CV Hypertension

Question 1

Thiazide Diuretics

Answer 1

decrease plasma V, ECF V, CO. renin-angiotensin system limits effect. black/elderly benefit most. dietary salt restriction potentiates. Adverse hypokalemia, can worsen gout/glucose control. often used with K sparing diuretic

Question 2

Loop Diuretics

Answer 2

decrease plasma V, ECF V, CO. limited by renin-angiotensin system. most effective diuretic, but not as good as thiazide at decreasing BP. Adverse hypokalemia. often used with K sparing diuretic

Question 3

K Sparing Diuretic

Answer 3

low efficacy alone, used with loop/thiazide diuretics. Adverse hyperkalemia

Question 4

Aldosterone Antagonists

Answer 4

increase renal E of NA H2O Cl. mostly used in combination to treat resistant hypertension. benefit in HF. Adverse hyperkalemia, gynecomastia

Question 5

β Blockers

Answer 5

decrease CO, renin release, sympathetics. low doses effective. works best in young/middle aged patients, not as well in blacks. Adverse fatigue, hypoglycemia. used with caution in patients with cardiac conduction disorders or obstructive lung disease

Question 6

Renin-Angiotensin Inhibitors (ACEI + ARB)

Answer 6

decrease venous/arterial contraction, sympathetics, TPR. strongly potentiated by diuretic. excellent protection in diabetes, coronary artery disease and HF. generally well tolerated. ARB have fewest side effects. Adverse cough, hypotension. no benefit to combine

Question 7

Renin-Angiotensin Inhibitors (Aliskiren)

Answer 7

inhibits enzymatic activity of renin, decrease vessel contraction, increase E - decrease TPR. less effective in blacks. strongly potentiated by diuretic. added effects when combined with ACEI or ARB. Adverse diarrhea, expensive, unproven

Question 8

α Blockers

Answer 8

decrease vessel contractile response to EPI/NE, decrease TPR. tolerance is a problem, used for resistant hypertension. Adverse hypotension, headache common. cause strong fluid retention

Question 9

Centrally Acting Sympatholytics

Answer 9

activate α2 R in brainstem. decrease sympathetics, decrease CO + TPR. only used in resistant hypertension. Adverse sedation dry mouth common. sudden stopping can cause hypertension. methyldopa for pregnancy

Question 10

Direct Arterial Vasodilators

Answer 10

decrease arteriolar contraction - decrease TPR. strongly activate sympathetics and renin-angiotensin system. lower BP in everyone substantially. tolerance develops, not widely used. Adverse headache, hair growth common. given in combo with diuretic/β blockers