Hypertension I Flashcards
BP=
CO X PVR
Risk factors for hypertension
Family History, Sex, Diet, Smoking, Diabetes, Hyperlipidemia
What is diuresis?
An increase in urine volume
What is Natriuresis?
An increase in renal sodium excretion
Clinical uses of diuretics?
HTN, Edema, CHF, Kidney Disease, Cirrhosis, Hypercalcemia, Diabetes Insipidus
Site of Acetazolamide activity?
Proximal Tubule
What does Acetazolamide do?
It is a carbonic anhydrase inhibitor. This prevents the H+/Na+ antiporter from absorbing Na
Why is Acetazolamide not super effective?
Na still absorbed in the loop
Potential side effect of Acetazolamide to watch for?
Metabolic Acidosis
Hemodynamic Effects of long-term diuretic administration
Peripheral resistance decrease
Plasma Volume decreased or unchanged
HR+CO don’t change
Plasma renin activity is increased
Name the important loop diuretics
Furosemide
Bumetanide
Ethacrynic Acid
Loop diuretics act by…
Inhibiting the Na+-K+2Cl- symporter
Inhibits reabs of Na, Cl, Mg, Ca
Clinical use of Loop Diuretics
Edematous Conditions
Acute Pulmonary Edema
Loop diuretic toxicities?
Dehydration Hypokalemic metabolic alkalosis Ototoxicity Hyperuricemia Hypomagnesemia
Contraindications for Loop Diuretics?
Sulfa Allergy
Thiazides + Loops – who is best for HTN in patients with normal renal fxn
Thiazides
How do thiazides work?
Inhibit Na/Cl cotransporters in the distal tubule
Thiazide diuretic names
Things that end in thiazide
Chlorthalidone
Indapamide
Metolazone
Actions of Thiazide diuretics
Inhibit NaCl reabsorption in DCT
Enhance Ca reabs in the kidney
May open Ca channels –> Vasodilation
Decrease in peripheral resistance from neg. Na balance
Clinical uses of Thiazides
Hypertension
Congestive Heart Failure
Influence of Thiazides on Ca
Loss of Na in the DCT leads to activtion of the Ca/Na antiporter, causing increase Ca absorption
Thiazide toxicities
Hypokalemia/Hypokalemic metabolic alkalosis Hyperuricemia Hypercalcemia Impaired Carb. tolerance Hyperlipidemia ED
Contraindications for Thiazides?
Sulfa allergies
Major type of drugs that act in the collecting tubule…
Na Channel Inhibitors
Whats the wording commonly used for Na Channel inhibitors in the collecting tubule?
Potassium Sparing Diuretics
Without NA coming in, no Na/K antiporter action, so K is spared
Two examples of Potassium sparing diuretics
Amiloride
Triamterene
Clinical uses for Amiloride?
Adjunctive treatment with thiazide or loop diuretic in CHF or HTN
Can reduce BP
Toxicities of Amiloride and Triamterene?
Hyperkalemia
Hyperchloremic metabolic acidosis
Contraindications for prescribing Amiloride?
K+ Supplements
ACE inhibitors
Clinical uses for Triamterene?
Edema assoc. with CHF, hepatic cirrhosis, nephrotic syndrome, or hyperaldosteronism
Can’t lower BP alone
Contraindications for Triamterene?
Kidney Stones
K+ Supplements
ACE Inhibitors
How do aldosterone antagonists work
Control Aldosterone expression
Modifies # of Na channels via transcription of proteins and channels that put them in
Main aldosterone antagonists to know?
Spironlactone
Eplerenone
Actions of Spironlactone
Blocks Aldosterone
Inhibits 5-alpha reductase
Clinical uses for Spironlactone in CV Disease
Hypertension or CHF w/ other diuretics
Toxicities of Spironlactone?
Hyperkalemia
Hyperchloremic metabolic acidosis
Gynecomastia + Impotence
Benign Prostatic Hyperplasia
Contraindications for Spironlactone?
K+ Supplements
ACE Inhibitors (Promotes K+ Retention)
Chronic Renal Insufficiency
Actions of Eplerenone
Selective antagonism of mineralocorticoid receptor in kidney, heart, BV, and brain
Clinical use of Eplerenone
Hypertension
Full therapeutic effect within 4 weeks
Toxicities and adverse reactions to Eplerenone?
Hyperkalemia
Hypertriglyceridemia
Contraindications for Eplerenone?
K+ supplements/K+ sparing diuretics ACE inhibitors Chronic Renal Insufficiency Diabetes+microalbuinuria CYP450 3A4 inhibitors (ex. ketoconazole)
