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Questions and Answers
Which of the following is NOT a characteristic of angiotensin receptor blockers (ARBs)?
Which of the following is NOT a characteristic of angiotensin receptor blockers (ARBs)?
- They selectively bind to the angiotensin II receptor type 1 (AT1)
- They are typically named with the suffix 'sartan'
- They prevent angiotensin II from binding and exerting its hypertensive effects
- They increase the levels of angiotensin II in the body (correct)
Which of the following diuretics acts on the proximal tubule, loop of Henle, and collecting duct by creating an osmotic force?
Which of the following diuretics acts on the proximal tubule, loop of Henle, and collecting duct by creating an osmotic force?
- Osmotic diuretics (correct)
- Thiazide diuretics
- Loop diuretics
- Potassium-sparing diuretics
Which of the following diuretics acts on the early distal tubule, preventing the reabsorption of sodium and chloride?
Which of the following diuretics acts on the early distal tubule, preventing the reabsorption of sodium and chloride?
- Potassium-sparing diuretics
- Osmotic diuretics
- Loop diuretics
- Thiazide diuretics (correct)
Which of the following diuretics blocks aldosterone receptors in the late distal convoluted tubule, leading to increased sodium excretion and decreased potassium excretion?
Which of the following diuretics blocks aldosterone receptors in the late distal convoluted tubule, leading to increased sodium excretion and decreased potassium excretion?
Which of the following is a centrally acting sympatholytic agent used for the control of hypertension during pregnancy?
Which of the following is a centrally acting sympatholytic agent used for the control of hypertension during pregnancy?
Which of the following is a common side effect associated with the use of methyldopa?
Which of the following is a common side effect associated with the use of methyldopa?
Which of the following diuretics acts on the ascending limb of the loop of Henle, preventing the reabsorption of sodium, water, and potassium?
Which of the following diuretics acts on the ascending limb of the loop of Henle, preventing the reabsorption of sodium, water, and potassium?
Which of the following is a common suffix used for angiotensin receptor blocker (ARB) medications?
Which of the following is a common suffix used for angiotensin receptor blocker (ARB) medications?
Which of the following statements about the mechanism of action (MOA) of angiotensin receptor blockers (ARBs) is correct?
Which of the following statements about the mechanism of action (MOA) of angiotensin receptor blockers (ARBs) is correct?
Which of the following diuretics acts on the late distal convoluted tubule to decrease the synthesis of sodium channels and potassium pumps?
Which of the following diuretics acts on the late distal convoluted tubule to decrease the synthesis of sodium channels and potassium pumps?
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Study Notes
Blood Pressure and Hypertension
- Blood pressure is the force exerted by circulating blood against the walls of the body's arteries.
- High blood pressure (HBP or hypertension) is when blood pressure is consistently too high.
- Blood pressure is measured using two numbers: systolic blood pressure (measures pressure in arteries when the heart beats) and diastolic blood pressure (measures pressure in arteries when the heart rests between beats).
Etiology of Hypertension
- No identifiable cause
- Risk factors include:
- Different underlying conditions (e.g. kidney disease, adrenal gland tumors, thyroid problems, cardiovascular disease, neurological disorders, diabetes, pregnancy)
- Certain medications (e.g. OCPs, NSAIDs, nasal decongestants, sympathomimetics, corticosteroids)
Management of Hypertension
Non-Pharmacological Treatment
- Increased physical activity
- Weight loss
- Avoiding stress
- Limited alcohol and tobacco consumption
- Dietary modifications (DASH diet)
Pharmacological Treatment
Centrally Acting Sympatholytics
- Clonidine and α-methyl dopa are examples
- α-2 agonists that result in vasodilation and a fall in blood pressure
- Methyldopa is a drug of choice for control of hypertension in pregnancy
- Clonidine should be taken off gradually before stopping completely to avoid rebound hypertension
Alpha Adrenergic Blockers
- Prazosin is a selective α-1 blocker
- Blocks postsynaptic α-1 receptors in blood vessels, leading to a fall in blood pressure
- Causes postural hypotension
- Preferred in hypercholesterolemia
Beta Adrenergic Blockers
- Propranolol and atenolol are examples
- Work by blocking β-1 adrenergic receptors in the heart and kidney, leading to a fall in blood pressure
- Avoided in asthma, diabetes, and hypercholesterolemia
Vasodilators
- Examples: nifedipine, amlodipine, verapamil, and diltiazem
- Mechanism of action: blocking the entry of calcium into cells, reducing the contraction of vascular smooth muscle and cardiac muscle, which lowers blood pressure
- Contraindications: heart failure
- Safe in asthma
- Interacts with digoxin
ACE Inhibitors and ARBs
- ACE inhibitors: captopril, lisinopril, and enalapril
- Mechanism of action: preventing the production of angiotensin II, which lowers blood pressure
- ARBs: losartan and valsartan
- Mechanism of action: selectively binding to angiotensin receptor 1 (AT1), preventing angiotensin II from exerting its hypertensive effects
Diuretics
- Osmotic diuretics: mannitol
- Mechanism of action: creating an osmotic force that pulls water into the nephron, increasing water excretion
- Loop diuretics: furosemide
- Mechanism of action: preventing reabsorption of sodium, water, and potassium, enhancing their excretion
- Thiazide diuretics: hydrochlorothiazide and chlorthalidone
- Mechanism of action: preventing reabsorption of sodium and chloride, causing salt and water excretion
- Potassium-sparing diuretics: spironolactone
- Mechanism of action: blocking aldosterone receptors, decreasing sodium channels and potassium pumps, increasing sodium excretion and decreasing potassium excretion
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