Jan4 M3-Antihypertensives, K and PO4 binders, Renally Cleared Drugs

Question 1

3 ways kidney affects CVS

Answer 1

• EPO production: RBCs
• ECF volume
• TPR

Question 2

three kinds of baroreceptors

Answer 2

arterial, cardiopulmonary, intrarenal

Question 3

what intrarenal baroreceptors do

Answer 3

RAAS, GFR, salt and water reabsorption

Question 4

what produces ADH

Answer 4

hypothalamus (not pituitary)

Question 5

3 messages to renin production and which one is different

Answer 5

• SS via beta adrenergic receptors
• decreased P in renal arterioles
• macula densa (this one can also decrease renin prod)

Question 6

how macula densa communicates an increased flow

Answer 6

senses increased Na delivery, releases ATP (adenosine) which then decreases GFR and renin secretion

Question 7

how macula densa communicates a decreased flow

Answer 7

drop in Na delivery, secretes NO and PGs, GFR and renin secretion increase

Question 8

in the control of sodium excretion, what are drivers of Na excretion

Answer 8

dopamine, ECF conc of Na, ECF volume, natriuretic peptides

Question 9

in the control of sodium excretion, what are drivers of Na retention

Answer 9

AT2, aldo, SS, ADH

Question 10

why ACEi causes cough

Answer 10

ACE metabolizes kinins and substance P. kinins enhance production of PGs which may cause bronchial irritation and cough

Question 11

only way to resolve ACEi cough side effect if present

Answer 11

stop this med and take ARB instead

Question 12

less common side effects of ACEi

Answer 12

• severe hypotension (if hypovolemic)
• acute renal failure (if bilateral RAS)
• hyperK

Question 13

4 drug types in BP management

Answer 13

• AT blockers (RAAS inhibitors)
• Sympathoplegic agents
• Direct vasodilators (like hydralazine)
• Diuretics

Question 14

anti htn drugs: choice in diabetic patient with proteinuria

Answer 14

RAAS inhibitors (AT blockers)

Question 15

anti htn drugs: choice in patients with angina

Answer 15

beta blockers or CCB

Question 16

anti htn drugs in HF

Answer 16

diuretic**,ARB, ACEi, beta blocker or hydralazine + nitrates

Question 17

anti htn drugs in BPH (benign prostatic hyperplasia)

Answer 17

a1 blockers

Question 18

5 classes of diuretics

Answer 18

CA inhibitors
loop diuretics
thiazides
K-sparing diuretics
osmotic

Question 19

thiazides mode of action

Answer 19

block Na-Cl transporter in the DCT (5-7% reabso of Na note done)

Question 20

3 thiazides

Answer 20

indapamide, hydrochlorothiazide, metolazone

Question 21

thing that can influence effect of thiazides and loop diuretics

Answer 21

renal PG production, modified if taking NSAIDs

Question 22

side effect of thiazides (electrolytes)

Answer 22

hypokalemia and metabolic alkalosis

Question 23

3 mechanisms of hypoK and metabolic alkalosis as side effects in thiazides

Answer 23

• increased Na to CT exchanged for K and H (CD for water..)
• secondary hyperaldo
• volume contraction

Question 24

other side effects of thiazides

Answer 24

hyponatremia, hyperuricemia, hyperglycemia, weakness-fatigue-parasthesias
changes in serum lipids

Question 25

loop diuretics are of choice in what 2 conditions

Answer 25

pulmonary edema and CHF

Question 26

2 mechanisms of loop diuretics and why are said to be potent

Answer 26

- block Na-K-2Cl cotransporter in TAL (potent bc medullary interstitium not salty as a consequence - venous vasodilation by inducing production of PGs and NO in endoth cells to relax SM

Question 27

2 categories of loop diuretics, their drugs and why use the second

Answer 27

- sulfonamides (furosemide, bumetanide, torsemide) | - nonsulfonamides (ethacrynic acid): for sulfonamide intolerant patients

Question 28

side effects of loop diuretics

Answer 28

hypokalemia, metabolic alkalosis (contraction), hyperuricemia, hypomagnesemia, ototoxicity

Question 29

how diuretics are handled by the body and consequence

Answer 29

kidneys secrete them actively. can develop resistance (transporters in the kidney change)

Question 30

reasons for diuretic resistance

Answer 30

- high Na diets - CKD, aging - NSAIDs, low BP, low flow to the kidney - gut edema (less abso)

Question 31

K-sparing diuretics 2 different modes of action

Answer 31

MRA (nuclear receptor) | Na channel blockers in the CT and CD

Question 32

2 MRAs

Answer 32

spironolactone, eplerenone

Question 33

2 CT Na channel blockers

Answer 33

amiloride, triamterene

Question 34

CA inhibitors name and mode of ation

Answer 34

acetazolamide. no H + HCO3 produced so no Na-H exchange in PCT

Question 35

3 side effects of CAi

Answer 35

hyperchloremic MA renal stones renal potassium wasting

Question 36

osmotic diuretics: prototypic one and where acts mainly

Answer 36

mannitol. mainly PCT and DL

Question 37

side effects of mannitol (water and electrolytes)

Answer 37

- volume expansion (prior to diuresis) - dehydration, hyperK and hyperNa - hypoNa: in renal failure (water not excreted)

Question 38

main side effect of k-sparing diuretics

Answer 38

hyperK