Pharm Test 7

Question 1

Hypertension

Answer 1

(>140/>90)
normal= <120/<80, preHTN= 120-139/80-89, stage 1 =140-159/90-99, stage 2= >160/>100
-primary(essential)= unknown cause- 90%, secondary= caused by disease
Risk factors= diabetes, obesity, smoke, stress, history
Complications= stroke, ischemia, LV hypertrophy, aneurysm, arrhythmia

Question 2

Blood Pressure control

Answer 2

BP= CO x PVR, reduced CO (beta 1-heart and renin), decrease PVR (alpha 1 on vessels)
1) Baroreceptor reflex/SNS= when low BP- releases renin
2) Renin-angiotensin-aldosterone= vasoconstrictor (incase SVR), increase aldosterone (increases Na reab- increase CBV)
so if we inhibit/block these, we can lower BP

Question 3

Treatment Sequence (which drugs tried first)

Answer 3

1st- thiazide, 2nd- ACE inhibitor, 3rd- ARB, 4th- Ca blocker

Question 4

3 Types of Diuretics

Answer 4

work by decreasing water/Na reab= lower CBV

Thiazide, Loop, Potassium sparing

Question 5

Thiazide Diuretics

Answer 5

inhibits Na-Cl reab channels in early distal, increase Na and water excretion

• needs functional kidney
• can cause: hypokalemia, hyperuricemia, hyperglycemia

Question 6

Loop Diuretics

Answer 6

inhibits Na-2Cl-K reab in thick ascending limb of loop= decreased renal vascular resistance, increase RBF

• works better with non functional kidney
• can cause: hypokalemia

Question 7

Potassium Sparing Diuretics

Answer 7

blocks Na/K atpase on principal cell in distal, and also blocks the Na from coming in and K from leaving

• used with others to spare K
• aldosterone receptor antagonist (prevents Na reab)

Question 8

Beta Blockers

Answer 8

block increase CO and renin release
(nonselective beta blockers bad for patients with asthma because of b2 vasoconstriction when blocked)
-can cause: hypotension, bradycardia, fatigues, insomnia
-don’t withdraw fast= angina, MI, death

Question 9

ACE Inhibitors

Answer 9

decreases AngII (vasodilates), increase bradykinin/increase NO (vasodilates), lowers aldosterone (less Na reab)

• good for: diabetic nephropathy, MI, decreasing LV hypertrophy
• can cause: dry mouth, rash, hyperkalemia, weird poop/taste

Question 10

ARB

Answer 10

AngiotensinII Receptor Blockers

• decrease AngII, decrease aldosterone, no effect on bradykinin
• good for: patients with DM, HF, kidney disease
• can cause: less dry mouth, teratogenic (fetal malformation)
• dont use with ACE

Question 11

Renin Inhibitor

Answer 11

directly lowers renin- reduces Na/water reab

• not used with ARB, ACE, or thiazides
• can cause cough, diarrhea

Question 12

Calcium Channel Blockers

Answer 12

prevents Ca from coming into heart and smooth muscles around vessels so they can’t contract

Question 13

Alpha 1 Blocking Agents

Answer 13

block a1 on arterials= dilates, lowers BP and PVR

• reflex tachycardia, orthostatic hypotension
• use with diuretic because Na/water still reab

Question 14

Alpha and Beta Blockers

Answer 14

blocks alpha 1, beta 1 and 2

lowers BP and PVR

Question 15

Other 2 Antihypertensives

Answer 15

both are alpha 2 agonists= decrease SNS and lowers BP and PVR
-clonidine and methyldopa

Question 16

What to do if HTN on CBP

Answer 16

1) flow down 2) ask anesthesiologists depth 3) drugs

Question 17

Carbonic Anhydrase Inhibitors

Answer 17

increase urine pH, cuz inhibits reab of bicarb

Question 18

Mannitol dose

Answer 18

during .5-1 g/kg

prime 12.5 g/50 ml

Question 19

Loop Diuretic dose

Answer 19

20-40 mg bolus to pump?