Hypertension

Question 1

Diagnosis of hypertension

Answer 1

1. Two or more measurements of blood pressure with diastolic pressure > 90 mmHg
2. Systolic pressure > 140 mmHg
3. Pulse pressure >65 mmHg
4. > 50 yo, SBP >140 mmHg

Question 2

Essential or primary hypertension

Answer 2

85-90% of cases, no identifiable cause, increased peripheral vascular resistance; normal cardiac output

Question 3

Blood pressure =

Answer 3

CO X PVR

Question 4

Diuresis

Answer 4

increase in urine volume

Question 5

Natriuresis

Answer 5

increase in renal sodium excretion

Question 6

why do many diuretics cause K+ loss (hypokalemia)?

Answer 6

sodium reabsorption triggers K+ secretion into the urine

Question 7

Diuretics that act in the proximal tubule

Answer 7

carbonic anhydrase inhibitors

Question 8

why are carbonic anhydrase inhibitors not very efficacious?

Answer 8

they work so early on in the nephron (not a mainstay treatment for hypertension)

Question 9

Effects of long-term administration of diuretics on total peripheral resistance

Answer 9

decreased

Question 10

Effects of long-term administration of diuretics on plasma volume

Answer 10

decreased or unchanged

Question 11

Effects of long-term administration of diuretics on plasma renin activity

Answer 11

increased (works against you)

Question 12

Diuretics that act in the loop of henle

Answer 12

loop diuretics

Question 13

Name some loop diuretics

Answer 13

furosemide
bumetanide
ethacrynic acid

Question 14

What do loop diuretics inhibit

Answer 14

inhibits the Na+/K+/2Cl- cotransporter in the thick ascending limb

Question 15

Clinical uses of loop diuretics in cardiovascular disease

Answer 15

edematous conditions

acute pulmonary edema

Question 16

Toxicities of loop diuretics

Answer 16

dehydration, hypokalemic metabolic alkalosis, ototoxicity, hyperuricemia, hypomagnesemia

Question 17

More effective antihypertensive than loop diuretics in patients with normal renal function

Answer 17

thiazides

Question 18

Diuretics that act in the distal convoluted tubule

Answer 18

thiazides

Question 19

Name some thiazide diuretics

Answer 19

chlorthiazide, hydrochlorothiazide, trichlormethiazide, methyclothiazide, polythiazide, cyclothiazide

Question 20

Name some thiazide-like diuretics

Answer 20

chlorthalidone, indapamide, metolazone

Question 21

What is the difference between thiazide and thiazide-like diuretics

Answer 21

they are structurally unique but target the same Na+/Cl- transporter

Question 22

Thiazides enhance the reabsorption of what

Answer 22

enhance Ca2+ reabsorption in the kidney

Question 23

What do thiazides inhibit

Answer 23

inhibit NaCl reabsorption in the distal convoluted tubule

Question 24

What might thiazides open that leads to vasodilation

Answer 24

may open Ca2+ -activated K+ channels leading to vasodilation

Question 25

Clinical uses of thiazide diuretics in cardiovascular disease

Answer 25

hypertension, CHF

Question 26

Thiazide diuretic toxicity

Answer 26

hypokalemia, hypokalemic metabolic alkalosis, hyperuricemia, hypercalcemia, impaired carbohydrate tolerance, hyperlipidemia, hyponatremia, erectile dysfunction

Question 27

Contraindications for thiazide diuretics

Answer 27

sulfa allergies

Question 28

Diuretics that act in the collecting tubule

Answer 28

K+-sparing diuretics

aldosterone antagonists

Question 29

What kind of diuretics are Amiloride and Triamterene?

Answer 29

K+-sparing diuretics

Question 30

What does Amiloride inhibit

Answer 30

inhibits the Na+ channels in the apical membrane of the collecting tubule, reduced Na+ entry into these cells also reduces K+ excretion (K+ sparing)

Question 31

Clinical uses of Amiloride

Answer 31

adjunctive treatment with thiazide or loop diuretic in CHF or hypertension, some efficacy in reducing BP

Question 32

Amiloride toxicities

Answer 32

hyperkalemia, hyperchloremic metabolic acidosis

Question 33

Contraindications for Amiloride

Answer 33

K+ supplements

ACE inhibitors

Question 34

Actions of Triamterene

Answer 34

inhibits the Na+ channels in the apical membrane of the collecting tubule, reduced Na+ entry into these cells also reduces K+ excretion (K+ sparing)

Question 35

Clinical uses of Triamterene

Answer 35

edema associated with CHF, hepatic cirrhosis, nephrotic syndrome, or hyperaldosteronism (no efficacy in lowering BP alone)

Question 36

Triamterene toxicities

Answer 36

hyperkalemia, hyperchloremic metabolic acidosis

Question 37

Triamterene contraindications

Answer 37

kidney stones, K+ supplements, ACE inhibitors

Question 38

Spironlactone (Aldactone) actions

Answer 38

block actions of aldosterone, inhibition of 5alpha-reductase

Question 39

Clinical uses of spironlactone in cardiovascular disease

Answer 39

hypertension or CHF with other diuretics

Question 40

Spironlactone toxicities

Answer 40

hyperkalemia, hyperchloremic metabolic acidosis, gynecomastia, impotence, benign prostatic hyperplasia

Question 41

Spironlactone contraindications

Answer 41

K+ supplements, ACE inhibitors, chronic renal insufficiency

Question 42

Eplerenone (Inspra) actions

Answer 42

selective antagonism of mineralocorticoid receptor in kidney, heart, blood vessels, and brain

Question 43

Clinical uses of eplerenone

Answer 43

hypertension, alone or in combination (full therapeutic effect should be observed within 4 weeks)

Question 44

Toxicities and adverse reactions of Eplerenone

Answer 44

hyperkalemia, hypertriglyceridemia

Question 45

Eplerenone contraindications

Answer 45

K+ supplements, K+-sparing diuretics, ACE inhibitors, chronic renal insufficiency, diabetes associated with microalbuminuria, CYP450 3A4 inhibitors (ketoconazole)