pharmacology htn

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1
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what is the biggest contributing factor to hypertension
peripheral resistance
2
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what is the blood pressure equation
cardiac output x peripheral resistance = arterial bp
3
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what determine cardiac output
heart rate x stroke volume
4
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what is the MOA of diuretics?
acts on kidney to increase excretion of Na and H2O decrease in blood volume- decreased BP
5
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what is the MOA of ACE?
inhibit synthesis of Angiotensin II - decrease peripheral resistance and blood volume
6
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what is the moa of ARBs (AT1 blocker)?
blocks binding of angiotensin II to its receptors
7
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what is the moa of centrally acting drugs
act on central a2A receptors to decrease sympathetic outflor fall in BP
8
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list thiazides
hydrochlorothizide, chlorthalidone
9
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high ceiling drug
furosemide
10
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potassium sparing drugs
spironlactone, triamterene, and amiloride
11
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triamterene is a
potassium sparing
12
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centrally acting
clonidine, methyldopa
13
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what is the moa of a-adrenergic blockers
blocking of alpha adrenergic receptros in smooth muscles
14
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list a-adrenergic blockers
prazosin, terazosin, doxazosin, phenoxybenzamine, phentolamine
15
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what is moa of calcium blockers
blocks influx of Ca++ in smooth muscle cells - relaxation of SMCs - decrease BP
16
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Which of the following belong to diuretics? (list 6)
carbonic anhydrase inhibitors
thiazides
sodium glucose cotransporter 2 (SGLT2) inhibitors
loop diuretics
potassium sparing diuretic
agents that alter water excretion (aquaretics)
17
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where does thiazide and carbonic anhydrase inhibitor belong to?
diuretic
18
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what is goal of the kidney?
excrete excess sodium in the body to make urine
19
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what does the afferent arteriole do?
blood comes in and filters it, adds filtrate
20
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what does the efferect arteriole do?
dumps protein and RBCs back into the blood as you are filtering throught the bowman's capsule
21
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what is the role of the PCT -proximal convoluted tubule?
reabsorbs 90% of water, sodium, potassium, glucose, amino acid into the blood
reabsorbs nutrients ( tubular fluid) from the filtrate
22
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what is true about the descending loop
its permeable to water but impermeable to sodium
23
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what is true about the ascending loop?
impermeable to water, permeable to sodium
24
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where does aldosterone work?
collecting duct
25
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a cup shaped chamber in the renal corpuscle is called
glomerular capsule - bowman's capsule
26
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what concentrates urine and establishes osmotic gradient for water reabsorption?
nephron loop
27
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what adjust tubular fluid composition by reabsorption and secretion of potasium
distal convoluted tubule (DCT)
28
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what renal site determine efficacy and potency the most and is the most significant drug target?
loop
29
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what renal site determine efficacy and potency the least
late distal tubule
30
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drug that acts on early distal tubule
thiazides
31
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drug that acts on loop of henle
furosemide
32
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drugs acting on late distal tubule
triamterene, spironolactone, amiloride
33
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which of the following is true about carbonic anhydrase inhibitor?
they were found that bacteriostatic sulfonamides causes an alkaline diuresis and hypercholemic metabolic acidosis
34
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name a carbonic anhydrase inhibitor
acetazolamide
35
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describe the MOA of CA inhibitor
usually the more H+ that is pumped out into the urine, the more Na+ that is being reabsorbed into the blood -> water follows Na+ where-ever it goes so BP increases -> CARBONIC ANHYDRASE INHIBITORS PREVENT H FROM BEING MADE FROM BREAKDOWN OF CARBONIC ACID
36
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name naturetics
thiazides and loops
37
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what is the first step in treating htn that is inexpensive and effective
thiazide diuretics
38
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which of the following class of diuretics has vasodilator activity? ****
thiazides
39
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which of the following diuretics drugs has vasodilator activity? ****
hydrochlorothiazides
40
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what is the main function of thiazides
its a diuretic so it decrease sodium, water retention, decrease blood volume, cardiac output decrease
41
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what are hydrochlorothiazide effects?
HYPOTENSIVE!!
gout -elevates UA
dm -elevates glucose
hypokalemia
42
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what metabolite cause vasodilator activity in HCTZ?
urinary kallikreain
43
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what drug and drug class has diuretic activity and vasodilation?
HCTZ - thiazides
44
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what drug can you not give if the patient has a sulfonamide allergy?
hydrochlorothiazide
45
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what drug causes lithium toxicity, decrease calcium excretions and decrease effectiveness of insulin/sulfonylureas?*** know these three
hydrochlorothiazide
46
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what is true about hydrochlorothiazides?**
glucose levels go up by decreasing effectivness of insulin/sulfonylureas -makes diabetes worse - so need to increase insulin dose
47
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what will happen if someone is taking lithium and hctz?
drug interaction - lithium toxicity -increase lithium levels
48
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what drug interaction will happen if a person takes HCTZ and calcium salts?
decrease calcium excretion which will increase calcium blood levels
49
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someone with diabetes take HCTZ what happen
drug interaction with insulin - decrease effectiveness
50
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what should you do if the thiazide therapy is failing?**
DO NOT increase dose, -may cause hypokalemia take another antihypertensive

add on loop diuretics when there is severe htn - combination therpay
51
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which of the following is true about indapamide
its a modified thiazide
drug is lipid neutral - will not increase your lipid levels
52
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what are thiazides used for?
hypertension
CHF
Edema
ideiopathic hypercalcuria
diabetes insipidus - decrease plasma volume
53
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what adverse drug effects do thiazides cause again
hyperglycemia
hyperuricemia
hyperlipidemias
hyponatremia
54
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which of the following is true about metolazone?
used in patients with renal failure and nephrotic syndrome
cardiovascular agent - quinazole diuretic related to the thiazide class
inhibits sodium transport in distal tubules
55
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what drug is primarily used with furosemide to inhibit early distal tubular pump which is responsible for loop diuretic resitance?
furosemid
56
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what is the more effective and potent naturetics?
loop diuretic
57
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loop diuretic moa
blocks sodium, potassium, and chloride cotransporter (loop usually is meant to reabsorb ions and not water)
58
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which of the following drug belongs to loop diuretics?
furosemide
59
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if someone takes diuretics and take thiazide, what will happen?
increase glucose level (because potassium gets excreted out – it helps in production of insulin)
60
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what is the moa of furosemide
inhibits Na+Cl- reabsorption in the thick ascending limb
61
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furosemide decreases ...
peripheral resistance
62
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what side effects of furosemide?
Hyponatremia, hypokalemia, hyperglycemia, hyperlipidemia
63
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*which of the following is a potassium sparing diuretic?
spironlactone
64
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what drug is good for diabetes patients?
sparing potassium
65
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what is combined with spironlactone if using combination therapy?
thiazide diretics - K+losing naturetics
66
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If 3 Na go out, then how many cl comes in?
2
67
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what blocks sodium potassium chloride cotransporter?
loop diuretics
68
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what drugs are direct ENac inhibitors?
amloride and triamterene
69
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what is moa of amiloride and triamterene?
inhibit the influx through epithelial Na channel in the luminal membrane
70
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what inhibits aldosterone ?**** his favorite question
spironlactone
71
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what does triamterene inhibit? ***
membrane function
72
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what drug inhibits Na/K+ ATPase?
amiloride
73
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what drug can you not give if the patient has liver dysfunction?
spironolactone
74
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why is spironalctone better than HCTZ? ***
NO hypokalemia, hyperglycemia, hyperuricemia, which is seen with thiazide and loops
75
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what is the MOA of eplerenone?***
selectively binds to mineralocorticoid receptor and BLOCKS THE BINDING OF ALDOSTERONE, a component of the Renin angiotensin aldosterone system (RAAS)
76
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Which of the following is selective aldosterone-receptor antagonist?***
eplerone
77
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What block aldosterone (usually works through the mineralocorticoid receptor ?
eplerone
78
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which drug should you be cautious with if patient has type 2 diabetes?
eplerone
79
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eplerone is contraindicated in patients
high serum potassium
creatinine clearance more than 30
concomitant administration of strong CYP3A4 inhibtors like ketoconazole, itraconazole, nefazodone, oleandomycin, clarithromycin, ritonavir, and nelfinavir)
80
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Which of the following is the metabolite of spironolactone?***
canrenoate and canrenone
81
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what is a good alternative to spironolactone if you have hepatic issue such as cirrhosis?
canrenoate and canrenone
82
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which of the following is true about canrenoate and canrenone?
theyre metabolites bypasses hepatic metabolism
83
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amiloride is used to treat
HTN and CHF
84
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which of the following is true about amiloride?
potassium sparing effect useful for preventing hypokalemia combined with THZ or other kaliuretic agents
85
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what produces angiotensinogen
liver
86
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what produces renin
kidney
87
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where does angiotensinogen 1 go to?
lungs
88
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angiotensin 2 causes
vasoconstriction
89
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what blocks angiotensin 2 from causing vasoconstriction
ARBS
90
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what blocks angiotensin 1 from converting to 2?
ACEi
91
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the production of angiotensinogen is increased by
corticosteroids, estrogen, thyroid homones, and ANG II
92
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renin is secreted in repsonse to what
-decrease in arterial blood pressure
-decrease Na+ in macula densa
-increased sympathetic nervous activity
93
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renin acts on a plasma protein like
angiotensinogen which is synthesized into the blood stream by the liver
94
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AT II is a
potent vasoconstictor which lead to increase BP
95
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AT II has a very
short half life - 1min
96
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nitric oxide is responsible for
vasodilation
97
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list actions of angiotensin ii
powerful vasoconstrictor
aldosterone secretion stimulation
vasoconstriction of renal arterioles (no blood filtration)
decrease nitric oxide
decrease fibronlysis in blood
induce drinking behavior
98
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what are the ill effects of ATII?**
hypertension
myocardial infaction
renal damage
99
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Which of the following are true about ACEi?
they reverse cardiac and vascular hypertrophy and remodeling
100
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which of the follwoing ACE inhibitor?
ends in -pril like captopril