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Year2 Renal > Exam 3 Linger- Intro to antiHTN agents > Flashcards

Exam 3 Linger- Intro to antiHTN agents Flashcards

1
Q

What is formula for MAP

A

CO x TPR

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2
Q

reflex tachycardia is a compensatory response from waht system

A

SAN

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3
Q

edema is a compensatory response from what system

A

renin activity

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4
Q

When do you initiate pharmacologic intervention with HTN

A

stage I classification

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5
Q

what anti HTN work on the vasomotor center in CNS

A

methyldopa, clinidine, guanabenz, guanfacine

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6
Q

What are the 4 main mech actions anti HTN

A

diuretics
agents that block Angiotensin
direct vasodilators
sympathoplegic agents (blockers)

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7
Q

What are the monotherapy options for patients with CKD

A

ACEI

ARB

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8
Q

what is monotherapy choice for black without CKD

A

thiazide or CCB

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9
Q

what is the monotherapy choice for nonblacks without CKD

A

thiazide diuretic, ACEI, ARB, CCB

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10
Q

how much of CO do kidneys receive

A

25%

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11
Q

What is actively reabsorbed in proximal tubule

A

sodium bicarb
sodium chloride
K
ALL glucose and AA

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12
Q

what is passivley reabsorbed in prox tubule

A

60% water

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13
Q

What enzyme is found in prox tubule that is key to HCO3 reabsorption

A

Carbonic anhydrase

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14
Q

What occurs in thin descending limb

A

water reabsorption

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15
Q

what occurs in thin ascending limb

A

impermeable to water and solutes

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16
Q

What occurs in thick ascending limb

A

impermeable to water
Na reabsorption
Na K 2Cl cotransporter which leaves - net charge so K leaks back out which will drive Mg and Ca back into cells

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17
Q

What occurs in distal convoluted tubule

A

impermeable to water
NaCl co transporter that is affected by thiazides
Ca reabsorbed by Ca channels that are regulated + by PTH

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18
Q

What occurs in collecting tubule

A

K secretion!
2 Na into cell ENaC
K and H out (metabolic alkalosis)

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19
Q

Where does aldosterone work and what is the effect

A

on collecting tubule
increases ENaC expression so increase Na reabsorption, more K and H secretion
water retention from Na reabsorption

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20
Q

Where does ADH work and what is the effect

A

increases amount of aquaporins in the collecting tubule to reabsorb water
no ADH the tubule is impermeable to water (dilute urine)

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21
Q

What is the effect of alcohol on ADH

A

prevents release of ADH

pee alot

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22
Q

How do diuretics work short term/long term

A

immediately cause volume contraction

over time–> have vasodilatory properties

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23
Q

What clinical situations are diuretics helpful in

A

heart failure, kidney disease, renal failure, liver disease, HTN, nephrolithiasis, hypercalcemia, diabetes inspidus

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24
Q

What are the carbonic anhydrase inhibitors

A
  • amides

e. g acetazolamide

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25
what are the loop diuretics
Ethacrynic acid furosemide bumetanide tosemide
26
What are the thiazide diuretics
-azides HCTZ chlothalidone and metolazone indapamide!!
27
What are the K sparing diuretics
Aldosterone Antagonists= eplerenone and spironolactone "-one" ENaC inhibitors: amilioride and triamterene
28
What are the osmotic diuretics
mannitol and isosorbide
29
What are the ADH antagonists
-vaptan | conivaptan, tolvaptan
30
Where do CA inhibitors act
proximal tubule primarily and prevent uptake HCO3 decrease the H inside cell needed to run Na H exchange decrease Na reabsorption acidosis
31
What are CA inhibitors used for
glaucoma, AMS and metabolic alkalosis
32
What are side effects of CA inhibitors
acidosis, hypokalemia renal stones, paresthesias sulfonamide HS
33
Where do loop diuretics work and result?
thick ascending limb block Na K 2Cl dec Na absorption so dec K secretion and dec Mg Ca reabsorption
34
what are side effects of loop diuretics
hypokalemia, alkalosis, hypocalcemiam hypomagenesemia, hyperuricemia, ototoxicity, sulfonamide HS
35
what are loops worked for
edema, herat failure, HTN, ARF, anion overdosem hypercalcemic states
36
why are loops good for kidney stones
flushing out tubules even though excreting more Ca
37
which loop does not contain sulfa
ethacrynic acid
38
where do thiazides work and effect
DCT inhibit NaCl decrease Na reabsorption enhance reabsorption Ca from volume contraction
39
why are thiazides helpful in kidney stones
increase Ca reabsorption
40
what are thiazides used for
HTN, mild heart failure, nephrolithiasis, nephrogenic DI
41
what are the side effects of thiazides
hypokalemia, alkalosis, hyperCa, hyperuricemia, hyperglycemia, hyperlipidemia, sulfa HS
42
what patient population should you be careful with thiazides
DM and gout
43
How do the aldosterone antagonist diuretics work
block R which usually increases ENaC. therefore decreases expression and dec Na reabsorption, dec K secretion
44
how do the othe rK sparing diuretics work (not aldosterone antagonist)
directly inhibit ENaC
45
What are the side effects of aldosterone R antagonist diuretics
hyperkalmia, acidosis, anti-androgenic effects | gynecomastia in men
46
what are the indications to use aldosterone R block diuretic
hyperaldosteronism adjunct to save K with other diuretics female hirsutism heart failure
47
what are indications to use direct ENaC inhibitors
lithium induced nephrogenic DI (amiloride)
48
which diuretics increase body pH (alkalosis)
loop and thiazide
49
What are the ACEI durgs
-pril captopril enalapril enalaprilat
50
what are the ARB drugs
-sartans losartan valsartan
51
what drugs block renin secretion
clonidine and propanolol by blocking the B1 R on the juxtaglomerular cells
52
what drug is a direct renin inhibitor
aliskiren
53
what is the effect of AngII on pituitary
increase ADH secretion
54
describe physical effects of ANG II on heart
vascular and cardiac hypertrophy remodeling
55
what is the rapid pressor response to ANG II? slow pressor?
rapid is systemic vasoconstriction | slow is the altered renal function (aldosterone and Na reabsorption)
56
What are the effects of ACEI
block conversion ANG I to ANG II | prevent degradation of bradykinin
57
What are ACEI used for
HTN, heart failure, L ventricular dysfunction, prophylaxis of future CV evens like MI, CAD, stroke nephropathy (DM +/-)
58
what are the results of ACE I systemically
lower TPR dec MAP both systolic and diastolic no change SV or CO
59
do ACEI affect baroReceptor
no
60
what are the adsverse effects of ACEI
cough, angioedema (reduced metabolism bradykinin) hyperkalmeia, ARF hypotension teratogenic proteinuria, skin rash, altered sense of taste
61
what are the drug interactions of ACEI
antacids, capsaicin NSAIDs, K+ sparing diuretics, digoxin, lithium, allopurinol
62
Why are ACEI renal protective
vasodilate efferent arterioles more to reduce back pressure on glomerulus
63
why are ACEI used for renal disease until GFR is <5%
because will decrease GFR even more, harmful
64
What are the risk factors for ACEI induced ARF
MAP insufficiency volume depletion renal vascular disease (b/l stenosis) (PAD) vasoconstrictor agents (cyclosporin and NSAIDs)
65
What are the ANG II R and effects
AT1 and AT2 AT1 is GPCR smooth muscle contraction AT2 causes production NO and causes smooth muscle dilation
66
ACEI affect what ANG II R?
AT1 and AT2 because block production ANGII
67
ARBS block what ANG II R?
just AT1 so does not increase NO and bradykinin. only blocks smooth muscle constriction
68
what are ARBs used for
HTN, diabeitc nephropathy, HF , L ventricular dysfunction after AMI, prophylaxis
69
what are adviser effects ARBs
not cough or angioedema | but otherwise same as ACEI
70
What is a big difference of ACEI and ARB
ACEI icnrease bradykinin | ARB no influence on bradykinin
71
How does aliskiren work
inhibits renin so blocks conversion angiotensinogen to ANG I
72
What are the feedback loops from aliskiren
rise in plasma renin levels | ONLY drug that decreases renin activity
73
What are the DHP CCBs
-dipines amlodipine nifedipine
74
what are the non-DHP CCBs
diltiazem | verapamil
75
What are the K channel openers
diazoxide and minoxidil | they hyperpolarize membrane
76
what are the dopamine agonists that vasodilate
fenoldapam
77
what are the NO donors
hydralazine nitroprusside organic nitrats: nitroglycerin and isosorbide dinitrate
78
What channel to CCB work on
L type
79
What is the predominant effect on DHP CCB
arteriolar vasodilation | decrease TPR
80
what is the predominant effect of non-DHP CCB
prominent Cardiac effects | decreased CO
81
which CCB has greatest negative inotropic effect on heart
verpapamil and then diltiazem
82
Which CCB decrease rate of SA node depolarization and slow the AV node conduction
verapamil and diltiazem
83
What is important about pharmkinetics of CCBs
high first pass effect
84
whatare the side effects of CCBs
dizziness, hypotension, HA, flushing, nausea, peripheral edema, coughing, wheezing pulmonary edema
85
what is a specfiic side effect to verapamil
constipation
86
what drugs can you not concurrently use with verapamil or diltiazem
beta blokcers because AV block
87
what patients should not be prescribe the non-DHP CCBs
ventricular dysfunction, SA or AV nodal conduction defects or a systolic pressure less than 90
88
What are the clinical uses of CCBs
HTN, HTN EM, Angina
89
What is the MOA of K channel openers
increased K permeability leading to hyperpolarization of smooth m membrane reduce probability of contraction
90
What are the adsverse effects of minoxidil
HA, sweating, hypertrichosis | reflex tachycardia and ema
91
What must you prescribe with minoxidil to prevent reflex tachycardia and edema
beta blocker and diuretic
92
how does fenoldopam work
dilate afferent renal artery
93
what are the side effects of fenoldopam
tacycardia, HA and flusing
94
when is fenoldapam used
HTN EM and post-operative HTN
95
what are major contraindications for fenoldopam
avoided in patients with glaucoma because increase intraocular P
96
What is the MOA of hydralazine
release NO from endothelium and vasodilate arterioles
97
what are the clinical uses of hydralazine
HTN in pregnancy with methyldopa concurrently heart failure HTN EM
98
what are the adverse effects of hydralazine
fluid and Na retention HA, nausea, anorexia, sweting, flushing, palpitations reflex tachy can provoke angina lupus like syndrome!
99
what is Tx for lupus like syndrome created by hydralazine use
withdrawl of drug
100
What is MOA of nitroglycerin
dilates arterial and venous vessels decrease TPR and venous return decrease pre and afterloads
101
what are the adverse effects of nitroprusside
excessive hypotension, cyanide poisoning
102
what are the adverse effects of nitrates
orothostatic hypotension, syncope, throbbing HA
103
when is nitroprusside used
HTN EM. IV only
104
What are the main nonselective Beta blockers
propanolol timolol, nadolol, carteoolol, penbutolol | pindolol
105
What are the B1 selective beta blockers
atenolol, metoprolol esmolol, bisoprolol, betaxolol | acebutolol, nebivolol
106
what are the alpha and beta blockers
carvedilol, labetalol
107
what are the alpha 1 blockers
prazosin doxasin terazosin
108
what are the a2 agonists (central acing
clonidine, methyldop, guanabenz, guanfacine
109
what to alpha blockers do
block vasoconstriction
110
what is the purpose of B1 selective blockers
cardioselective
111
what is labetalol used for
IV in severe HTN | acceptable option for HTN during pregnancy
112
which non selective beta blockers have vasodilatory effects
carteolol, carvedilol, labetalol
113
which selevtice beta blockers can induce peripheral vasodilation
betaxolol, nebivolol
114
what beta blocker is given IV for pre-operative tachycardia and HTN, HTN EM, arrhythmias
esmolol
115
what are the pharmodynic effects of alpha 1 selective blockers
decrease TPR, decrease venous return, decrease preload does not inc HR or CO does not inc NE release(still have neg feedback from alpha2) relazes smooth muscle in prostate
116
what are the adverse effects of alpha 1 selective blockers
postural hupotension and syncope | usually given at bedtime to minimize hypotension
117
What occurs after injection of clonidine
increase BP via peripheral a2B | decreased BP due to central a2A
118
how does oral clonidine cause decreased BP
decreased CO preload
119
what is the clinical use of clonidine
essential HTN | adjunct for narcotic, alcohol and tobacco withdrawal
120
what are the sideeffets of clonidine
dry mouth, sedation, impotence, depression
121
what occurs if sudden withdrawl of clonidine
HTN crisis
122
what are side effects of methyldopa
sedation, dry mouth, sexual dysfunction, postural hypotension, anemia
123
what are some HTN medications used in pregnancy
methyldopa, beta blockers: labetalol, pindolol, metoprolol CCB: nifedipine, nicardipine
124
What durgs are contraindication in pregnancy
ACEI, ARBs, alkiskren | nitroprusside
125
What drugs are used for HTN EM
vasodilators: Na nitroprusside nitroglycerin, niardipine, celivdipine, fenoldopam, hydralazine, enalaprilat adrenergic antagonists: labetalol, metoprolol, esmolol, phenolamine
126
What drugs are used as initial mono therapy
thiazide ACEI or ARB( always in CKD +/- DM) CCB beta blockers if indicated
127
pregnant patient has liver disease, which medication is contraindicated
methyldopa
128
patient has HTN and BPH, what drug should you give him
alpha blocker
129
patient has HTN and osteoporosis, what drug should you give him
thiazide
130
patient has hyperthyroidism and HTN was drug should you give him
beta blocker
131
What are compelling indications to use beta blocker and non-DHP CCB together
atrial fibrillation or flutter | angina

Year2 Renal (20 decks)

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