Hypertension Drugs

Question 1

what do loop diuretics act on?

Answer 1

the sodium reabsorbing protein in the loop of henle

Question 2

by not absorbing Na what do we inherently block reabsoroption of?

Answer 2

Water

Question 3

name the loop diuretic

Answer 3

furosemide

Question 4

what is the adverse effect of loop diuretics?

Answer 4

alkalosis…high serum pH

Question 5

3 things affecting the BP

Answer 5

cardiac output
vasculature resistance
blood volume

Question 6

what is the mechanism of thiazide diuretics?

Answer 6

block the sodium and chloride symporter in the distal convuluted tubule…so less Na and less H2O

Question 7

adverse effects of thaizide diuretics?

Answer 7

alkalosis and hypokalemia

Question 8

name the two thiazide diuretics

Answer 8

hydrochlorothiazide

chlortalidone

Question 9

mechanism of K+ sparing diuretics

Answer 9

inhibit the ENaC or epithelial sodium channel in the collecting duct

or it blocks the effects of aldosterone on the collecting duct

Question 10

what is the ENaC diuretic?

Answer 10

traimterene

Question 11

what are the two aldosterone inhibiting diuretics?

Answer 11

spironolactone and eplerenone

Question 12

spironolactone toxicity

Answer 12

gynecomastia

Question 13

explain how loop and thiazide diuretics cause hypokalemia

Answer 13

leads to increased sodium downstream and in collecting duct there is a Na and K antiporter so you get more Na flowing into blood since high conc down stream and more K leaving blood into the collecting duct

Question 14

what is the mechanism of hydralizine?

Answer 14

somehow increases concentration of cyclic GMP which leads to vasodilation through NO pathway

Question 15

what is the mechanism of diazoxide?

Answer 15

makes K+ channels stay open longer causing hyperpolarization and not letting contraction of SMC to occur

Question 16

what is the mechanism of calcium channel blockers (hydropyridines/non)

Answer 16

block calcium channels and lower smooth muscle contraction strength

Question 17

name the two hydropyridines

Answer 17

amlodipine
nifedipine
nimodipine

Question 18

name the two non hydropyridines

Answer 18

verapimil

diltiazem

Question 19

toxicity of calcium channel blockers

Answer 19

gingival enlargement…big gums

Question 20

of the calcium channel blockers, which do you give during pregnancy?

Answer 20

nifedipine

Question 21

name the two ACE inhibitors

Answer 21

captopril

lisinopril

Question 22

name the two ARB inhibitors

Answer 22

Losartan

Valsartan

Question 23

what is the mechanism of ARB drugs

Answer 23

they block the angiotensis receptors where it would lead to alodsterone and vasoconstriction

Question 24

name the three toxicities of ARB and ACE inhibitors

Answer 24

dry cough
angioedema
hyperkalemia

Question 25

how do ACE inhibs lead to angioedema

Answer 25

by blocking the ACE, the secondary role of ACE to breakdown bradykinin does not occur so you get leaky capillaries that cause angioedema

Question 26

should ACE inhibitors be given during pregnancy?

Answer 26

eh...its debatable

Question 27

how does clonidine affect blood pressure?

Answer 27

it is an A2 agonist that actually decreases the sympathetic effects..

Question 28

what do beta antagonist disrupt?

Answer 28

blood sugar...so be careful giving to diabetics

Question 29

how do beta antagonists affect folks with asthma? why is this problem moot now?

Answer 29

beta blockers block B2 in the lungs and lead to vasoconstriction...can worsen asthma most beta blockers are specific to B1 and the heart now

Question 30

3 types of sympathetic drugs to give for HBP

Answer 30

beta blockers- metoprolol atenolol esmolol a1 antagonist- prazosin a2 agonist-clonidine

Question 31

of the sympathetic drugs for hypertension, which are riskiest with pregnancy?

Answer 31

beta blockers

Question 32

what group has highest risk of angioedema with ACE and ARB?

Answer 32

african americans have three times the risk...so not a first line drug

Question 33

what is the threshold of BP for initiating treatment?

Answer 33

140/90

Question 34

in what circumstances does the threshold for BP treatment change and what does the threshold move to?

Answer 34

if patient has CVD, CKD, diabetes, or high risk of CVD | 130/80

Question 35

what is most dominating risk factor is developing ASCVD?

Answer 35

AGE

Question 36

if patient has BP of 135/85 and has greater then 10% chance of having ASCVD in next ten years...do we treat HBP?

Answer 36

Yes

Question 37

name the four preferred first line HBP medication classes

Answer 37

thiazide diuretics ACE inhibitors ARBs calcium antagonists it is common to combine any of these to dual treat...except ACE and ARB since they sorta do same thing