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Pharm 2 Exam SHEA > HTN 4 > Flashcards

HTN 4 Flashcards

1
Q

Which two meds are Aldosterone Antagonists?

A

1. Spironolactone

  1. eplerenone
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2
Q

Mechanism of which group of diuretics?

  • Blocks aldosterone receptor in distal convoluted renal tubule
  • inhibiting sodium and water retention,
  • inhibiting vasoconstriction.
A

Aldosterone Antagonists

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3
Q

Which Aldosterone antagonist?

  • is more specific with little affinity for androgen or progesterone receptors—HTN and HF
A

Eplerenone

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4
Q

What are the 7 side effects of Aldosterone antagonists (Spironolactone, eplerenone)

A
  1. *Hyperkalemia,
  2. *hyponatremia
  3. *Gynecomastia
  4. *Menstrual irregularities
  5. *decreased libido
  6. *impotence (inability to orgasm/achieve erection)
  7. GI disturbances
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5
Q

Efficacy/monitoring of which group of meds:

  1. *Modest diuresis
  2. *Often used in combo with thiazides and loop diuretics which can counteract the K+ loss
  3. *Monitor K+ levels
    • Eplerenone greater risk so avoid in DM with microalbuminuria, CrCl <50ml/min or elevated serum creatinine
A

Aldosterone Antagonists

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6
Q

**When should you adjust dosage of Spironolactone?**

A

**Adjust in renal impairment**

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7
Q

The drug interactions of thiazides and loops are similar to that of which group of diuretics?

A

Aldosterone antagonists

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8
Q

What are aldosterone antagonists used for in pediatrics?

A

**HTN and Diuretic**

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9
Q

Which medication is used in the treatment of female acne and hirsutism?**

A

Aldosterone antagonists

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10
Q

What is the 1 ADE of Amiloride

A

**Hyperkalemia**

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11
Q

Amiloride (a K+ sparing diuretic) is usually used in combination with which group of diuretics?

A

Thiazides (b/c of excessive potassium loss)

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12
Q

Mechanism of which group of meds:

–Blocks the epithelial Na+ channel action proximal to the distal convoluted tubule

  • results in cessation of K+ secretion.
A

Potassium sparing Diuretics (amiloride, triamterene)

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13
Q

What is the side effect of potassium sparing diuretics (amiloride, triamterene)?

A

**Hyperkalemia**

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14
Q

What disease are potassium sparing diuretics (amiloride, triamterene) contraindicated in?

A

renal failure

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15
Q

When should you avoid giving potassium sparing diuretics (amiloride, triamterene)?

A

Avoid in patients also treated w/ ACE-I

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16
Q

Efficacy/monitoring of ________ diuretics

–*Diuretic effect is modest

–*Monitor K+

A

Potassium sparing diuretics (amiloride, triamterene)

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17
Q

When should you avoid giving Triamterene (a K sparing diuretic)

A

**Avoid use in CrCl <10ml/min**

18
Q

When should you adjust the dosage of Amiloride (a K sparing diuretic)?

A

Adjust in renal impairment

19
Q

Potassium sparing diuretics (amiloride, triamterene) decrease the levels/effect of which 2 things?**

A
  1. Cardiac glycoside**
  2. quinidine
20
Q

Which group of diuretics have the following drug interaction:

**Decrease levels/effects of diuretic

  • NSAIDS**
A

Potassium sparing Diuretics (amiloride, triamterene)

21
Q

**Rarely is ______ prescribed without HCTZ**

A

**triamterene**

(a potassium sparing diuretic)

22
Q

Which group of diuretics has the most amount of NaCl in the urine

A

Loop Diuretics

23
Q

Which of the diuretics has a low amount of K in the urine?

A

K sparing diuretics

24
Q

What is the common ending of all ACE-Inhibitors?

A

-opril

25
Q

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**

A

ACE inhibitors (“-prils”)

26
Q

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

A

ACE-I (“-prils”)

27
Q

Mechanism of which group of meds?

–Angiotensin receptor blocker—net result is same as ACE inhibitor

A

ARB (“-sartans”)

28
Q

The following are adverse effects of which 2 groups of meds?

  1. Hypotension in patients w/ bilateral renal artery
  2. Modest increase in Sr Cr ~35% or absolute increase of less than 1mg/dL do not warrant changes-vasoconstriction of efferent arterioles
  3. **Hyperkalemia**
  4. HA, dizziness, fatigue, nausea, taste disturbances,
  5. <1%–Neutropenia and agranulocytosis, proteinuria, glomerulonephritis and acute kidney failure
A

ACE and ARBs

29
Q

What are 3 side effects of just ACE inhibitors (NOT ARBs)

A

1. Dry cough*

2. Angioedema*

  1. Rash

(ACEs also cause Hyperkalemia like ARBs)

30
Q

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

A

ACEI and ARB

31
Q

What patient population are ACEI and ARBs most effective in?**

A

**young white patients**

32
Q

What patient population are ACEI and ARBs least effective in?**

A
  1. blacks
  2. older persons
  3. predominantly systolic HTN
33
Q

What 6 things are important to monitor in patients taking ACE/ARBs?

A
  1. BUN
  2. **serum creatinine
  3. renal function
  4. WBC
  5. **K+
  6. CBC with diff in collagen vascular disease and/or renal impairment
34
Q

**What antihypertensives are the choice in DM?**

A

ACEI and ARBs

35
Q

What are 5 drug interactions of ACEs and ARBs?

A
  1. Other antihypertensives
  2. Potassium supplements
  3. Potassium sparing diuretics
  4. NSAIDs
  5. ***PDE5—may increase levels of ACEI and ARB
36
Q

T/F: you are able to take ACE/ARBs in pregnancy?

A

FASE

**ACE/ARBs are absolutely contraindicated in pregnancy**

37
Q

**What is the US Boxed warning for aliskiren (DRI)**

A

Not to be used in pregnant patients (injury and possible death of developing fetus)

38
Q

What is aliskiren (DRI) a synergist with?

A

–Synergistic with diuretics, ACEIs ARBs (avoid if CrCl <60ml/min)

39
Q

What 4 types of patients should ACEI, ARBs and direct rening inhibitors be avoided?

A
  • hyperkalemia
  • pulmonary (cough)
  • pregnant
  • CKD
40
Q

Review of ANS: What are the 4 SNS receptors and what do they do?

A
  • 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
41
Q

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

A

M1-5

  • CNS
  • Heart–decrease rate
  • Smooth muscle
  • Peripheral nerves
  • Glands

Pharm 2 Exam SHEA (15 decks)

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