Therapeutic Considerations

Question 1

How is aliskiren excreted and metabolized

Answer 1

-hepatobiliary excretion with minimal hepatic metabolism by CYP34A

Question 2

Which drugs increase the half-life of aliskiren?

Answer 2

-atrovastatin and ketoconazole

Question 3

Which drugs decrease the half-life of aliskiren?

Answer 3

furuosemide

Question 4

What effect does aliskiren have on chronic kidney disease?

Answer 4

-it may reduce proteinuria

Question 5

What are the three patterns of metabolism of ACE inhibitors?

Answer 5

1. administered as an active drug and processes to active metabolites (captopril)
2. ester prodrugs converted to active metabolites in plasma (enalapril and ramipril)
3. administred as active drug and excreted unchanged (lisinopril)

Question 6

ACE inhibitors cause which two side effects as result of bradykinin action?

Answer 6

-cough and angioedema

Question 7

What are two possible first dose effects of ACE inhibitors? In which types of patients is it most common

Answer 7

• first-dose hypertension and/or acute renal failure

- more common in patients with bilateral renal artery stenosis

Question 8

ACE inhibitors administered with with other class of drug can cause hyperkalemia?

Answer 8

-potassium sparing diuretics

Question 9

Which two disease processes do ACE inhibitors delay?

Answer 9

• they delay the progression of cardiac contractile dysfunction in heart failure and after MI
• they also delay the progression of diabetic neuropathy

Question 10

ACE inhibitors administered with which other drug may predispose a patient to Stevens-Johnson syndrome?

Answer 10

-co-administration with allopurinol

Question 11

How do angiotensin II receptor antagonists compare to ACE inhibitors

Answer 11

-angiotensin II receptor antagonists do not cause cough or angioedema, but they may be less effective vasodilators compared to ACE inhibitors

Question 12

Angiotensin II receptor antagonists used with ACE inhibitors can improve outcome in which two pathologic processes?

Answer 12

-heart failure and stroke

Question 13

When are angiotensin II receptor antagonists prescribed as first-line therapy?

Answer 13

-if patients have intolerable reactions to ACE inhibitors

Question 14

What effects does nesiritide (BNP) have on hemodynamic factors?

Answer 14

-it decreases pulmonary capillary wedge pressure, it decreases systemic vascular resistance, and improves cardiac hemodynamic parameters such as stroke volume

Question 15

Nesiritide may be associated with lower incidence of arrhythmia in comparison with with other drug?

Answer 15

-dobutamine

Question 16

Which two side effects of nesiritide are more common in the presence of acute heart failure?

Answer 16

-hypotension and renal dysfunction

Question 17

Co-administration of nesiritide and which other drug class increases the risk of hypotension?

Answer 17

-ACE inhibitors

Question 18

Which two plasma substances does nesiritide lower?

Answer 18

-aldosterone and endothelin-1

Question 19

Which vasopressin receptor 2 antagonist is non selective and must be administered IV?

Answer 19

-conivaptan

Question 20

Which vasopression receptor 2 antagonist is an orally available V2-selective agent?

Answer 20

-tolvaptan

Question 21

Which vasopressin receptor 2 antagonist may slow renal cyst growth in polycystic kidney disease?

Answer 21

-tolvaptan

Question 22

Use of which drug is associated with mild to moderate metabolic acidosis?

Answer 22

-acetazolamide

Question 23

Which drug is used in heart failure to restore acid-base balance?

Answer 23

-acetazolamide

Question 24

What affect do carbonic anhydrase inhibitors have on the eye?

Answer 24

-reduced secretion of aqueous humor may reduce elevated intraocular pressure in glaucoma

Question 25

Which drug can be used prophylactically against acute mountain sickness?

Answer 25

-acetazolamide

Question 26

What effect do carbonic anhydrase inhibitors have on urine?

Answer 26

-the alkalinize urine and increase urinary excretion of endogenous and exogenous organic anions; can be used in the treatment of hyperuricemia or gout

Question 27

Which drug increases plasma concentration of acetazolamide, potentially leading to CNS toxicity?

Answer 27

-aspirin

Question 28

Which drug promotes vigorous natriuresis?

Answer 28

-mannitol

Question 29

What is a potential consequence of mannitol?

Answer 29

-excess water loss can lead lead to hypernatremia

Question 30

When would mannitol be used?

Answer 30

-it is used primarily for rapid reduction of intracranial pressure in the setting of head trauma, brain hemorrhage, or symptomatic cerebral mass, rarely used in treatment of compartment syndrome

Question 31

What is the most potent loop diuretic?

Answer 31

-bumetanide

Question 32

What is the pro type loop diuretic?

Answer 32

-furosemide

Question 33

Which loop diuretic could be used if the patient has a sulfa allergy?

Answer 33

-ethracynic acid

Question 34

Loop diuretics are the front-line treatment for which conditions?

Answer 34

• pulmonary and peripheral edema in heart failure

- edematous states secondary to diminished oncotic pressure of hypoalbuminemia

Question 35

What two states can loop diuretics counteract?

Answer 35

-hypercalcemic and hyperkalemic states

Question 36

Which class of drugs is the first-line treatment of hypertension?

Answer 36

-thiazide diuretics

Question 37

HCTZ decreases tolerance of which substance? What are the implications?

Answer 37

-HCTZ decreases glucose tolerance and may unmask diabetes in patients at risk

Question 38

Thiazide diuretics should not be administered with which other types of drugs?

Answer 38

-antiarrhythmic agents that prolong the QT interval

Question 39

What is a side effect of thiazide diuretics when used with patients who have nephrogenic diabetes inspidus?

Answer 39

-a modest decrease in urine flow

Question 40

Collecting duct diuretics are used with which other class of drugs to counteract potassium wasting?

Answer 40

-thiazide diuretics

Question 41

What receptor does spironolactone antagonize? What are the therapeutic effects?

Answer 41

-it antagonizes the androgen receptor which can cause impotence and gynecomastia in men; treats acne and hirsutism in women

Question 42

Which class of drugs treats hypokalemic alkalotic states?

Answer 42

-collecting duct diuretics

Question 43

Which drugs are the drugs of choice for treatment of Liddle’s syndrome?

Answer 43

-amiloride and triamterene