Antihypertensives

Question 1

What is HTN major risk factor for

Answer 1

Stroke
CAD
Renal disease

Question 2

What is the main mechanisms of action for HTN with thiazide diuretitcs

Answer 2

Open up K+ channels in VSM hyperpolarizing membrane causing vasodilation.
Also block Na+/Cl- exchanger decreasing Na+ reabsorption–> fluid loss (this effect is temporary as RAAS activated bringing up volume)

Question 3

What is the best dual therapy for HTN

Answer 3

ACEi with thiazide diuretic as ACEi blocks the RAAS upregulation.

Question 4

Thiazide side effects

Answer 4

Increase uric acid
Reduce glucose tolerance
Erectile dysfucntion

Question 5

Describe the mechanism of action of loop diuretics

Answer 5

Inhibit the Na+/K+/Cl- co-transporter in the ascending LOH. Causes Na+ loss and H2O. Potent diuretic. Little effect on BP as a monotherapy

Question 6

Describe the mechanism of action of K+ sparing diuretics

Answer 6

Spironolactone (aldosterone antagonist). Stop aldosterone acting on the Na+/K+ exchangers in the distal collecting duct. Causes Na+ loss and K+ reabsorption.

Question 7

What kind of HTN is typical for younger and non-black people and best first line rx

Answer 7

RAAS up regulation.

Block renin with ACEi.

Question 8

What kind of HTN do older and black people have

Answer 8

Low renin

So use a drug independent of RAAS–> diuretic of Ca2+ blocker.