HTN2

Question 1

what are the 4 main physiological categories of drugs that regulate BP

Answer 1

1. diuretics
2. RAA agents
3. sympathoplegic agents
4. vasodilators

Question 2

what are the 4 classes of diuretics

Answer 2

1. thiazides
2. loop diuretics
3. K-Sparing
4. Aldosterone Agonists

Question 3

the first 6-8 weeks of thiazide tx what happens to CO and TVR

Answer 3

1. decrease in CO

2. initial increase in SVR

Question 4

when are aldosterone agonists used for HTN

Answer 4

for pt’s with heart failure or post MI

Question 5

What pt’s do not have much of a response to thiazides for HTN

Answer 5

CrCl< 30 ml/min

Question 6

what diuretic shows a response that increases with an increase in dosing?

Answer 6

loop diuretics

Question 7

what type of patients is HTN tx with loop diuretics appropriate for

Answer 7

pt’s with heart failure and cirrhosis (sodium retention)

Question 8

when are K sparing diuretics used for HTN

Answer 8

to avoid K depletion and

in combo to enhance natriuretic effect

Question 9

what are 3 classes of drugs that treat RAA system for HTN

Answer 9

1. direct renin inhibitors
2. ACE inhibitors
3. ARB’s

Question 10

True/ False:

angiotensinogen is produced continously by the liver

Answer 10

True

Question 11

True/ False:

Renin is continuously released by the kidneys

Answer 11

false

release in response to stress (diet, emtion, or physiologic)

Question 12

what is formed by renin reacting with angiotensinogen

Answer 12

angiotensin I

Question 13

what are the 3 pathways of renin release?

Answer 13

macula densa pathway
intrarenal baroreceptor pathway
beta-adrenergic receptor pathway

Question 14

where is renin stored

Answer 14

juxtaglomerular cells in kidney

Question 15

what is the macula densa

Answer 15

cell that signals for renin release if Na levels are low

Question 16

what activates renin release with a decrease in renal blood flow

Answer 16

intrarenal baroreceptors

Question 17

ACE has what effect on what other substance other than Angio I?

Answer 17

breaks down bradykinin (a vasodilator)

Question 18

angiotensin II has what 3 major effects?

Answer 18

1. rapid pressor effect
2. slow pressor response
3. vascualr and cardiac hypertrophy

Question 19

what is the MOA of angio II’s rapid pressor response

Answer 19

direct vasoconstriction and increased NE release leads to altered peripheral resistance

Question 20

what is the MOA of angio II’s slow pressor response

Answer 20

1. increases sodium reabsorption in proximal tubule
2. increases aldosterone release from adrenal cortex
3. direct alteration of hemodynamics (renal vasoconstriction)

Question 21

what is the MOA of angio II’s vascular and cardiac hypertophy and remodeling effect

Answer 21

1. encreased expression of proto-oncogenes and growth factors
2. increases afterload and vascular wall tension

Question 22

what bioreaction is stopped by direct renin inhibitors

Answer 22

angiotensinegin to angio I

Question 23

what type of bioavailability does aliskiren have

Answer 23

very low bioavailability (2.5-3%)

Question 24

what type of affinity does aliskiren have for renin?

Answer 24

very high affinity

Question 25

what greatly decreases aliskiren absorption

Answer 25

high fat meals

Question 26

what is dosing form and interval of aliskiren

Answer 26

PO once daily (usually adjunct)

Question 27

what are the adverse effects of aliskiren

Answer 27

(similar to ACEI's)
GI upset 
hyperkalemia
angioedema
dry cough (less than ACEI's)

Question 28

what is the contraindication for aliskiren

Answer 28

pregnancy