HTN 4 Flashcards
Which two meds are Aldosterone Antagonists?
1. Spironolactone
- eplerenone
Mechanism of which group of diuretics?
–Blocks aldosterone receptor in distal convoluted renal tubule inhibiting sodium and water retention, and inhibiting vasoconstriction.
Aldosterone Antagonists
Which Aldosterone antagonist is more specific with little affinity for androgen or progesterone receptors—HTN and HF
Eplerenone
What are the 7 side effects of Aldosterone antagonists (Spironolactone, eplerenone)
- *Hyperkalemia,
- *hyponatremia
- *Gynecomastia
- *Menstrual irregularities
- *decreased libido
- *impotence
- GI disturbances
Efficacy/monitoring of which group of meds:
- *Modest diuresis
- *Often used in combo with thiazides and loop diuretics which can counteract the K+ loss
-
*Monitor K+ levels
- Eplerenone greater risk so avoid in DM with microalbuminuria, CrCl <50ml/min or elevated serum creatinine
Aldosterone Antagonists
**When should you adjust dosage of Spironolactone?**
**Adjust in renal impairment**
The drug interactions of thiazides and loops are similar to that of which group of diuretics?
Aldosterone antagonists
What are aldosterone antagonists used for in pediatrics?
**HTN and Diuretic**
Which medication is used in the treatment of female acne and hirsutism?**
Aldosterone antagonists
What is the 1 ADE of Amiloride
**Hyperkalemia**
Amiloride (a K+ sparing diuretic) is usually used in combination with which group of diuretics?
Thiazides (b/c of excessive potassium loss)
Mechanism of which group of meds:
–Blocks the epithelial Na+ channel action proximal to the distal convoluted tubule
- results in cessation of K+ secretion.
Potassium sparing Diuretics (amiloride, triamterene)
What is the side effect of potassium sparing diuretics (amiloride, triamterene)?
**Hyperkalemia**
What disease are potassium sparing diuretics (amiloride, triamterene) contraindicated in?
renal failure
When should you avoid giving potassium sparing diuretics (amiloride, triamterene)?
Avoid in patients also treated w/ ACE-I
Efficacy/monitoring of ________ diuretics
–*Diuretic effect is modest
–*Monitor K+
Potassium sparing diuretics (amiloride, triamterene)
When should you avoid giving Triamterene (a K sparing diuretic)
**Avoid use in CrCl <10ml/min**
When should you adjust the dosage of Amiloride (a K sparing diuretic)?
Adjust in renal impairment
Potassium sparing diuretics (amiloride, triamterene) decrease the levels/effect of which 2 things?**
- Cardiac glycoside**
- quinidine
Which group of diuretics have the following drug interaction:
**Decrease levels/effects of diuretic
- NSAIDS**
Potassium sparing Diuretics (amiloride, triamterene)
**Rarely is ______ prescribed without HCTZ**
**triamterene**
(a potassium sparing diuretic)
Which group of diuretics has the most amount of NaCl in the urine
Loop Diuretics
Which of the diuretics has a low amount of K in the urine?
K sparing diuretics
What is the common ending of all ACE-Inhibitors?
-opril
Mechanism of which group of meds?
–**Action reduces angiotensin II mediated vasoconstriction and aldosterone secretion**
–Bradykinin accumulation—additive vasodilation by releasing nitric oxide
–**Reduces direct stimulation by angiotensin II on myocardial cells to help prevent or regress LVH**
ACE inhibitors (“-prils”)
Mechanism of which group of meds?
–Directly inhibit angiotensin-converting enzyme and block the conversion of angiotensin I to angiotensin II
–Stimulate synthesis of vasodilating prostaglandins
–Sometimes reduces SNS activity
*these were not bolded on the slide
ACE-I (“-prils”)
Mechanism of which group of meds?
–Angiotensin receptor blocker—net result is same as ACE inhibitor
ARB (“-sartans”)
The following are adverse effects of which 2 groups of meds?
- Hypotension in patients w/ bilateral renal artery
- Modest increase in Sr Cr ~35% or absolute increase of less than 1mg/dL do not warrant changes-vasoconstriction of efferent arterioles
- **Hyperkalemia**
- HA, dizziness, fatigue, nausea, taste disturbances,
- <1%–Neutropenia and agranulocytosis, proteinuria, glomerulonephritis and acute kidney failure
ACE and ARBs
What are 3 side effects of just ACE inhibitors (NOT ARBs)
1. Dry cough*
2. Angioedema*
- Rash
(ACEs also cause Hyperkalemia like ARBs)
Efficacy/monitoring of which two groups of meds?
–Single therapy can control about 40-50% of patients, combo with diuretic or CCB is potent
-**Choice in DM-delay progression of kidney disease, adjunct in CHF-afterload reduction, LV dysfunction after MI
ACEI and ARB
What patient population are ACEI and ARBs most effective in?**
**young white patients**
What patient population are ACEI and ARBs least effective in?**
- blacks
- older persons
- predominantly systolic HTN
What 6 things are important to monitor in patients taking ACE/ARBs?
- BUN
- **serum creatinine
- renal function
- WBC
- **K+
- CBC with diff in collagen vascular disease and/or renal impairment
**What antihypertensives are the choice in DM?**
ACEI and ARBs
What are 5 drug interactions of ACEs and ARBs?
- Other antihypertensives
- Potassium supplements
- Potassium sparing diuretics
- NSAIDs
- ***PDE5—may increase levels of ACEI and ARB
T/F: you are able to take ACE/ARBs in pregnancy?
FASE
**ACE/ARBs are absolutely contraindicated in pregnancy**
**What is the US Boxed warning for aliskiren (DRI)**
Not to be used in pregnant patients (injury and possible death of developing fetus)
What is aliskiren (DRI) a synergist with?
–Synergistic with diuretics, ACEIs ARBs (avoid if CrCl <60ml/min)
What 4 types of patients should ACEI, ARBs and direct rening inhibitors be avoided?
- hyperkalemia
- pulmonary (cough)
- pregnant
- CKD
Review of ANS: What are the 4 SNS receptors and what do they do?
- α1 vasoconstriction of arterioles and venules
- α2 regulation of α1
- β1 increase HR, contractility and renin release (heart and kidney)
- β2 vasodilation of arterioles and venules; bronchodilation and vasodilation (lung, liver, pancreas, and arteriolar smooth muscle), gluconeogenesis
Review of ANS: What is the PNS receptor and what does it act on?
•M1-5
–CNS
–Heart–decrease rate
–Smooth muscle
–Peripheral nerves
–Glands
M1-5
- CNS
- Heart–decrease rate
- Smooth muscle
- Peripheral nerves
- Glands
