Treatments Quiz 5 (final week)

Question 1

Carvedilol

Answer 1

Selective Beta blocker

Improves survival in CHF

Question 2

Ethacrynic acid

Answer 2

Loop diuretic that blocks NKCC in ascending loop of Henle.

Same as furosemide.

Question 3

Apresoline

Answer 3

Arterial Vasodilator

Question 4

Treatment for Diastolic CHF

Answer 4

Beta-blocker (more time for filling) and ACEI’s (decrease afterload and preload, but still has shown efficacy)

Not diuretics or Nitro

Question 5

Nesiritide (Natrecor)

Answer 5

MOA: drug form of BNP –> decrease in systemic vascular resistance and central venous pressure as well as an increase in natriuresis (sodium excretion). Thus, the net effect of BNP is a decrease in blood volume, which lowers systemic blood pressure and afterload, yielding an increase in cardiac output, partly due to a higher ejection fraction.

Needs to be infused IV

For stage IV HF. Improved dyspnea

Side effect - hypotension, cost

Question 6

Metolazone (Zaroloxyn)

Answer 6

Quinazoline diuretic (similar to thiazides except PCT not DCT)

Inhibits Na/Cl cotransporter in PCT.

Side effects = hypokalemia

Question 7

Ace Inhibitors (-pril)

Answer 7

MOA: Inhibit conversion of Angiotensin I to Angiotensin II
-Angiotensin II on the VSM results in an increase in intracellular Ca++ leading to vasoconstriction (increased BP)
-Angiotensin II on the proximal tubule results in increased Na+ reabsorption (H2O follows) → increased fluid volume → increased CO → increased BP
-Angiotensin II also results in an increased H+ excretion → increased Bicarbonate reabsorption → increased pH
Angiotensin II also acts on the adrenal cortex to cause an increase in aldosterone → sodium retention and potassium excretion (too much ACEI→ not enough potassium excretion = HYPERKALEMIA)

Question 8

Angiotensin Receptor Blocker

Answer 8

MOA - Block receptors of Angiotensin II (AT1) on both the Vascular Smooth Muscle and the proximal tubule of the kidney.

• Angiotensin II on the VSM results in an increase in intracellular Ca++ leading to vasoconstriction (increased BP)
• Angiotensin II on the proximal tubule results in increased Na+ reabsorption (H2O follows) → increased fluid volume → increased CO → increased BP
• Angiotensin II also results in an increased H+ excretion → increased Bicarbonate reabsorption → increased pH

Question 9

Clonidine

Answer 9

MOA: Stimulates alpha 2 receptors à block adenylyl cyclase à decrease norepinephrine release à decrease blood pressure

• Use in hypertensive urgency
• Adverse effects – fatigue, sedation, dry mouth, salt/water retention

Question 10

Aliskiren

Answer 10

Direct Renin Inhibitor

Rarely used due to its severe side effects but it does exist.

Question 11

HCTZ (thiazide diuretics)

Answer 11

Blocks Sodium Reabsorption in the DCT of the kidney → decreased water reabsorption

Specifically blocks the Na/Cl co-transporter by competing for the binding of the chloride site

In an unrelated mechanism, thiazides increase Calcium reabsorption

Side effects: hypokalemia

Question 12

Furosemide

Answer 12

Inhibits the NKCC pump on ascending Loop of Henle→ decreased sodium transport → decreased H2O reabsorption

Side effects: hypokalemia

Question 13

Spironolacone

Answer 13

MOA: aldosterone receptor antagonist –> decreased sodium resorbtion (increased potassium resorbtion)

Positive effects in treating CHF.

Potassium sparing –> can cause hyperkalemia

Question 14

Terazosin (-zosins)

Answer 14

Antagonism of alpha receptors leads to decreased constriction of VSM → decreased TPR → decreased BP

*for final just remember the various effects of adrenergic agonists on BP given adrenergic antagonists

Question 15

Hydralazine

Answer 15

MOA unknown –> arteriolar specific vasodilation.

Used in pregnancy and for African Americans w/ CHF (along w/ isosorbide dinitrate = BiDil)

Question 16

Clonidine

Answer 16

Alpha 2 agonist –> decreased NE release

Question 17

Alpha-methyl dopa

Answer 17

Alpha 2 agonist –> decreased NE release

Safe in pregnancy

Question 18

Guanabenz

Answer 18

Alpha 2 agonist –> decreased NE release

Question 19

Polystyrene sulfonate (Kayexalate)

Answer 19

Gastrointestinal excretion of potassium is accomplished using sodium polystyrene sulfonate (Kayexalate), which binds potassium in the colon in exchange for sodium.

It can be given orally or as a retention enema. The enema form is faster

Question 20

Dextrose/Insulin

Answer 20

Elevated insulin levels induce rapid transport of potassium from the extracellular space into cells via cellular sodium-potassium adenosine triphosphatase.

The dextrose is to prevent hypoglycemia w/ insulin injection.

A beta-2 agonist nebulizer can have additional effects of lowering potassium.

Question 21

DASH diet

Answer 21

Dietary Approach to Stop Hypertension

The DASH diet encourages you to reduce the sodium in your diet and eat a variety of foods rich in nutrients that help lower blood pressure, such as potassium, calcium and magnesium.

Plant-focused diet, rich in fruits and vegetables, nuts, with low-fat and non-fat dairy, lean meats, fish, and poultry, mostly whole grains, and heart healthy fats.

Limit of 2,300mg of Na.