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RENAL II Exam 3 > Intro to Antihypertensive Agents I > Flashcards

Intro to Antihypertensive Agents I Flashcards

1
Q

prehypertension

A

SBP 120-139
DBP 80-89

recommend lifestyle changes

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2
Q

stage 1 HTN

A

SBP 140-159
DBP 90-99

begin treating HTN

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3
Q

stage 2 HTN

A

SBP >160

DBP >100

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4
Q

mean arterial pressure

A

MAP = CO x TPR

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5
Q

cardiac output

A

CO = HR x SV

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6
Q

drug strategy with HTN

A

reduce CO

reduce TPR

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7
Q

compensation for HTN meds**

A

reflex tachycardia - increased symapthetics

edema - increased renin activity

**so can add different drug to counteract

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8
Q

weight reduction

A

5-20 decreased SBP

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9
Q

DASH diet

A

8-14 decreased SBP

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10
Q

dietary sodium reduction

A

2-8 decreased SBP

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11
Q

physical activity

A

4-9 decreased SBP

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12
Q

moderation of alcohol

A

2-4 decreased SBP

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13
Q

antihypertensive sites of action

A

arterioles
venules
heart
kidneys

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14
Q

major classes of antihypertensive meds

A
  • diuretics
  • agents blocking ANG action
  • direct vasodilators
  • sympathoplegic agents
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15
Q

diuretics

A

act at kidney tubules

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16
Q

agents that block ANG action

A
  • angiotensin receptors of vessels
  • beta-receptors of JG cells
  • ACE inhibitors
  • renin inhibitors
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17
Q

direct vasodilators

A

on vascular smooth m.

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18
Q

sympatholytics

A
  • vasomotor center of brain
  • beta-receptors of heart
  • alpha receptor of vessels
  • beta receptors of JG cells
19
Q

patients with CKD

A

ACE inhibitors

ARB (angiotensin receptor blocker)

20
Q

black patients without CKD

A

thiazide diuretic

calcium channel blockers

21
Q

nonblack patient without CKD

A

thiazide diuretic**
ACE inhibitor
ARB
CCB

22
Q

kidney blood flow

A

20-25% of CO

23
Q

carbonic anhydrase

A

formation/dehydration of carbonic acid in proximal tubule

24
Q

proximal tubule activity

A
  • active reabsorption of HCO3, NaCl, K, glucose, AAs
  • passive reabsorption of water
  • Na/K pump maintains Na concentration in cell low
  • carbonic anhydrase

**site of action of carbonic anhydrase inhibitors

25
Q

thin descending loop of henle

A

water reabsorption

26
Q

thin ascending loop of henle

A

impermeable to water, other ions/solutes

27
Q

thick ascending loop of henle

A

Na/H/2Cl cotransport

-established concentration gradient

28
Q

K leak in thick ascending limb

A

high K in cells - K diffuses back to lumen

-creates positive charge- drives the paracellular reabsorption of Mg, Ca

29
Q

tubular fluid

A

concentrated in descending limb and diluted in ascending limb

30
Q

distal convoluted tubule

A
  • 10% NaCl reabsorbed
  • impermeable to water

Na/Cl cotransporter - active NaCl out of lumen

-Ca is reabsorbed by calcium channels

31
Q

thiazide diuretics

A

blocks Na/Cl cotransporter in the distal convoluted tubule

32
Q

Ca reabsorption

A

distal convoluted tubules

  • has Ca channels
  • regulated by PTH

-increased PTH/increased reabsorption

33
Q

most important site of K secretion**

A

collecting tubule
-site where all diuretic induced K balance changes occur

most diuretics - hypokalemia - bc more sodium to CT lumen > more Na pulled out at ENaC > causes more K secretion

also hypokalemia with metabolic alkalosis > lumen negative favors retention of H+ in lumen > urine pH goes down > body pH goes up

more Na to CT - more K secretion

34
Q

collecting tubule

A
  • proton pump - increased urine acidity
  • ENaC - 2-5% Na reabsorption

creates electrical gradient that facilitates K secretion down concentration gradient

35
Q

aldosterone

A

increased ENaC and basolateral Na/K ATPase in collecting tubule

water retention - increase in blood volume and BP

36
Q

ENaC

A

in collecting tubule

  • increased Na reabsorption
  • 2-5% of total
  • does create gradient to facilitate K secretion
37
Q

ADH

A

aka vasopression

  • released from pituitary
  • increases aquaporin 2 on collecting tubules
  • via V2 receptor

-increased water reabsorption

38
Q

ADH level control

A

serum osmolality and volume status

39
Q

diuretics

A
  • carbonic anhydrase inhibitors
  • loop diuretics
  • thiazide diuretics
  • potassium-sparing diuretics
40
Q

diuretic use

A

increase rate of urine flow

edematous and nonedematous states

41
Q

site of loop diuretics

A

Na/K/2Cl cotransporter in thick ascending limb

42
Q

site of thiazide diuretics

A

Na/Cl cotransporter

43
Q

site of potassium sparing diuretics

A

sodium channels

44
Q

site of potassium sparing diuretics

A

mineralocorticoid receptors

and sodium channels

RENAL II Exam 3 (17 decks)

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