Lecture 6 Hypertension

Question 1

Systolic pressure > ____ or 2 or more measurements with diastolic bp > ____ mm hg is hypertension

Answer 1

140; 90

Question 2

Pulse pressure > ____ is a very important indicator of hypertension

Answer 2

65

Question 3

Cause of most hypertension?

Answer 3

increased peripheral vascular resistance from no identifiable cause

Question 4

diuresis is an increase in ____ ____; natriueresis is an increase in renal _____ ____

Answer 4

urine volume;

sodium excretion

Question 5

Diuretics that block Na reasborption proximally cause it to be reabsorbed in the _____ ____. This leads to excretion of _____ and hypo_____

Answer 5

collecting duct;
potassium, kalemia

(besides potassium sparing drugs)

Question 6

mannitol is an _____ _____. where does it act?

Answer 6

osmotic diuretic;

PCT and descending loop of henle (where water absorption usually occurs)

Question 7

Acetazolamide works by inhibiting ____ ____ in the ____ ____

Answer 7

carbonic anhydrase;

proximal tubule

Question 8

Carbonic anhydrase inhibitors cause excretion of _______ and water (in the short term)

Answer 8

NaHCO3

Question 9

use of carbonic anhydrase inhibitors?

Answer 9

glaucoma, urinary alkinization, mountain sickness

Question 10

effect of long term use of diuretics:
HR and CO: \_\_\_\_\_\_\_
TPR: \_\_\_\_\_\_\_\_\_
plasma volume : \_\_\_\_\_\_\_\_
plasma renin: \_\_\_\_\_\_\_

Answer 10

no change;
decreased;
unchanged/decreased;
increased

Question 11

3 loop diuretics

Answer 11

furosemide, bumetanide, ethacrynic acid

Question 12

the loop diuretics act on the _____ transporter located where?

Answer 12

Na-K-2Cl; thick ascending limb

Question 13

normally, what happens to the potassium after it is transported by the NKCC transporter? Why is this important?

Answer 13

diffuses back into membrane;

drives gradient to reabsorb Ca and Mg

Question 14

In addition to acting on the NKCC transporter, loop diuretics also stimulate ____ release

Answer 14

Prostaglandin E release

Question 15

release of PGE caused by the loop diuretics causes an _____ in renal blood flow due to _____ of the afferent arteriole

Answer 15

increase; vasodilation

Question 16

what ions have reduced absorption when using loop diuretics?

Answer 16

NaCl, K+, Mg2+, Ca2+

Question 17

2 general uses of loop diuretics:

Answer 17

edematous conditions;

acute pulmonary edema

Question 18

what can be used as a loop diuretic if a patient has a sulfa allergy?

Answer 18

ethacrynic acid

Question 19

Memory hook for side effects of loop diuretics?

Answer 19

OH DANG

Question 20

OH DANG side effects of loop diuretics:
O = ______
H = ______

Answer 20

ototoxicity

hypokalemia/hypomagnesemia

Question 21

DANG side effects of loop diuretics:
D = \_\_\_
A = \_\_\_\_\_\_ and \_\_\_\_\_
N = \_\_\_\_\_\_\_\_\_
G = \_\_\_\_\_\_

Answer 21

Dehydration
Allergy/metabolic Alkalosis
Nephritis (interstitial)
Gout

Question 22

In patients with normal renal function, what are more effective anti-hypertensives?

Answer 22

thiazides

Question 23

Thiazide diuretics to know (3)

Answer 23

chlorothalidone, hydrochlorothiazide, metolazone

Question 24

Thiazide diuretics act by inhibiting the _____ symporter in what location of the renal tubule?>

Answer 24

NaCl;

DCT

Question 25

Thiazide diuretics also enhance ____ reabsorption in the kidney

Answer 25

Ca

Question 26

Inhibition of the ____ symporter causes a decrease in _____ Na. Na enters the cell, cause ____ to exit into the blood

Answer 26

NaCl;
intracellular;
Ca

Question 27

Thiazide side effects:
Hyper____ acronym;
______ metabolic ____;
hypo_____

Answer 27

GLUC;
hypokalemic metabolic alkalosis;
natremia

Question 28

hyperGLUC acronym of thiazide side effects:
G = \_\_\_\_\_\_\_
L = \_\_\_\_\_\_\_\_\_
U = \_\_\_\_\_\_\_\_\_
C = \_\_\_\_\_\_\_

Answer 28

G = hyperglycemia
L = hyperlipidemia
U = hyperuricemia
C = hypercalcemia

also sulfa allergy and erectile disfunction

Question 29

spironalactone and eplerenone act in the ____ ____ by inhibiting what?

Answer 29

collecting duct; aldosterone receptor

Question 30

_____ and _____ act in the collecting duct by inhibiting what transporter?

Answer 30

triamterene, amiloride;

ENaC (Epithelial Na transporter)

Question 31

drugs acting in the collecting duct are called ____ _____

Answer 31

potassium sparing

Question 32

2 general uses of thiazide diuretics?h

Answer 32

HTN, HF

Question 33

triamterene and amiloride are almost always used with _____ or other diuretics

Answer 33

thiazides

Question 34

2 side effects of amiloride/triamterene:

hyper____, which has cardiac toxicities;

_____ metabolic _____

Answer 34

kalemia;

hyperchloremic metabolic acidosis

Question 35

triamterene is specifically contraindicated in patients with ____ ____

Answer 35

kidney stones

Question 36

aldosterone antagonists reduce the number of _____ channels in the collecting duct

Answer 36

Na+

Question 37

_____ blocks the actions of aldosterone and inhibits 5 alpha reductase

Answer 37

spironlactone

Question 38

side effects specific to spironlactone:

______, _____, and ___ ___ ____

Answer 38

gynecomastia, impotence, BPH

Question 39

spironlactone and eplerenone can also cause _____ and _____ metabolic ____

Answer 39

hyperkalemia;

hyperchloremic metabolic acidosis

Question 40

of the 2 aldosterone antagonists, ____ can be used alone. its effects should be observed within ___ ___

Answer 40

eplerenone, 4 weeks

Question 41

____ is contradicted in patients with diabetes or those taking CYP450 3A4 inhibitors such as _____

Answer 41

eplerenone, ketoconazole