterioles only; orally administered for long-term maintenance of severe HTN; issues with CHF (Na/H2O retention) and lupus-like syndrome

Answer 24

Hydralazine

Question 25

Why is hydralazine (vasodilator) often used in combination with other drugs

Answer 25

To avoid toxicities (reflex tachycardia, Na/H2O retention and Lupus-like syndrome)

Question 26

Vasodilator that opens K+ channels; hyperpolarizes smooth muscle cells; administered paraenteraly for HTN emergencies

Answer 26

Diazoxide

Question 27

Vasodilators that block Ca++ channels

Answer 27

``` Amlodipine Diltiazem Nifedipine Nimodipine Verapamil ```

Question 28

Non-dihydropyridines (Ca channel blockers); affect cardiac tissue

Answer 28

Verapamil | Diltiazem

Question 29

Dihydropyridines (Ca channel blockers); affect vascular smooth muscle

Answer 29

Amlodipine | Nifedipine

Question 30

Adverse effect of Ca channel blockers

Answer 30

Drug-induced gingival enlargement (DIGE)

Question 31

Ca channel blocker of choice during pregnancy

Answer 31

Nifedipine

Question 32

ACE Inhibitors

Answer 32

Captopril | Lisinopril

Question 33

Angiotensin Receptor Blockers (ARBs)

Answer 33

Losartan | Valsartan

Question 34

Common toxicities for ACE inhibitors and ARBs

Answer 34

Dry cough Angioedema Arrhythmias (hyperkalemia) Drug Risk Classification D

Question 35

African Americans are 3x as likely to have what reaction to ACE inhibitors/ARBs

Answer 35

Angioedema

Question 36

ACE Inhibitors and ARBs are _______ in the first trimester and ________ during the 2nd/3rd trimester

Answer 36

Teratogenic; fetal hypotension and renal failure

Question 37

a1 antagonist

Answer 37

Prazosin

Question 38

a2 agonist

Answer 38

Methyldopa | Clonidine

Question 39

b-blockers

Answer 39

Atenolol Metoprolol Carvedilol

Question 40

b1 specific blockers

Answer 40

Atenolol | Metoprolol

Question 41

Why are b-blockers less likely to induce reflex tachycardia than vasodilators

Answer 41

Doesn't directly cause vasodilation (and thus doesn't trigger baroreceptors as easily)

Question 42

Drug that is almost always given to those with congestive heart failure

Answer 42

B-blockers (decrease mortality)

Question 43

Toxicities of b-blockers

Answer 43

Blood sugar changes | Bronchospasms (non-selective)

Question 44

Toxicity of a1 antagonists

Answer 44

1st dose orthostatic hypotension (especially with Prazosin)

Question 45

b-blockers have what drug risk classification during the 2nd/3rd trimesters

Answer 45

D (risk to human fetus, but benefits may outweight risks)

Question 46

Drug of choice for HTN during pregnancy

Answer 46

Methyldopa

Question 47

Why don't we typically give ACE inhibitors or ARBs to hypertensive African-Americans?

Answer 47

3x risk for angioedema

Question 48

Why is polypharmacy done when attempting to control HTN?

Answer 48

Physiological compensation when giving anti-hypertension drugs

Question 49

If you have a hypertensive patient with angina, you could give what classes of anti-hypertensives

Answer 49

B-blockers | Ca blockers

Question 50

If you have a hypertensive patient with diabetic nephropathy, you could give what classes of anti-hypertensives

Answer 50

ACE inhibitors | ARBs

Question 51

If you have a hypertensive patient with heart failure, you could give what classes of anti-hypertensives

Answer 51

Diuretics ACE inhibitors ARBs B-blockers

Question 52

If you have a hypertensive patient with Benign Prostatic Hyperplasia, you could give what class of anti-hypertensives

Answer 52

a1 antagonists

Question 53

ventricular wall tension during contraction; the resistance that the ventricle must overcome to expel blood during systole (proportional to blood pressure and vascular stiffness)

Answer 53

afterload

Question 54

First line drug for HTN

Answer 54

Thiazide