Hypertension Drugs (Exam 1)

Question 1

Summarize Antihypertensive Drug Mechanisms

Answer 1

Question 2

Summarize Antihypertensive Drug Mechanisms (Part 2)

Answer 2

Question 3

Which of the following would put the person at the highest risk for hypokalemia? Also identify the classification of each hypertensive agent.

a) hydrochlorothiazide
b) furosemide
c) triamterene
d) bumetanide

Answer 3

a) Thiazide diuretic
b) Loop diuretic
c) Potassium sparing drug
d) Loop diuretic

Answer is a) hydrochlorothiazide

Question 4

Is hypertension symptomatic?

Answer 4

Usually no but if it is, symptoms include:

1) Morning headache
2) Nose bleeding (epistaxis)
3) Dizziness when diastolic blood pressure is greater than 110 mmHg

Question 5

What is the formula for calculating blood pressure?

Answer 5

heart rate x stroke volume x vascular resistance

Question 6

What is the formula for cardiac output?

Answer 6

heart rate x stroke volume

Question 7

What is a normal BP? What is the goal for under 60? Over 60?

Answer 7

120/80

<130/80

<140/90 *unless diabetic or heart failure

Question 8

What are the thresholds for Elevated BP, Stage 1 Hypertension, and Stage 2 Hypertension?

Answer 8

Elevated BP: 120-129/<80

Stage 1: 130-139 or 80-89

Stage 2: >140 or >90

Question 9

What are the primary causes of secondary hypertension?

Answer 9

Most common causes are due to renal disease

Another major one is drug-induced

Other: Primary aldosteronism, Cushing’s Syndrome, pheochromocytoma, coarctation or aorta, thyroid disease, obstructive sleep apnea

Question 10

What are examples of drug-induced secondary hypertension?

Answer 10

NSAIDs/COX-2 inhibitors

Oral contraceptives

Adrenocorticoids (steroids)

Cocaine, amphetamines, other illicit durgs

Sympathomimetics (decongestants/anorectics)

Some OTC diet supplements (ephedra, ma huang)

Cyclosporin; tacrolimus (immunosuppresants)

EPO

Question 11

When is renin synthesized?

Answer 11

When there is a decrease in renal artery pressure or an increase in sympathetic nerve activity

Question 12

What does excess sodium and renal sodium retention lead to? Obesity? Stress?

Answer 12

Excess sodium and renal sodium retention: Increased cardiac output

Obesity: Increased peripheral vascular resistance

Stress: Increased cardiac output

Question 13

What is chronic hypertension sustained by: increased vascular resistance or cardiac output?

Answer 13

Increased vascular resistance because blood volume and cardiac output are often normal

Question 14

What is the goal of medication therapy for hypertension?

Answer 14

Prevention of MI, CVA, and CKD (kidney) and other vascular therapies

Question 15

Thiazide Diuretics

• Mechanism
• Role
• Drugs

Answer 15

Role: Essential hypertension (especially isolated systolic hypertension) and Edema

*Note: you need functioning kidneys to use these; exception is metolazone (Zaroxolyn)

chlorthalidone (Thalitone): 1st prescribed; longer half life; prevents CVD

hydrocholorthiazide (Microzide/Dyazide): 2nd prescribed; enhanced by food

Question 16

What are potential side-effects of Thiazide Diuretics?

Answer 16

Increased urination

Decreased K⁺, Na⁺, Mg⁺⁺, Cl^-

Increased Ca⁺⁺

Increased Uric acid

Glucose intolerance

*Caution in patients taking digoxin (toxic reaction due to decrease K⁺)

Question 17

Loop Diuretics

• Mechanism
• Role
• Drugs

Answer 17

Role: Essential hypertension (pts resistant to thiazide diuretics or impaired renal function), Edema, Heart failure, Renal failure

ethacrynic acid (Edecrin): no sulfa component; worst ototoxicity

furosemide (Lasix): eratic bioavailability (affected by food)

torsemide (Demadex): bioavailability not affected by food; arguably the best of the listed options available

Question 18

What are potential side effects of loop diuretics?

Answer 18

Increased urination

Sexual dysfunction

Ototoxicity (hearing or balance issues)

Electrolyte abnormalities (No hypercalcemia)

-Decreased K, Na, Mg, and Cl

Question 19

Potassium Sparing Diuretics

(also Magnesium sparing)

Answer 19

Role: averts urinary loss of Mg⁺⁺ to help correct hypokalemia and is almost always used in combination therapy