HTN Pharm

Question 1

Types of primary HTN

Answer 1

• Low renin
• Normal renin
• High renin

Question 2

Primary oral antihypertensive agents (5)

Answer 2

• Thiazide diuretics
• ACEi
• ARB
• CCB (dihydropyridine)
• CCB (non-dihydropyradine)

Question 3

Thiazide diuretic (hydrochlorothiazide) MOA

Answer 3

Blocks luminal Na/Cl reabsorbtion channels in DCT

*Na preferentially reabsorbed in CT (via Na/H anti), K then secreted

• Decreased serum Na, K, Cl, Mg
• increased serum Ca, sugar, uric acid

Question 4

Loop diuretic (furosemide) MOA

Answer 4

Blocks luminal Na/K/2Cl reabsorption channels in TAL

• Decreased serum Na, K, Cl, Mg, Ca
• Increased serum sugar and uric acid

Question 5

Which diuretic classes cause a hypochloremic metabolic alkalosis?

Answer 5

Loop and thiazide diuretics

*increased amounts of Na reaching the CD will cause Na to be preferentially reabsorbed in exchange for the release of K and H, leading to alkalosis

Question 6

Which K-sparing diuretics act by blocking ENaC channels in the CD? (2)

Answer 6

Amiloride, Triamterene

*blocks Na reabsorption thru ENaC, therefore no gradient for K to be secreted through ROMK channels

Question 7

Which K-sparing diuretics act by competitively antagonizing aldosterone receptors on CD tubular cells?

Answer 7

Spironolactone, Eplerenone

*blockage of aldosterone receptor prevents ENaC channels from being added to principle cell luminal membrane

Question 8

Which diuretics can be utilized in patients with low GFR?

Answer 8

Loop diuretics:

• Furosemide
• Torsemide
• Bumetanide
• Ethacrynic acid

Question 9

Which drug class preserves kidney function in hyperfiltering diabetics by decreasing GFR (preventing constriction of efferent arteriole)?

Answer 9

ACEi and ARB

• Angiotensin II maintains tone of efferent arteriole, blocking it takes stress off the kidneys by decreasing GFR
• Leads to rise in serum creatinine

Question 10

What happens if an a2 agonist (clonidine) or a B-blocker is stopped abruptly?

Answer 10

Rebound hypertension and possible death due to excessive sympathetic tone

Question 11

What drug can be used for hypertensive emergency in pregnancy?

Answer 11

Hydralazine

*arteriolar vasodilation via unknown MOA

Question 12

Effect of nitroprusside

Answer 12

peripheral arteriolar and venous vasodilation

Question 13

Treatment of choice for HTN in patient with stable ischemic heart disease

Answer 13

B-blockers, ACEi, ARB

if goal not met add CCB or thiazide diuretic

Question 14

Treatment of choice for HTN in patient with chronic kidney disease

Answer 14

ACEi, ARB if intolerant

Question 15

Pharmacological management of pt with aortic dissection

Answer 15

Esmolol or Labetalol (control HR and SBP)

• alternatively may use verapamil or diltiazem
• if SBP remains high can give nitroprusside