Quiz 1 AntiHTN/Diuretics Flashcards
- **We have a 28-year-old female patient with Stage II essential hypertension, tachycardia, and occasional palpitations (ventricular ectopic beats). Normally we might consider prescribing a beta blocker to control the blood pressure and cardiac responses, but our patient also has asthma, and she is trying to get pregnant. Which of the following drugs would be the best alternative to the beta blocker in terms of likely efficacy on pressure and heart rate, and in terms of relative safety?
a. Diltiazem
b. Enalapril
c. Furosemide
d. Phentolamine
e. Prazosin
A. Diltiazem (calcium channel blocker)
Asthma, no non selective Beta Blocker
A 55 year old male patient comes to his primary care physician for his routine health care examination. He is completely asymptomatic and has nothing significant in his past medical history. He has 10 pack years of cigarette smoking but he does not drink. His PR:80/min; BP: 150/78 mm Hg; Temperature: 37.1C(98.8F). Labs show hematocrit of 43%, blood glucose of 90 mg/dl, serum creatinine of 0.7 mg/dL, serum Na of 140 mEq/L and serum K of 4 mEq/L. Urinalysis and EKG are unremarkable. His blood pressure readings on subsequent visits are 155/80 mmHg, 160/78 mmHg and 150/70 mmHg. Life-style modifications fail to contrl his blood pressure. Which of the following is the best initial pharmacological therapy for the control of his blood pressure?
A. Thiazide diuretics B. Hydralazine C. Sodium Nitroprusside D. Angiotensin Receptor Blockers E. Sodium channel blockers
A. Thiazide Diuretics
- *An 83-year-old man has been effectively treated with hydrochlorothiazide to control his elevated blood pressure. He has had a recent onset of weakness. Blood chemistry analysis reveals hypokalemia. Another drug is added, and 1 month later his serum K+ is normal. Which of the following drugs most likely helped normalize his serum potassium levels?
a. Acetazolamide
b. Amiloride
c. Furosemide
d. Metolazone
e. Mannitol
B. Amiloride
(Amiloride is a K-sparing diuretic with a mild diuretic and
natriuretic effect)
A 52 year old man with a 30 pack year history of cigarette smoking presents to a physician. He was told that he has high cholesterol about 2 years ago, and he has history of mild HTN for which he has never been treated. He had MI 6 months ago. His post MI has been uncomplicated. His medications include one aspirin tablet every other day. Physical examination is normal except 4th heart sound. Which of the following is most appropriate next step in management to prevent morbidity and mortality?
A. Add beta blocker B. Add diuretics C. Add calcium channel blocker D. Increase aspirin dose three times daily E. Prescribe nitroglycerin for angina
A. Add beta blocker
*Morbidity and mortality
A 70-y/o woman is admitted to the emergency room because of a “fainting spell” at home. She appears to have suffered no trauma from her fall, but her bp is 110/60 when lying down and 60/40 when she sits up. Neurologic examination and an ECG are within normal limits when she is lying down. Questioning reveals that she has recently started taking “water pills” for a heart condition. Which of the following drugs is the most likely cause of her fainting spell?
a. Acetazolamide
b. Amilioride
c. Furosemide
d. Mannitol
e. Spironolactone
The case history suggests that the syncope is associated with diuretic use. Complications of diuretics that can result in syncope include both postural hypotension due to excessive reduction of blood volume and arrhythmias due to excessive potassium loss. Potassium wasting is more common with thiazides (because of their long duration of action), but these drugs rarely cause reduction of blood volume sufficient to result in orthostatic hypotension. The answer is C, furosemide.
An elderly patient with a history of heart disease and who is having difficutly breathing is brought into the ER. Examination reveals she has Pulmonary Edema. Which of the following treatment is most commonly indicated? A. Hydrochlorthiazide B. Chlorathridone C. Spirinolactone D. Furosemide E. Mannitol
Furosemide
Lippencott Osmotic Diuretics
A 23 year old man expresses concern about his upcoming skiing trip to Breckenridge Colorado (elevation=10,000 feet) He states every time he goes there he gets high altitude sickness that is relieved when he is given oxygen. The family physician gives the patient a prescription for oxygen to use when he arrives in Colorado as well as a perscription for Acetazolamide to take three days prior and throughout his 4 day trip. Carbonic Anhydrase Inhibitors exert their diuretic effect by inhibiting reabsorption of Na+ in which of the following parts of the nephron? A. PCT B. Ascending Limb C. DCT D. Cortical Collecting Duct E. Outer Medulary Collecting Duct
A. PCT
Acetazolamide, a member of the sulfanide family of antibacterial drugs blocks carbonic anhydrase activity which of the following would most likely occur after treatment with Acetazolamide?
A. Increase bone resorption
B.Metabolic alkylosis
C. Increased acid production by parietal cells
D. Inhibition of diuresis
E. Decrease bicarbonate in the pancreatic juice
E. Decrease bicarbonate in the pancreatic juice
***A patient is hospitalized and waiting for coronary angiography. His history includes angina pectoris that is brought on by “modest” exercise, and is accompanied by transient electrocardiographic changes consistent with myocardial ischemia. There is no evidence of coronary vasospasm. In
the hospital he is receiving nitroglycerin and morphine (slow intravenous infusions), plus oxygen via nasal cannula.
He suddenly develops episodes of chest discomfort. Heart rate during these episodes rises to 170-190 beats/min; blood pressure reaches 180-200/110-120 mm Hg, and prominent findings on the EKG are runs of ventricular ectopic beats that terminate spontaneously, plus ST-segment elevation.
Although there are several things that need to be done for immediate care, administration of which one of the following is most likely to remedy (at least temporarily) the majority of these signs and symptoms and pose the lowest risk of doing further harm?
a. Aspirin
b. Captopril
c. Furosemide
d. Labetalol
e. Lidocaine
f. Nitroglycerin (increased dose as a bolus)
g. Prazosin
C. Labetalol (decrease HR and decrease BP because it has beta and alpha blocking properties)
Given its combination of both α/β blocking effect, it is the best approach for managing the hypertension, the tachycardia, oxygen supply-demand imbalance that leads to both CP and the ischemic ST-changes, and the ventricular ectopy - which is probably a reflection of excessive catecholamine stimulation of β1
receptors
A patient presents for treatment of his severe essential HTN. He is being treated with numerous medications for high blood pressure, and hydralazine was recently added to his medication regimen. He explains that he has been experiencing flushing and headaches since his last visit, when hydralazine therapy was started. Which of the following is an adverse effect of hydralazine?
A. Anginal attack B. Bradycardia C. First-dose orthostatic hypotension E. Nephrotoxicity F. Pulmonary embolism
A. Anginal attack, orthostatic HTN if given
Adverse effect of hydralazine
***An elderly male patient who has just been referred to your practice has been taking a drug for symptomatic relief of benign prostatic hypertrophy.
In addition to its effects on smooth muscles of the prostate and urethra, this drug can lower blood pressure in such a way that it reflexly triggers tachycardia, positive inotropy, and increased AV nodal conduction. The drug neither dilates nor constricts the bronchi. It causes the pupils of the eyes to constrict and interferes with mydriasis in dim light. Initial oral dosages of this drug have been associated with a high incidence of syncope. Which prototype is most similar to this unnamed drug in terms of the pharmacologic profile?
a. Captopril
b. Hydrochlorothiazide (prototype thiazide diuretic)
c. Labetalol
d. Nifedipine
e. Prazosin
f. Propranolol
g. Verapamil
E. Prazosin
Alpha 1 beta blockers - BPH (Benign prostatic hypertrophy
A 60 year old hypertensive woman presents to her physician with visual changes. Transient ischemic attack is ruled out. She is then referred to an ophthalmologist, who prescribes a medication that subsequently causes drowsiness and tingling in her arms. Lab evaluation reveals hyper choleric metabolic acidosis. Which of the following drugs was most likely prescribed? A. Acetazolamide B. Demeclocyline C. Etharcrynic acid D. Furosemide E. Hydrochlorothiazide F. Spironolactone
A. Acetazolamide
A patient with heart failure has been managed with digoxin and furosemide and is doing well by all measures, for 3 years. He develops acute rheumatoid arthritis and is placed on rather large doses of a very efficacious nonsteroidal anti-inflammatory drug—one that inhibits both cyclooxygenase pathways (COX-1 and -2). Which of the following is the most likely outcome of adding the NSAID?
A. Hyperchloremic acidosis indicative of acute diuretic toxicity
B. Dramatic increase of furosemide’s potassium-sparing effects
C. Edema, weight gain, and other signs/symptoms indicative of reduced diuresis
D. Increased digoxin excretion
E. Reduced digoxin effects because the NSAID competes with digoxin for myocyte receptor-binding sites
C. Edema, weight gain, and other signs/symptoms indicative of reduced diuresis
***A 48 year old hypertensive patient has been sucessfully treated with a thiazide diuretic for the last five years. Over the last three months, his diastolic pressure has steadily increased, and he has been started on an additional hypertensive medication. He complains of several instances of being unable to achieve an erection and that he is no longer able to complete three sets of tennis. The second anyhypertensive medication is most likelt which one of the following?
A. Captopril B. Losartan C. Minoxidil D. Metoprolol E. Nifedipine
D. Metoprolol
Beta blockers - decrease in sexual dysfunction
***A 48 year old hypertensive patient has been sucessfully treated with a thiazide diuretic for the last five years. Over the last three months, his diastolic pressure has steadily increased, and he has been started on an additional hypertensive medication. He complains of several instances of being unable to achieve an erection and that he is no longer able to complete three sets of tennis. The second anyhypertensive medication is most likelt which one of the following?
A. Captopril B. Losartan C. Minoxidil D. Metoprolol E. Nifedipine
D. Metoprolol
Beta blockers - decrease in sexual dysfunction
