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Pharm 2 Exam SHEA > HTN 2 > Flashcards

HTN 2 Flashcards

1
Q

What is typically first line management of HTN?

A
  1. Weight loss
  2. Healthy diet (DASH diet)
  3. Reduced intake of dietary sodium
  4. Enhanced intake of dietary potassium
  5. Physical activity
  6. Moderation in alcohol intake
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2
Q

What are the 6 different antihypertensive groups?

A
  1. RAAS
    • ACE
    • ARB
  2. Sympathetic Antagonists/Agonists
    • Beta Blockers
    • Alpha 1 Blockers
    • Central alpha agonists (Alpha 2 Agonists)
  3. Calcium Channel Blockers
  4. Diuretics (thiazide)
  5. Aldosterone antagonists
  6. Direct vasodilators
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3
Q

What do agents that block production or action of angiotensin do?

A

Reduce peripheral vascular resistance and (potentially) blood volume

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4
Q

What do sympatholytic (sympathoplegic) agents do?

A

Lower BP by reducing PVR by inhibiting cardiac function

increasing venous pooling in capacitance vessels.

  • The latter two effects reduce cardiac output
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5
Q

What do calcium channel blockers do?

A

Inhibits calcium influx leading to coronary and peripheral vasodilation

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6
Q

What do diuretics do in regards to lowering blood pressure?

A

Lower blood pressure by depleting the body of sodium and reducing blood volume and perhaps by other mechanisms.

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7
Q

What do aldosterone antagonists do?

A

Inhibits aldosterone resulting in inhibition of sodium and water retention and inhibiting vasoconstriction

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8
Q

What do Direct vasodilators do?

A

Reduce pressure by relaxing vascular smooth muscle thus dilating resistance vessels and increasing capacitance to varying degrees

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9
Q

Oral antihypertensives–> What are the primary agents?

A
  1. Thiazides (Chlorthalidone, Hydrocholorthiazide, Indapamide, Metolazone)
  2. ACE inhibitors (Benazepril, Captopril, etc)
  3. ARBS (Azilsartan, Candesartan, Eprosartan, Irbesartan, Losartan)
  4. CCB- Dihydropyridines (Amlodipine, Felodipine, Isradipine, Nicardipine, Nifedipine, etc)
  5. CCB- nondihydropyridines (Diltiazem, Verapamil)
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10
Q

The following are oral antihypertensive drugs that are _____Agents (primary or secondary?)

  1. Diuretics- Loop (Bumetanide, Furosemide, Torsemide)
  2. Diuretics- Potassium sparing (Amiloride, Triamterone)
  3. Diuretics- Aldosterone antagonists (Eplerenone, Spironolactone)
  4. Beta Blockers- Cardioselective (Atenolol, Betaxolol, Bisoprolol, Metoprolol,etc)–> POST-MI

5. Beta blockers- Cardioselective and vasodilatory (Nebivolol)

  1. Beta blockers- noncardioselective (Nadolol, Propanolol)
  2. Beta Blockers- Intrinsic Sympathomimetic activity (Acebutolol, Penbutolol, Pindolol)
  3. Combined alpha and beta Beta blockers
  4. DRI
  5. Alpha Blockers
  6. Central alpha agonists
  7. Direct vasodilators (Hydralizine, Minoxidil)
A

Secondary

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11
Q

Overview of the site of action of diuretics

A
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12
Q

RAAS sites of action of antihypertensive drugs

***Make sure to know this!***

A
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13
Q

Which part of the nephron is:

  1. the major site for sodium chloride and sodium bicarbonate reabsorption
  2. Responsible for 60–70% of the total reabsorption of sodium.
A

Proximal Convoluted Tubule (PCT)

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14
Q

•Conversion of bicarbonate to carbon dioxide via _______permits rapid reabsorption of the carbon dioxide in the PCT of the nephron

A

Carbonic acid

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15
Q
  • What is a carbonic anhydrase inhibitor?
  • What are 2 clinical appications?
A
  • Acetazolamide
  • Glaucoma
  • Mountain sickness
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16
Q

The following describes the pharmacokinetics of which inhibitor?

Oral, parenteral

Diuresis is self-limiting

Effects in glaucoma and mountain sickness persist

A

Carbonic anhydrase inhibitors (Acetazolamide)

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17
Q

ADEs of what?

  1. Metabolic acidosis
  2. Sedation
  3. Paresthesias
  4. Hyperammonemia in cirrhosis
A

Carbonic anhydrase inhibitors (Acetazolamide)

18
Q

What are 3 loop diuretics

A
  1. Bumetanide
  2. Furosemide
  3. Torsemide
19
Q

What are the 4 Thiazide diuretics?

A
  1. Chlorthalidone,
  2. Hydrochlorothiazide (HCTZ)
  3. Indapamide
  4. Metolazone
20
Q

What are 3 Potassium sparing diuretics?

A
  1. Amiloride w/wo HCTZ
  2. Triamterene
  3. Triamterene/HCTZ
21
Q

What are the 2 Aldosterone Antagonists (also potassium sparing)

A
  1. Spironolactone w/wo HCTZ
  2. Eplerenone
22
Q

The following is the overall mechanism of which meds?

–Blocks the reabsorption of sodium and chloride

–Water follows due to the osmotic pressure w/in the nephron

–Diuresis results in decreased plasma and stroke volume

-Site of action varies along the nephron

A

Diuretics

23
Q

The following is describing which part of the nephron?

  • Segment pumps sodium, potassium, and chloride out of the lumen into the interstitium
  • major site of calcium and magnesium reabsorption
  • Reabsorption of 20–30% of the sodium filtered at the glomerulus
A

Thick Ascenting Limb of the Loop of Henle (TAL)

24
Q

Reabsorption of sodium, potassium, and chloride are all accomplished by a Na+/K+/2Cl− carrier (NKCC2) in which part of the nephron?

What type of medications target this?

A

Thick Ascending Limb of the Loop of Henle

Target of loop diuretics

25
Q

The following in the mechanism of which group of medications?

  1. Blocks the Na+ K+ Cl- symporter (NKCC2) at the thick ascending Loop of Henle
  2. More potent diuresis, a smaller decrease in PVR and less vasodilation (HCTZ more effective in lowering BP)
A

Loop Diuretics (Furosemide, bumetanide, torsemide)

26
Q

The following describes the efficacy of what group of meds?

–**Diuresis exceeds BP lowering

–Useful when GFR <30ml/min or serum creatinine of 2.5-3.0

–**Preferred in heart failure or severe edema

–**Less likely to cause hyperglycemia, hyperlipidemia

A

Loop Diuretics (furosemide, bumetanide, torsemide)

27
Q

The following are drug interactions (similar to HCTZ) of which group of meds?

–May increase level/effect of cardiac glycosides-digoxin and certain antiarrhythmics

–Increases levels of Lithium

–NSAIDS may decrease efficacy

A

Loop Diuretics (furosemide, bumetanide, torsemide

28
Q

What are ADH Agonists

A

Desmopressin

Vasopressin

29
Q

Mechanism of which meds?

Agonists at V1 and V2 ADH receptors, activate insertion of aquaporin water channels in collecting tubule, reduce water excretion

A

ADH Agonists (Desmopressin, vasopressin)

30
Q

What are ADH and Desmopressin useful in tx?

A

Pituitary Diabetes insipidus

no value in the nephrogenic form of diabetes insipidus

  • Salt restriction, water restriction, thiazides, and loop diuretics may be used
  • These therapies reduce blood volume, which is a very strong stimulus to proximal tubular reabsorption
  • Proximal tubule partially substitutes for the deficient concentrating function of the collecting tubule in nephrogenic diabetes insipidus
31
Q

What is the P-kinetics of ADH agonists

A

SQ nasal

32
Q

What are the 2 ADEs of ADH agonists?

A

Hyponatremia

HTN

33
Q

ADH and desmopressin ______urine volume and _____ its concentration

A

Reduce, increase

34
Q

How can SIADH be treated?

A
  • Certain tumors produce peptides (eg, small cell carcinoma of the lung) which can cause significant water retention and dangerous hyponatremia
  • This syndrome of inappropriate ADH secretion (SIADH) can be treated with demeclocycline and conivaptan (ADH antagonists)-
  • also can use lithium but more toxic
35
Q

_______ and _____inhibit the action of ADH at some point distal to the generation of cAMP and presumably interfere with the insertion of water channels into the membrane.

A

Demeclocycline and Lithium

  • Demeclocycline was previously used for this purpose.
  • Lithium also has ADH-antagonist effects but is never used for this purpose.
36
Q

•What 2 meds are ADH antagonists.

A

Conivaptan and tolvaptan

37
Q

Mechanism for what meds?

Antagonist at V1a, V2 receptors

which one is more selective for V2 receptors?

A

ADH antagonists (conivaptan, tolvaptan)

Tolvaptan is like conivaptan but more selective for V2 receptors

38
Q

Toxicity of agonists and antagonists:

•In the presence of ______or _______, a large water load may cause dangerous hyponatremia. Large doses of either peptide may cause hypertension in some persons

A

ADH or desmopressin

39
Q

Toxicity of agonists and antagonists

•_____ and _______ may cause demyelination with serious neurologic consequences if hyponatremia is corrected too rapidly

A

Conivaptan and tolvaptan

40
Q

________may cause infusion site reactions

A

Conivaptan

41
Q

•In children younger than 8 years,___________ causes bone and teeth abnormalities

A

Demeclocycline (like other tetracyclines)

42
Q

_______ causes nephrogenic diabetes insipidus as a toxic effect; because of its other toxicities, the drug is never used to treat SIADH

A

Lithium

Pharm 2 Exam SHEA (15 decks)

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