pharmacology htn

what is the biggest contributing factor to hypertension

peripheral resistance

what is the blood pressure equation

cardiac output x peripheral resistance = arterial bp

what determine cardiac output

heart rate x stroke volume

what is the MOA of diuretics?

acts on kidney to increase excretion of Na and H2O decrease in blood volume- decreased BP

what is the MOA of ACE?

inhibit synthesis of Angiotensin II - decrease peripheral resistance and blood volume

what is the moa of ARBs (AT1 blocker)?

blocks binding of angiotensin II to its receptors

what is the moa of centrally acting drugs

act on central a2A receptors to decrease sympathetic outflor fall in BP

list thiazides

hydrochlorothizide, chlorthalidone

high ceiling drug

furosemide

potassium sparing drugs

spironlactone, triamterene, and amiloride

triamterene is a

potassium sparing

centrally acting

clonidine, methyldopa

what is the moa of a-adrenergic blockers

blocking of alpha adrenergic receptros in smooth muscles

list a-adrenergic blockers

prazosin, terazosin, doxazosin, phenoxybenzamine, phentolamine

what is moa of calcium blockers

blocks influx of Ca++ in smooth muscle cells - relaxation of SMCs - decrease BP

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)

where does thiazide and carbonic anhydrase inhibitor belong to?

diuretic

what is goal of the kidney?

excrete excess sodium in the body to make urine

what does the afferent arteriole do?

blood comes in and filters it, adds filtrate

what does the efferect arteriole do?

dumps protein and RBCs back into the blood as you are filtering throught the bowman's capsule

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

what is true about the descending loop

its permeable to water but impermeable to sodium

what is true about the ascending loop?

impermeable to water, permeable to sodium

where does aldosterone work?

collecting duct

a cup shaped chamber in the renal corpuscle is called

glomerular capsule - bowman's capsule

what concentrates urine and establishes osmotic gradient for water reabsorption?

nephron loop

what adjust tubular fluid composition by reabsorption and secretion of potasium

distal convoluted tubule (DCT)

what renal site determine efficacy and potency the most and is the most significant drug target?

loop

what renal site determine efficacy and potency the least

late distal tubule

drug that acts on early distal tubule

thiazides

drug that acts on loop of henle

furosemide

drugs acting on late distal tubule

triamterene, spironolactone, amiloride

which of the following is true about carbonic anhydrase inhibitor?

they were found that bacteriostatic sulfonamides causes an alkaline diuresis and hypercholemic metabolic acidosis

name a carbonic anhydrase inhibitor

acetazolamide

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

name naturetics

thiazides and loops

what is the first step in treating htn that is inexpensive and effective

thiazide diuretics

which of the following class of diuretics has vasodilator activity? ****

thiazides

which of the following diuretics drugs has vasodilator activity? ****

hydrochlorothiazides

what is the main function of thiazides

its a diuretic so it decrease sodium, water retention, decrease blood volume, cardiac output decrease

what are hydrochlorothiazide effects?

HYPOTENSIVE!!
gout -elevates UA
dm -elevates glucose
hypokalemia

what metabolite cause vasodilator activity in HCTZ?

urinary kallikreain

what drug and drug class has diuretic activity and vasodilation?

HCTZ - thiazides

what drug can you not give if the patient has a sulfonamide allergy?

hydrochlorothiazide

what drug causes lithium toxicity, decrease calcium excretions and decrease effectiveness of insulin/sulfonylureas?*** know these three

hydrochlorothiazide

what is true about hydrochlorothiazides?**

glucose levels go up by decreasing effectivness of insulin/sulfonylureas -makes diabetes worse - so need to increase insulin dose

what will happen if someone is taking lithium and hctz?

drug interaction - lithium toxicity -increase lithium levels

what drug interaction will happen if a person takes HCTZ and calcium salts?

decrease calcium excretion which will increase calcium blood levels

someone with diabetes take HCTZ what happen

drug interaction with insulin - decrease effectiveness

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

which of the following is true about indapamide

its a modified thiazide
drug is lipid neutral - will not increase your lipid levels

what are thiazides used for?

hypertension
CHF
Edema
ideiopathic hypercalcuria
diabetes insipidus - decrease plasma volume

what adverse drug effects do thiazides cause again

hyperglycemia
hyperuricemia
hyperlipidemias
hyponatremia

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

what drug is primarily used with furosemide to inhibit early distal tubular pump which is responsible for loop diuretic resitance?

furosemid

what is the more effective and potent naturetics?

loop diuretic

loop diuretic moa

blocks sodium, potassium, and chloride cotransporter (loop usually is meant to reabsorb ions and not water)

which of the following drug belongs to loop diuretics?

furosemide

if someone takes diuretics and take thiazide, what will happen?

increase glucose level (because potassium gets excreted out – it helps in production of insulin)

what is the moa of furosemide

inhibits Na+Cl- reabsorption in the thick ascending limb

furosemide decreases ...

peripheral resistance

what side effects of furosemide?

Hyponatremia, hypokalemia, hyperglycemia, hyperlipidemia

*which of the following is a potassium sparing diuretic?

spironlactone

what drug is good for diabetes patients?

sparing potassium

what is combined with spironlactone if using combination therapy?

thiazide diretics - K+losing naturetics

If 3 Na go out, then how many cl comes in?

2

what blocks sodium potassium chloride cotransporter?

loop diuretics

what drugs are direct ENac inhibitors?

amloride and triamterene

what is moa of amiloride and triamterene?

inhibit the influx through epithelial Na channel in the luminal membrane

what inhibits aldosterone ?**** his favorite question

spironlactone

what does triamterene inhibit? ***

membrane function

what drug inhibits Na/K+ ATPase?

amiloride

what drug can you not give if the patient has liver dysfunction?

spironolactone

why is spironalctone better than HCTZ? ***

NO hypokalemia, hyperglycemia, hyperuricemia, which is seen with thiazide and loops

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)

Which of the following is selective aldosterone-receptor antagonist?***

eplerone

What block aldosterone (usually works through the mineralocorticoid receptor ?

eplerone

which drug should you be cautious with if patient has type 2 diabetes?

eplerone

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)

Which of the following is the metabolite of spironolactone?***

canrenoate and canrenone

what is a good alternative to spironolactone if you have hepatic issue such as cirrhosis?

canrenoate and canrenone

which of the following is true about canrenoate and canrenone?

theyre metabolites bypasses hepatic metabolism

amiloride is used to treat

HTN and CHF

which of the following is true about amiloride?

potassium sparing effect useful for preventing hypokalemia combined with THZ or other kaliuretic agents

what produces angiotensinogen

liver

what produces renin

kidney

where does angiotensinogen 1 go to?

lungs

angiotensin 2 causes

vasoconstriction

what blocks angiotensin 2 from causing vasoconstriction

ARBS

what blocks angiotensin 1 from converting to 2?

ACEi

the production of angiotensinogen is increased by

corticosteroids, estrogen, thyroid homones, and ANG II

renin is secreted in repsonse to what

-decrease in arterial blood pressure
-decrease Na+ in macula densa
-increased sympathetic nervous activity

renin acts on a plasma protein like

angiotensinogen which is synthesized into the blood stream by the liver

AT II is a

potent vasoconstictor which lead to increase BP

AT II has a very

short half life - 1min

nitric oxide is responsible for

vasodilation

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

what are the ill effects of ATII?**

hypertension
myocardial infaction
renal damage

Which of the following are true about ACEi?

they reverse cardiac and vascular hypertrophy and remodeling

which of the follwoing ACE inhibitor?

ends in -pril like captopril