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htn pharm 4-23-06


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Changes in Cardiac Output affect two major pathways?
1. Carotid sinus firing, sympa discharge 2. Renal blood flow, renin-ang pathway
What is the effect of the following drugs: 1. Positive inotropic drugs 2. Beta blockers 3. Ace inhibitors 4. AII antagonists 5. Vasodilators and 6. Diuretics
1. Increases cardiac output. 2. Inhibit renin release. 3. Inhibit ACE 4. Inhibits effects of AngII including increasing the preload, increasing the afterload and remodelling. 5. Decrease the preload and afterload. 6. Decrease the preload and afterload
What are the adverse effects of these two diueretics: hydrochlorothiazide, loop diuretics
1. Hypokalemia, hyperlipidemia, hyperuricemia, lassitude, hypercalcemia, hyperglycemia 2. Hypokalemia, met alk, hypotension, ototoxicity
These are wahat class of drugs: clonidine, methyldopa, ganglionic blockers, reserpine, guanethidine, prazosin, beta blockers?
Adverse effects of clonidine?
dry mouth, sedation, severe rebound HTN
Adverse effects of methyldopa?
sedation, positive coombs test
Adverse effects of ganglionic blockers?
orthostatic HTN, blurred vision, constitpation, sexual dysfuncction
Adverse effects of reserpine?
sedation, depression, nasal stuffiness, diarrhea
adverse effects of beta blockers?
impotence, asthma, cardiovascular, cns
Adverse effects of guanethidine?
orthostatic and exercise Hypotension, sex dysfxn, diarrhea
Adverse effects of prazosin?
1st dose orthostatic hypotension, dizzy, headache
The following are what class: hydralazine, minoxidil, nifedipine, verapamil, nitroprusside
which diuretic causes lupus like syndrome? Other toxicities?
hydralazine, nausea, headache, reflex tachycardia, angina, salt retention
adverse effets of minoxidil?
hypertrichosis (hair growth - think Rogaine with minoxidil!), pericardial effusion, reflex tachycardia, angina, salt retention
Side effects of nifedipine, verapamil?
dizziness, flushing, constipation, nausea
which vasodilator causes cynide toxicity?
Adverse effects of ACE-I Captorpil? Think CAPTOPRIL
C: cough, A: angioedema, P: proteinuria, T: taste changes, O: hypOtension, P: pregnancy problems like fetal renal damage, R: rash, I: increased renin, L: lower angiotensin. Also hyperkalemia.
Losartan is a ----------- R-Inhibitor? With ____-toxicity and ____kalemia
angiotensin II, fetal renal, hyper
Which two anti-htn drugs do you use with B blockers to prevent reflex tachycardia, diuretic to block salt retention?
hydralizine, minoxidil
What is hydralizine's mechanims and clinical use?
increase cGMP --> smooth muscle relaxation. Vasodilates arteries > veins. Reduces afterload. Used for severe HTN or CHF
Calcium channel blockers, name three
nifedipine, verapamil, diltiazem
CCB Mechanism: block _____ chanels of cardiac and smooth muscles to reduce contractility
voltage dependednt L type Ca
Rank their effects on vascular smooth muscle ad on the heart: nifedipine, verapamil, diltiazem
smooth muscle nifed> diltia > verapamil heart: vera> diltia> nifedepine
What is the calcium channel blockers use?
HTN, angina, arrythmias (not nifedipine)
ACE -I, name three
pg 316 - captopril, enalapril, lisinopril
Mechanim of ACE-I considering bradykinin and renin release?
reduce lvels of ang II, prevent inactivation of bradykinin, renin release is increased to to loss of feedback inhibition
what is the clinical use of ACE-I
HTN, CHF, diabetic renal disease
What is the site of action of 1. Acetazolamide, 2. Osmotic agents, 3. Loop agents, 4. Thiazides, 5. Potassium sparing, 6. ADH antagonists
1. PCT 2. PCT, thin desc limb, CD 3. Thick ascending limb 4. Distal conv tubule 5. DCT a bit later 6. CD in inner medulla
How does mannitol an osmotic diuretic work?
increase tubular fluid osmolarity, producing increased urine flow
what is the use and toxicity of osmotic diuretics?
Use: shock, drug overdose, decrease intracranial pressure. Toxicity - pulmonary edema, dehydration. Contraindicated in anuria, CHF
Acetazolamide Is a ______inhibitor. Causes ______diuresis and _____ in total body HC03 stores.
Carbonic anhydrase, self-limited NaHCO3, reduction.
Acetazolamide What electrolye disturbace does it treat? Does it cause?
treats met alk, causes in toxicity hyperchloremic met acidosis. ACIDazolamide caues ACIDosis.
Acetazolamide Other toxicity?
neuropathy, NH3 toxicity, sulfa allergy
Acetazolamide uses?
glaucoma, urinary alk, met alk, altitude sickeness
Furosemide: Loops Lose ___
Furosemide inhibits _______cotransport
NA, K, 2CL
Furosemide also works by?
abolishes hypertonicit y of medulla, prevent concentration of urine. Increase Caexcertion. Loops Lose calcium
three uses for Furosemide?
edematous states, htn, hypercalcemia
Furosemide Toxicity using the OH DANG?
ototoxicity, hypokalemia, dehydration, allergy, nephritis interstitial, gout
Ethacrynic Acid How is this drug different from furosemide? And how does that affect its use?
Although both have the same action, ethacrynic is a phenoxyacetic acid derivative not a sulfonamide. Therefore use this drug when you are allergic to sulfa.
loop diuretic that does not exacerbate gout
ethacrynic acid
Hydrochlorothiazide is a thiazide diuretic that inhibits the reabsorption of ----- in the ---- tubule
NaCl; early distal tubule
Does hydrochlorothiazide increase or decrease the excretion of calcium ion?
A toxic dose of hydrochlorathiazide will do what to the blood levels of these electrolites: potassium, sodium, glucose, lipid, uric acid, calcium
hypokalemic metabolic alkalosis, hyponatremia, hyperGlycemia, hyperLipidemia, hyperUricemia, hyperCalcemia (hyperGLUC)
Spironolactone is a competitive antagonist to the --- receptor in the ---- tubule
aldosterone; cortical collecting tubule
Name two K+-sparing diuretics that block Na+ channels in the cortical collecting duct
Triamterine and amiloride
Besides causing hyperkalemia, a toxic dose of spironolactone will cause this endocrine effect
Gynecomastia (antiandrogen effect)
Name three K+-sparing diuretics
Spironolactone, Triamterene, Amiloride (The K+ STAys.)
Diuretics are classified as carbonic anhydrase inhibitors, loop diuretics, thiazides, and K+-sparing diuretics. Which of these causes in increase in urine NaCl?
All of them!
Which types of diuretucs increase urine K+?
All except K+-sparing diuretics. Carbonic anhydrase inhibitors, loop diuretics, thiazides.
Do carbonic anhydrase inhibitors increase or decrease blood pH?
Decrease, cause acidosis
Do K+-sparing diuretics cause acidosis or alkalosis?
Acidosis, decreases pH
Do loop diuretics cause acidosis or alkalosis?
Alkalosis, increases pH
Do thiazide diuretics cause an increase or decrease in blood pH?
Increase, cause alkalosis
Do loop diuretics increase or decrease levels of urine calcium ion?
Do thiazide diuretics increase or decrease levels of urine calcium ion?

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