Module 7 hypertensives

Question 1

CO =

Answer 1

CO = HR x SV

Question 2

BP =

Answer 2

BP = CO x peripheral resistance

Question 3

normal BP

Answer 3

S: less than 120
D: less than 80

Question 4

elevated

Answer 4

S: 120-129
D: less than 80

Question 5

HTN stage 1

Answer 5

S: 130-139
D: 80-89

Question 6

HTN stage 2

Answer 6

S: 140 or higher
D: 90 or higher

Question 7

Hypertensive crisis

Answer 7

S: > 180
D: > 120

Question 8

black population initial meds

Answer 8

thiazide diuretics

CCB

Question 9

diuretic classes

Answer 9

thiazide and thiazide-like
loop
potassium sparing

Question 10

how diuretics work

Answer 10

inc. urine output
- > dec. circulating blood volume
- > lower plasma volume, SV, and CO
- > dec. BP

Question 11

Thiazides

Answer 11

inhibit reabsorption of Na and Cl in distal convoluted tubule -> retention of water
most common diuretic for HTN tx

Question 12

loop diuretics

Answer 12

inhibit the Na/K/2Cl cotransport in ascending loop of Henle

-> retention of Na, Cl, and H2O in tubule -> excretion

Question 13

Potassium sparing

Answer 13

aldosterone antagonist, inhibits the aldosterone-mediated reabsorption of Na+ and secretion of K+
- prevent loss of K+

Question 14

Thiazides

Answer 14

hydroclorothiazide (HCTZ)

Chlorthiazide (diuril)

Question 15

Thiazide-like

Answer 15

Chlorthiadone
Indampamide (Lozol)
Metolazone (Zaroxolyn)

Question 16

Thiazide mechanism of action

Answer 16

prevent Na and Cl reabsorption at the thick ascending limb of loop of henle in DCT. (competitive antagonist)
-> inc. excretion 
renal K+ loss (can cause hypokalemia)
inc. Ca+ retention 
Not effective in pt with GFR < 30 mL/min

Question 17

Thiazide adverse effects

Answer 17

hypokalemia
hyponatremia
hypercalcemia

Question 18

Thiazide route of administration

Answer 18

oral

Question 19

Loop diuretic drugs

Answer 19

bumetanide (bumex)
ethacrynic acid (Edecrin)
Furosemide (lasix)
Torsemide (demadex)

Question 20

Loop diuretics mechanism of action

Answer 20

inhibits Na-K-Cl co-transporter at the loop of Henle

- alleviates congesting s/s of HF

Question 21

loop diuretics adverse effects

Answer 21

hypokalemia 
profound diuresis 
electrolyte depletion: Ca, K, Mg, Na
preg. category C
dehydration
dose related ototoxicity 
sulfa allergy

Question 22

Loop diuretics route of administration

Answer 22

oral

Question 23

Potassium sparing diuretics

Answer 23

Aldosterone receptor antagonists 
- sprinolactone (aldactone)
- eplerenone (Inspira)
Inhibitors of Na transport at DCT
- Amiloride (midamor)
- triamterene (Dyrenium)

Question 24

spironolactone (aldactone) mechanism of action

Answer 24

aldosterone antagonist (competetive), inhibits mineralcorticoid receptors
prevent reabsorption of Na and H2O at the DCT
inc. K+ reabsorption -> possible hyperkalemia

Question 25

spironolactone adverse effects

Answer 25

hyperkalemia 
agranulocytosis
anaphylaxis
hepatotoxicity
renal failure
Stevens-johnson syndrome or toxic epidermal necrolysis 
rash

Question 26

eplerenone (Ispra)

Answer 26

blocks aldosterone from binding at its receptor

• doesnt effect steroid receptors as much as spironolactone
  inc. K+ reabsorption

Question 27

amiloride (Midamor) and triamterene (Dyrenium) mechanism of action

Answer 27

inhibits Na reabsorption at the DCT

dec. H2O reabsorption
inc. K+ retention

Question 28

amiloride and triamterene adverse effects

Answer 28

hyperkalemia
pregnancy category D
kidney stones

Question 29

amiloride and triamterene mechanism of action

Answer 29

Na channel blockade in collecting duct -> inc. K reabsorption