Diuretics and antihypertensives (2 hrs Pharma)

Question 1

What percent of Na is reabsorbed at each segment of the nephron?

Answer 1

• Proximal Tubule- 70%
• Loop of Henle- 25%
• DCT/CD- 4.5%

Question 2

Where do Acetazolamide and mannitol act on the nephron?

Answer 2

PCT

Mannitol draws free water out of the tissue and into circulation.

Acetazolamide used to treat altitude sickness because it eliminates HCO3- in the blood.

Question 3

What do loop diuretics (such as furosemide aka Lasix) inhibit?

Answer 3

Na+ K+, Cl- cotransport in ascending loop.

Question 4

True or False: loop diuretics are the first line of defense for hypertension.

Answer 4

False:

thiazides are the first line of defense.

Question 5

What is the difference between Furosemide (Lasix), Ethacrynic Acid, and Torsemide?

Answer 5

• Furosemide (La SIX)
  
  • most commonly use loop. Dosed every SIX hours.
• Ethacrynic Acid
  
  • only non-sulfa containing loop or thiazide
• Torsemide
  
  • improved bioavailability with data in heart failure

Question 6

What do thiazide diuretics inhibit?

Answer 6

Na/Cl cotransporter in distal tubule. Used for BP control. May cause gout attacks in dehydrated patients. May also increase Ca++

Question 7

Which thiazide may increase Na excretion even in patients with Kidney disease or impaired GFR?

Answer 7

METOLAZONE + Loop Diuretic

Question 8

Where do Potassium Sparing Diuretics have their action? Why are the frequently used with other diuretics?

Answer 8

Collecting Duct. Often used to combat hypokalemia caused by other diuretics.

Question 9

How does spironolactone work?

Answer 9

It inhibits aldosterone receptors. Spironolactone may cause gynecomastia. Eplerenone avoids this side effect.

Question 10

What determines BP? FYI we left diuretics and are now talking about Hypertensive meds.

Answer 10

CO and Vascular Resistance.

Question 11

What does ACEI inhibit? How are ARBs different?

Answer 11

Conversion of Angiotensin 1–>Ang2.

ARBS block the receptor.

Question 12

All ACEI end in…

Answer 12

-pril

Question 13

What effect does Ang II have on the golmerulus

Answer 13

Constrict Efferent Arteriole. This is one reason why ACEI are helpful.

Question 14

Which type of Calcium Channel Blocker (CCB) has effect on BOTH vasodilation and cardiac conduction?

Answer 14

Non-Dihydropyridines: (Verapamil and Diltiazem) Anything ending with -dipine is strictly vasodilatory.

Question 15

What causes edema with use of CCBs?

Answer 15

Vasodilation. Therefore Diuretics DO NOT HELP with this because it is not a salt problem.

Question 16

Which type of CCB is a inhibitor of CP450?

Answer 16

NonDHPs

Question 17

With the Beta Blockers Labetalol and carvediol, metoprolol, and atenolol, what are some important differences?

Answer 17

Labetalol and carvedilol (alpha and beta blocker) provides extra antihypertensive effect Metoprolol – renal and hepatic elimination Atenolol – renal elimination

Question 18

Hydralazine and minoxidil are calssified as….

Answer 18

Vasodilators. They are NOT first line therapies for HTN.

Question 19

Alpha blockers end in…

Answer 19

-osin

Question 20

How do Alpha 2 receptor agonists work?

Answer 20

Stimulate CENTRAL presynaptic Alpha 2 receptor to decrease sympathetic tone.

Example Clonidine and methyldopa

Question 21

How do you distinguish between a HTN urgency and HTN emergency?

Answer 21

Urgency- Severe BP w/o progressive target organ damge. Emergency- 180/120 + impending or progressive organ dysfunction.

Question 22

What is Sodium Nitroprusside used for?

Answer 22

HTN emergency. It is must be used quickly and has an effect in 1-2 minutes.

Question 23

Which 2 CCBs are used for HTN emergency?

Answer 23

Clevidipine- ultra fast half life (1-2 min). Don’t worry about hepatic or renal metabolism.

Nicardipine- may cross blood brain barrier and help decrease intracranial pressure.

Question 24

Which drugs are Selective Beta 1 blockers?

Answer 24

Atenolol, Metoprolol

Question 25

Which drigs is/arenon-selective Beta 1 and 2 blockers?

Answer 25

Propanolol

Question 26

Which drugs block both Beta and Alpha receptors?

Answer 26

Carvediol and Labetolol.