Hypertension

Question 1

What 2 values are directly proportional to Arterial BP? (And thus most antihypertensive drugs try to lower these)

Answer 1

Cardiac Output & Peripheral Vascular Resistance

Question 2

What 2 control mechanisms of BP are targets of antihypertensive drug therapy?

Answer 2

the Baroreflexes (of sympathetic NS) and the Renin-Aldosterone system

Question 3

In which populations are Thiazide diuretics particularly useful?

Answer 3

elderly and blacks

Question 4

In which population are thiazide diuretics contraindicated in?

Answer 4

Patients with inadequate kidney function, creatine clearance < 50

Question 5

How do thiazide diuretics work?

Answer 5

They increase NA and water excretion –> decrease in blood volume –> decreases CO –> decrease BP

Question 6

True or false, Thiazides can be useful in combination with other antihypertensives?

Answer 6

True. Other agents can cause sodium and water retention which thiazides will counteract. These include ACEs, ARBs, B-blockers, K-sparing

Question 7

What are other side effects of thiazide diuretics?

Answer 7

Hypokalemia, Hypocalcemia, acute gout attacks

Question 8

Which drugs are classified as Thiazide diuretics?

Answer 8

hydrochlorothiazide (HCTZ), chlorothiazide, metolazone

Question 9

Which drug/drug class is most commonly used to treat glaucoma and mountain sickness but also has some mild diuretic effect?

Answer 9

Acetazolamide a carbonic anhydrase inhibitor

Question 10

Where on the nephron do each diuretic class act upon?

Answer 10

Prox tubule –> CA inhibitor (acetazolamide)
Ascending loop –> Loop diurectics
Distal tubule –> thiazides
Collecting tubule –> K-sparing

Question 11

Which drug class is the most efficacious of the diuretics?

Answer 11

Loops, because act at ascending loop. Even in patients with poor renal function

Question 12

What is the most concerning adverse effect of loop diuretics?

Answer 12

ototoxicity, especially when also given with an amino glycoside

Question 13

What are the adverse effects of K-sparing diuretics?

Answer 13

Gastric upset and peptic ulcers, gynecomastia, menstrual irregularity

Question 14

What are severe scenarios in which mannitol is used to maintain urine flow?

Answer 14

increased intracranial pressure, acute renal failure due to shock, drug toxicities, trauma

Question 15

Which drug class do the drugs furosemide and bumetanide belong to?

Answer 15

loop diuretics

Question 16

Mannitol is which type of diuretic?

Answer 16

osmotic

Question 17

Which other drugs are potassium sparing in addition to spironolactone?

Answer 17

triamterene, amiloride hydrochloride

Question 18

What do you monitor with your patients on diuretics?

Answer 18

weight loss and potassium

Question 19

Who are contraindicated to take spironalactone?

Answer 19

Renal dysfunction patients (increased risk of hyperkalemia)