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Pharmacology- HTN > Pharmacology-HTN > Flashcards

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
Q

How much does HCTZ lower SBP?

A

15 to 20 mmHg

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26
Q

How much does HCTZ lower DBP?

A

8 to 15 mmHg

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27
Q

What do you need to monitor in Thiazides?

A

BUN
Creatinine
Uric acid level
Electrolytes: K+, Na+, Ca++, Mg+++

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28
Q

What is the cortical collecting tubule controlled by?

A

Aldosterone

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29
Q

How much sodium reabsorption is the cortical collecting tubule responsible for?

A

2-5%

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30
Q

How does the sodium reabsorption occur at the cortical collecting tubule with Aldosterone?

A

Via ENaC–> accompanied by loss of potassium or hydrogen ions

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31
Q

What is the primary site of acidification of the urine and the last site of potassium excretion?

A

cortical collecting tubule

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32
Q

What is the site of action of the potassium-sparing diuretics?

A

Aldosterone receptor

Sodium channels

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33
Q

What are the clinical applications of Spironolactone

A

Excessive K+ loss when using other diuretics

Aldosteronism

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34
Q

What are the contraindications to Spironolactone

A

Hyperkalemia
Hyponatremia
Gynecomastia

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35
Q

What are the clinical applications of Amiloride

A

Excessive K+ loss when using other diuretics

Usually in combination with thiazides

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36
Q

What are the contraindications to Amiloride?

A

Hyperkalemia

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37
Q

What is the mechanism of potassium sparing diuretics?

A

Blocks the epithelial Na+ channel action proximal to the distal convoluted tubule

38
Q

What is the side effect of potassium sparing diuretics?

A

Hyperkalemia

39
Q

When is potassium sparing diuretics contraindicated?

A

Renal failure

40
Q

When do you want to avoid use of potassium sparing diuretics?

A

in CrCl <10 ml/min

41
Q

What does potassium sparing drugs decreases the levels/effect of?

A

Cardiac glycoside

42
Q

Mechanism of ARB

A

Angiotensin receptor blocker—net

43
Q

List an example of an ARB

A

Lasartan

44
Q

What are the two main side effects of ACE inhibitors AND ARBs?

A
  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
Q

What are the two main side effects of ACE inhibitors?

A
  1. Dry cough

2. Angioedema—Lip and tongue swelling most common

46
Q

What population are ACE1 and ARBs the most effective?

A

Young, white patients

47
Q

What population are ACE1 and ARBs the least effective?

A

Blacks
older persons
Pt’s predominantly systolic HTN

48
Q

What antihypertensive is the choice for DM?

A

ACE1 and ARBs

49
Q

What labs do we want to monitor in ACE1 and ARBs?

A

Serum creatinine

K+

50
Q

What antihypertensive is absolutely contraindicated in pregnancy?

A

ACE1 and ARBs

51
Q

List a Renin Inhibitor

A

Aliskiren

52
Q

What type of patient should ACEI, ARBs and renin inhibitors be avoided?

A
  • Hyperkalemia
  • Pregnant
  • Pulmonary/Cough
  • Significant CKD
53
Q

Action of α1receptors

A

Vasoconstriction of arterioles and venules

54
Q

Action of α2 receptors

A

regulation of α1

55
Q

Action of β1 receptors

A

Increase HR
Increase contractility
Renin release

56
Q

Action of β2 receptors

A

Vasodilation of arterioles and venules
Bronchodilation and Vasodilation: lung, liver, pancreas, and arteriolar smooth muscle
Gluconeogenesis

57
Q

What is the result of sympathoplegic drugs?

A 
A reduction in one or more of the following:
Venous tone
HR
Contractile force
CO
TPR
58
Q

List Beta Blockers

A

Propanolol
Metoprolol
Atenolol

59
Q

What is the mechanism of Beta Blockers?

A

Block β1 and β2 receptors of the SNS:

  • Negative chronotropic and inotropic= decreased CO
  • Inhibits release of Renin
60
Q

What are the main side effects of Beta Blockers?

A

Bradycardia,
AV conduction abnormalities
Acute heart failure
Acute exacerbations of asthma or COPD (bronchospasms)

61
Q

How are beta blockers differentiated?

A
  1. Cardioselectivity
  2. ISA
  3. Membrane-stabilizing effect
62
Q

What should you monitor with beta blockers?

A

Assess for CHF

Monitor BS in DM

63
Q

List the Alpha 1 blockers

A

Prazosin
Terazosin
Doxazosin

64
Q

What is the main side effect of Alpha 1 Blockers?

A

First Dose Phenomenon and an increased dose effect: Dizziness/faintness
Palpitations
Syncope

65
Q

What patients would we recommend an Alpha blocker to?

A

Pt’s with BPH

PTSD related nightmares and sleep disruption

66
Q

What are the drug interactions of Alpha 1 Blockers?

A

Decrease levels of:
Dabigatran
Linagliptin

67
Q

List Central Alpha 2 Agonists

A

Clonidine

Methyldopa

68
Q

Side effects of Methyldopa

A
  1. Sodium and water retention-Give a diuretic

2. Hepatitis or hemolytic anemia= transient rise in LFT’s

69
Q

Side effects of Clonidine

A

Anticholinergic side effects:

  • Sedation
  • Dry mouth
  • Constipation
  • Urinary retention
  • Blurred vision
70
Q

Side effects of Central Alpha 2 Agonists (both meds)

A

Rebound HTN with abrupt cessation

71
Q

List the Peripheral Adrenergic Antagonist

A

Reserpine

72
Q

What are the side effects of Reserpine?

A
  1. Significant sodium and water retention- Give with diuretic (Thiazide)
  2. Reflex Parasympathetic Activity
    - Nasal stiffness
    - Increased gastric secretion
    - Diarrhea
    - Bradycardia
73
Q

What population would we consider treating with Nondihydropyridine CCB?

A

Elderly with isolated systolic HTN

74
Q

What is the only CCB safe to use in pt’s with severe heart failure?

A

Amlodpine

75
Q

What do you use to treat Raynauds?

A

Dihydropyridine CCB

76
Q

What is an effective antihypertensive in African Americans?

A

CCB

77
Q

Side effects of ALL calcium channel blockers?

A

Gingival hyperplasia
Peripheral edema
Dizziness, flushing, HA

78
Q

Verapamil side effects

A

Constipation

79
Q

Calcium channel blocker drug interactions

A 
1. Inhibit metabolism of: 
Digoxin
Lovastatin
Simvastain
Cyclosporine
80
Q

What inhibits Nifedipine metabolism

A

large quantities of grapefruit juice (> 1quart)

81
Q

List the direct arterial vasodilators

A

Hydralazine

Minoxidil

82
Q

What is a side effect of Hydralazine?

A

Dose dependent lupus-like syndrome and slow acetylators

83
Q

What is a side effect of Minoxidil

A

Hypertrichosis

84
Q

What is an alternative use of minoxidil?

A

Male pattern baldness

–>both men and women

85
Q

List an osmotic diuretic

A

Mannitol

86
Q

Clinical applications for Osmotic Diuretics (Mannitol)

A
  • Solute overload in rhabdomyolysis, hemolysis
  • Brain edema w/ coma
  • Acute glaucoma
87
Q

What medications are useful in pituitary diabetes insidious?

A

ADH and Desmopressin

88
Q

Contraindications in ADH agonists (Desmopression, vasopressin)

A
  1. Hyponatremia

2. Hypertension

89
Q

What would you use to treat syndrome of inappropriate ADH secretion (SIADH)

A

ADH antagonists

  • Demeclocycline
  • Conivaptan
90
Q

What ADH antagonists would you use to treat hyponatremia?

A

Conivaptan

Pharmacology- HTN (1 decks)

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