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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?

25
Mechanism of which group of meds? ## Footnote **–\*\*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")
26
Mechanism of which group of meds? ## Footnote –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")
27
Mechanism of which group of meds? ## Footnote **–Angiotensin receptor blocker—net result is same as ACE inhibitor**
ARB ("-sartans")
28
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
ACE and ARBs
29
What are 3 side effects of just ACE inhibitors (NOT ARBs)
**1. Dry cough\*** **2. Angioedema\*** 3. Rash (ACEs also cause Hyperkalemia like ARBs)
30
Efficacy/monitoring of which two groups of meds? ## Footnote –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
31
What patient population are ACEI and ARBs **most effective in?\*\***
**\*\*young white patients\*\***
32
What patient population are ACEI and ARBs **_least_ effective in?\*\***
1. blacks 2. older persons 3. predominantly systolic HTN
33
What 6 things are important to monitor in patients taking ACE/ARBs?
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
**\*\*What antihypertensives are the choice in DM?\*\***
ACEI and ARBs
35
What are 5 drug interactions of ACEs and ARBs?
1. Other antihypertensives 2. Potassium supplements 3. Potassium sparing diuretics 4. **NSAIDs** 5. **\*\*\*PDE5—may increase levels of ACEI and ARB**
36
T/F: you are able to take ACE/ARBs in pregnancy?
FASE ## Footnote **\*\*ACE/ARBs are absolutely contraindicated in pregnancy\*\***
37
\*\*What is the **US Boxed warning** for aliskiren (DRI)\*\*
Not to be used in pregnant patients (injury and possible death of developing fetus)
38
What is aliskiren (DRI) a synergist with?
–Synergistic with diuretics, ACEIs ARBs (avoid if CrCl \<60ml/min)
39
What 4 types of patients should ACEI, ARBs and direct rening inhibitors be avoided?
- hyperkalemia - pulmonary (cough) - pregnant - CKD
40
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
41
Review of ANS: What is the PNS receptor and what does it act on? ## Footnote •M1-5 –CNS –Heart--decrease rate –Smooth muscle –Peripheral nerves –Glands
M1-5 * CNS * Heart--decrease rate * Smooth muscle * Peripheral nerves * Glands

Pharm 2 Exam SHEA (15 decks)

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