Drugs used for treatment of Hypertension 3

Question 1

what does diuretics do and act where?

Answer 1

Diuretics act on
various sites in the
nephron to cause
diuresis (increase in
urine production)

Question 2

Diuretics affects reabsoption and excretion of which ions

Answer 2

Affect reabsorption
and/or excretion of
Na+, K+, Mg2+,Ca2+, Cl-,
HCO3
-,

Question 3

Site action of Thiazide diuretics

Answer 3

early DCT

Question 4

The thiazide diuretic inhibits which symporter

Answer 4

Inhibit the Na+, Cl-, symporter

Question 5

Thiazide diuretic increases and decreases extretion of which ions

Answer 5

Increase, Na+, K+, Mg2+ excretion
and decrease Ca2+excretion

Question 6

greater volume of——————enriched tubular fluid to the late DCT and collecting ducts

Answer 6

NaCL

Question 7

Explain the mechanisms of Action of thiazide diuretics

Answer 7

Antihypertensive actions of thiazide diuretics. Initially, thiazide diuretics
decrease blood volume and thereby decrease cardiac output. Over time, the
drugs decrease peripheral vascular resistance (PVR), an action that may be
secondary to a reduction in the sodium content of smooth muscle cells

Question 8

cheap (cost-effective) drugs

Answer 8

Thiazide diuretics

Question 9

Explain the initial treatment of thiazide diuretics

Answer 9

Initial treatment of mild to moderate hypertension, though recent clinical
trials suggest that an angiotensin inhibitor or calcium channel blocker (CCB)
may be preferable because of the superior ability of these agents to control
blood pressure for the entire day, and because they tend to cause fewer
adverse effects.

Question 10

Thiazide diuretics use in combinations with which drugs in order to do what?

Answer 10

Thiazide diuretics are also used in combination with other types of
antihypertensive agents, because they have additive or synergistic effects
on blood pressure, and a diuretic may prevent the compensatory fluid
retention evoked by another agent.

Question 11

The recent clinical shows that the combination of indapamide and an angiotensin inhibitor does what?

Answer 11

Recent clinical trials have shown that the combination of indapamide and
an angiotensin inhibitor effectively controls blood pressure while reducing
the risk of stroke and myocardial infarction in hypertensive patients.

Question 12

Chemical name for thiazide diuretic

Answer 12

Sulpjonamide compounds

Question 13

explain how thiazide diuretics are metabolised and secreted?

Answer 13

Partially metabolised before excretion in the urine
* Actively secreted into the nephron by proximal tubular cells, travel
through nephron lumen to reach site of action (distal convoluted
tubule)

Question 14

Adverse effects for thiazide diuretics depends on what?

Answer 14

Dose-dependent adverse effects, but minimal increase in efficacy if
dose is increased

Question 15

Thiaizide diuretics appears to offer proctection against what?

Answer 15

Appear to offer protection against osteoporosis (decrease urinary
excretion of calcium

Question 16

explain the adverse effect of thiazide diuretic

Answer 16

• Dose-dependent (12.5mg versus 25 mg)
• Electrolyte (hypokalaemia, hypomagnesaemia, hyponatraemia,
  hypochloraemic alkalosis)
• Metabolic abnormalities: elevated glucose, uric acid and lipid levels
• Decreased insulin sensitivity and insulin secretion (hypokalaemia)
• Hyperuricaemia = decreased uric acid secretion from proximal tubule
  (precipitate gout)

Question 17

List 4 contra-indications for hydrochlorothiaizde

Answer 17

• Gout
• Pregnancy
• Severe liver impairment
• Kidney impairment (eGFR <30ml/min)

Question 18

List the caution for hydrochlorothiazide

Answer 18

Caution in patient with family history of skin cancer – counsel on sun
avoidance and sun protection

Question 19

Explain the MoA of Loop diuretics

Answer 19

Inhibit symporter that
transports Na+, K+,
2Cl- back into tubular
cells
Reduce back diffusion
of K+ and increase
excretion of Mg2+ and
Ca2+

Question 20

Explain the potency of loop diuretics

Answer 20

• Exert a more powerful natriuretic effect than other diuretics, because
  they inhibit the reabsorption of a greater percentage of sodium
• High-ceiling diuretics – dose dependent effect

Question 21

Indications for loop diuretics

Answer 21

• Oedema, pulmonary oedema
• Oedema secondary to heart failure, liver cirrhosis, etc.