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Pharmacology-HTN Flashcards

1
Q

What is the major determinant of SBP?

A

Cardiac Output

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2
Q

What largely determines DBP?

A

Total Peripheral Resistance

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3
Q

How do you calculate BP?

A

HR x SV x TPR

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4
Q

What is the major site for sodium chloride and sodium bicarbonate reabsorption?

A

Proximal Convoluted Tubule (PCT)

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5
Q

List potassium sparing drugs

A
  • Amiloride

- Triamterene

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6
Q

Where in the nephron is sodium, potassium and chloride pumped out of the lumen into the interstitial of the kidney?

A

Thick Ascending Limb of the Loop of Henle (TAL)

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7
Q

Where is a major site of calcium and magnesium reabsorption?

A

Thick Ascending Limb of the Loop of Henle (TAL)

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8
Q

Where in the nephron is it responsible for 20-30% of sodium reabsorption

A

Thick Ascending Limb of the Loop of Henle (TAL)

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9
Q

What is the mechanism of loop diuretics?

A

Blocks the Na+ K+ Cl- symporter (NKCC2) at the thick ascending Loop of Henle

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10
Q

When do we prefer to use Loop diuretics (i.e. furosemide)

A

Heart failure
Severe edema (fluid retention pt’s)
Kidney dz pt’s

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11
Q

What are the contraindications to TAL loop diuretics

A 
Hypokalemia
Hypomagnesemia
Hypocalcemia
Hypovolemia
Hyperuricemia
Ototoxicity
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12
Q

What is a rare allergy to TAL loop diuretics

A

Sulfonamide allergy

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13
Q

What is a poor antihypertensive?

A

Furosemide

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14
Q

When do we use Furosemide

A

Kidney disease

Fluid retention

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15
Q

What do we use to treat hypercalcemia?

A

Furosemide

Torsemide

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16
Q

What is the mechanism @ the distal convoluted tubule

A

actively pumps sodium and chloride out of the lumen of the nephron via the Na+/Cl− carrier (NCC)

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17
Q

What is the target of the thiazide diuretics?

A

Na+/Cl− carrier (NCC)

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18
Q

How much sodium is reabsorbed at the distal convoluted tubule?

A

5-8%

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19
Q

How much sodium is reabsorbed at the proximal convoluted tubule?

A

60-70%

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20
Q

What is the mechanism of Thiazide Diuretics?

A

Blocks the reabsorption of sodium and chloride in the distal convoluted tubule via NCC

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21
Q

How does Thiazide diuretics provide chronic anti hypertension?

A

through sustained decrease in PVR and direct smooth muscle relaxation

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22
Q

Clinical applications for distal convoluted tubule thiazide diuretics

A

HTN

Mild heart failure

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23
Q

Contraindications to distal convoluted tubule thiazide diuretics

A 
Hypokalemic
Hyponatremia 
Hypercalcemia
Hyperglycemia
Hyperlipidemia
Hyperuricemia
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24
Q

What are the limitations of thiazides?

A

GFR < 30ml/min for HCTZ

Unrestricted salt intake reduces efficacy

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25
How much does HCTZ lower SBP?
15 to 20 mmHg
26
How much does HCTZ lower DBP?
8 to 15 mmHg
27
What do you need to monitor in Thiazides?
BUN Creatinine Uric acid level Electrolytes: K+, Na+, Ca++, Mg+++
28
What is the cortical collecting tubule controlled by?
Aldosterone
29
How much sodium reabsorption is the cortical collecting tubule responsible for?
2-5%
30
How does the sodium reabsorption occur at the cortical collecting tubule with Aldosterone?
Via ENaC--> accompanied by loss of potassium or hydrogen ions
31
What is the primary site of acidification of the urine and the last site of potassium excretion?
cortical collecting tubule
32
What is the site of action of the potassium-sparing diuretics?
Aldosterone receptor | Sodium channels
33
What are the clinical applications of Spironolactone
Excessive K+ loss when using other diuretics | Aldosteronism
34
What are the contraindications to Spironolactone
Hyperkalemia Hyponatremia Gynecomastia
35
What are the clinical applications of Amiloride
Excessive K+ loss when using other diuretics | Usually in combination with thiazides
36
What are the contraindications to Amiloride?
Hyperkalemia
37
What is the mechanism of potassium sparing diuretics?
Blocks the epithelial Na+ channel action proximal to the distal convoluted tubule
38
What is the side effect of potassium sparing diuretics?
Hyperkalemia
39
When is potassium sparing diuretics contraindicated?
Renal failure
40
When do you want to avoid use of potassium sparing diuretics?
in CrCl <10 ml/min
41
What does potassium sparing drugs decreases the levels/effect of?
Cardiac glycoside
42
Mechanism of ARB
Angiotensin receptor blocker—net
43
List an example of an ARB
Lasartan
44
What are the two main side effects of ACE inhibitors AND ARBs?
1. Modest increase in Sr Cr ~35% or absolute increase of less than 1mg/dL do not warrant changes-vasoconstriction of efferent arterioles 2. Hyperkalemia
45
What are the two main side effects of ACE inhibitors?
1. Dry cough | 2. Angioedema—Lip and tongue swelling most common
46
What population are ACE1 and ARBs the most effective?
Young, white patients
47
What population are ACE1 and ARBs the least effective?
Blacks older persons Pt's predominantly systolic HTN
48
What antihypertensive is the choice for DM?
ACE1 and ARBs
49
What labs do we want to monitor in ACE1 and ARBs?
Serum creatinine | K+
50
What antihypertensive is absolutely contraindicated in pregnancy?
ACE1 and ARBs
51
List a Renin Inhibitor
Aliskiren
52
What type of patient should ACEI, ARBs and renin inhibitors be avoided?
- Hyperkalemia - Pregnant - Pulmonary/Cough - Significant CKD
53
Action of α1receptors
Vasoconstriction of arterioles and venules
54
Action of α2 receptors
regulation of α1
55
Action of β1 receptors
Increase HR Increase contractility Renin release
56
Action of β2 receptors
Vasodilation of arterioles and venules Bronchodilation and Vasodilation: lung, liver, pancreas, and arteriolar smooth muscle Gluconeogenesis
57
What is the result of sympathoplegic drugs?
``` A reduction in one or more of the following: Venous tone HR Contractile force CO TPR ```
58
List Beta Blockers
Propanolol Metoprolol Atenolol
59
What is the mechanism of Beta Blockers?
Block β1 and β2 receptors of the SNS: - Negative chronotropic and inotropic= decreased CO - Inhibits release of Renin
60
What are the main side effects of Beta Blockers?
Bradycardia, AV conduction abnormalities Acute heart failure Acute exacerbations of asthma or COPD (bronchospasms)
61
How are beta blockers differentiated?
1. Cardioselectivity 2. ISA 3. Membrane-stabilizing effect
62
What should you monitor with beta blockers?
Assess for CHF | Monitor BS in DM
63
List the Alpha 1 blockers
Prazosin Terazosin Doxazosin
64
What is the main side effect of Alpha 1 Blockers?
First Dose Phenomenon and an increased dose effect: Dizziness/faintness Palpitations Syncope
65
What patients would we recommend an Alpha blocker to?
Pt's with BPH | PTSD related nightmares and sleep disruption
66
What are the drug interactions of Alpha 1 Blockers?
Decrease levels of: Dabigatran Linagliptin
67
List Central Alpha 2 Agonists
Clonidine | Methyldopa
68
Side effects of Methyldopa
1. Sodium and water retention-Give a diuretic | 2. Hepatitis or hemolytic anemia= transient rise in LFT's
69
Side effects of Clonidine
Anticholinergic side effects: - Sedation - Dry mouth - Constipation - Urinary retention - Blurred vision
70
Side effects of Central Alpha 2 Agonists (both meds)
Rebound HTN with abrupt cessation
71
List the Peripheral Adrenergic Antagonist
Reserpine
72
What are the side effects of Reserpine?
1. Significant sodium and water retention- Give with diuretic (Thiazide) 2. Reflex Parasympathetic Activity - Nasal stiffness - Increased gastric secretion - Diarrhea - Bradycardia
73
What population would we consider treating with Nondihydropyridine CCB?
Elderly with isolated systolic HTN
74
What is the only CCB safe to use in pt's with severe heart failure?
Amlodpine
75
What do you use to treat Raynauds?
Dihydropyridine CCB
76
What is an effective antihypertensive in African Americans?
CCB
77
Side effects of ALL calcium channel blockers?
Gingival hyperplasia Peripheral edema Dizziness, flushing, HA
78
Verapamil side effects
Constipation
79
Calcium channel blocker drug interactions
``` 1. Inhibit metabolism of: Digoxin Lovastatin Simvastain Cyclosporine ```
80
What inhibits Nifedipine metabolism
large quantities of grapefruit juice (> 1quart)
81
List the direct arterial vasodilators
Hydralazine | Minoxidil
82
What is a side effect of Hydralazine?
Dose dependent lupus-like syndrome and slow acetylators
83
What is a side effect of Minoxidil
Hypertrichosis
84
What is an alternative use of minoxidil?
Male pattern baldness | -->both men and women
85
List an osmotic diuretic
Mannitol
86
Clinical applications for Osmotic Diuretics (Mannitol)
- Solute overload in rhabdomyolysis, hemolysis - Brain edema w/ coma - Acute glaucoma
87
What medications are useful in pituitary diabetes insidious?
ADH and Desmopressin
88
Contraindications in ADH agonists (Desmopression, vasopressin)
1. Hyponatremia | 2. Hypertension
89
What would you use to treat syndrome of inappropriate ADH secretion (SIADH)
ADH antagonists - Demeclocycline - Conivaptan
90
What ADH antagonists would you use to treat hyponatremia?
Conivaptan

Pharmacology- HTN (1 decks)

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