Cardio 1: Diuretics and Blood Pressure

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Questions and Answers

What is the effect of increasing blood pressure?

Decreased cardiac output

Increased blood pressure due to increased peripheral resistance (correct)

Decreased blood pressure due to decreased heart rate

Increased blood flow to the heart

What is the mechanism of action of furosemide?

Increasing potassium reabsorption

Inhibiting the RAAS system

Decreasing aldosterone production

Increasing sodium excretion in the loop of Henle (correct)

Why do diuretics that work further along the tubules of the kidney have less of an effect?

Because the proximal tubules are unable to reabsorb sodium

Because the distal tubules have a lower capacity for sodium reabsorption

Because more sodium is reabsorbed in the distal tubules (correct)

Because the kidneys are able to compensate for the loss of sodium

What is the main side effect of furosemide that can be decreased by administering it slowly via IV push?

Ototoxicity Signup and view all the answers

What electrolyte does spironolactone spare?

Potassium Signup and view all the answers

What is the mechanism of action of digoxin?

Inhibiting the Na+/K+-ATPase pump Signup and view all the answers

What is the therapeutic range of digoxin?

0.5-1.5 ng/mL Signup and view all the answers

Why should potassium levels be monitored while on digoxin?

Because potassium levels can affect digoxin's mechanism of action Signup and view all the answers

What should be checked before administering Digoxin?

Potassium levels Signup and view all the answers

What is the suffix for Dihydropiridine Calcium Channel Blockers?

-pine Signup and view all the answers

Why should you taper off Calcium Channel Blockers instead of stopping them suddenly?

To avoid rebound hypertension Signup and view all the answers

What is the prototype drug for beta blockers?

Propranolol Signup and view all the answers

What is the mechanism of action of Nitroglycerin?

Vasodilation of veins Signup and view all the answers

What is a common side effect of Clonidine?

Dry mouth Signup and view all the answers

What is the primary use of Hydralazine?

Hypertension Signup and view all the answers

What is the suffix for HMG-CoA Reductase Inhibitors (Statins)?

-statin Signup and view all the answers

What is the effect of mannitol on the body?

Pulls water out of tissues and into the blood Signup and view all the answers

Why should Furosemide be administered earlier in the day?

To avoid nocturia Signup and view all the answers

What is the effect of digoxin on the heart?

Increases the amount of calcium in heart muscles Signup and view all the answers

What should be monitored when a patient is taking Furosemide?

Potassium levels Signup and view all the answers

What is the mechanism of action of calcium channel blockers?

Blockade of calcium channels in the blood vessels and heart muscles Signup and view all the answers

What is a common adverse effect of beta blockers?

Bradycardia Signup and view all the answers

What is a contraindication for the use of grapefruit juice with calcium channel blockers?

Severe hypotension Signup and view all the answers

What is a common indication for the use of digoxin?

Atrial fibrillation Signup and view all the answers

What is a common adverse effect of nitrates?

Headache Signup and view all the answers

What is the suffix for beta blockers?

-olol Signup and view all the answers

What is the effect of hyperkalemia on digoxin?

Decreases the risk of toxicity Signup and view all the answers

What is the therapeutic range for digoxin levels?

0.8-2 ng/mL Signup and view all the answers

What is the effect of increasing blood flow to heart muscles during injury or ischemia?

Relieving the heart of added stress Signup and view all the answers

What is a side effect of phosphodiesterase inhibitors?

Dangerously low BP and death Signup and view all the answers

What should you do if you suspect someone is having a heart attack?

Call 911 Signup and view all the answers

What is the route of administration for nitroglycerin?

All of the above Signup and view all the answers

What is the mechanism of action of clonidine?

Decreases sympathetic response from brainstem to peripheral vessels Signup and view all the answers

What is a side effect of hydralazine?

Reflex tachycardia Signup and view all the answers

What is the purpose of statins?

Inhibit HMG-Coa reductase to reduce cholesterol synthesis Signup and view all the answers

What should you do if you miss a dose of statin?

Skip the missed dose and take the next dose as usual Signup and view all the answers

Study Notes

Cardio 1: Blood Pressure and Diuretics

Two ways to increase blood pressure: increasing blood volume and vasoconstriction
RAAS (Renin-Angiotensin-Aldosterone System) drugs:
- ACE inhibitors: Lisinopril, Captopril
- Angiotensin-II receptor blockers: Valsartan, Losartan
- Angiotensin Receptor Neprilysin inhibitor: Sacubitril- Valsartan
Diuretics:
- Four types: Loop diuretics, Thiazide diuretics, Potassium-sparing diuretics, Osmotic diuretics
- Furosemide: Administer early in the day to avoid nocturia; monitor potassium levels; can cause hypotension and ototoxicity

Furosemide

Best taken early in the day to avoid nocturia
Bumetanide is similar to Furosemide but works faster
Not all diuretics cause hypotension as a side effect
Furosemide must be administered slowly (20mg/min) via IV push to decrease the risk of ototoxicity
Furosemide can lead to hypokalemia (especially in IV push)

Hydrochlorothiazide

Educate patients on the use of sunblock due to increased photosensitivity
Has a milder effect than Furosemide

Spirinolactone

Spares potassium
Blocks aldosterone in distal tubule, retains potassium, and excretes more sodium
Often paired with other diuretics due to its mild effects
Restrict potassium-rich foods to avoid hyperkalemia
Can be used to treat acne and hirsutism in women due to its anti-androgen effects

Mannitol

Similar structure to glucose
Osmotic diuretic
Serves as a sugary substance that water wants to dilute, pulling water out of tissues and into the blood
Side effects: peripheral edema, dehydration
Monitor intake and output, vitals, and electrolytes
Not used to treat heart failure

Digoxin

Cardiac glycoside
Positive inotrope: increases the amount of calcium in heart muscles, leading to an increase in the force of heart muscle contraction, improving cardiac output
Should be prescribed in heart failure palliative care settings
Blocks Na/K pump
Has a narrow therapeutic range
Therapeutic range: 0.8-2ng/mL
Signs of toxicity: confusion, fatigue, dizziness, blurry vision, N/V
Hypokalemia can increase the risk of toxicity
Antidote: Digoxin Immune Fab (Digibind or Digifab)

Calcium Channel Blockers

Two groups: Dihydropyridines (Amlodipine, Clevidipine, Nicardipine) and Non-Dihydropyridines (Diltiazem, Verapamil)
Suffix: -Dipine
MOA: Blockade of calcium channels in blood vessels (Dihydropyridines) and heart muscles (Non-Dihydropyridines) causing a decrease in vascular resistance, blood pressure, and heart contraction
Indications: SHARP (Subarachnoid Hemorrhage, Hypertension, Angina, Raynaud's phenomenon, Prinzmetal Angina)
Side effects: Orthostatic hypotension, dizziness, constipation, flushing, headache, peripheral edema, gingival hyperplasia
Avoid grapefruit juice, as it can cause severe hypotension
Must be tapered off to avoid rebound hypertension

Beta Blockers

Suffix: -olol
Prototype drug: Metoprolol, Propranolol
Check heart rate and systolic BP before administering
Do not administer if heart rate is less than 60bpm and systolic BP is less than 100 mmHg
Monitor diabetic patients closely, as beta blockers can mask tachycardia, a common symptom of hypoglycemia
Indications: Hypertension, stable angina, chronic and compensated heart failure, dysrhythmias, anxiety, tachycardia
Side effects: Bradycardia, heart blocks, breathing problems, lowered blood pressure, blood sugar masking

Nitrates

Prototype drugs: Nitroglycerin, Isosorbide Mononitrate
Suffix: -Nitro, -Nitrate
MOA: Increase blood flow to heart muscles during injury or ischemia by vasodilating and relaxing the vessels, relieving the heart of added stress
Indications: Acute chest pain, preventing chest pain, acute coronary syndrome
Side effects: Flushing, headaches, hypotension
Do not chew or drink grapefruit juice with nitrates
Call 911 if acute chest pain persists

Alpha Blockers

Prototype drug: Terazosin
Alpha 1 blocker: Can cause severe orthostatic hypotension

Centrally Acting Alpha 2 Agonist Agents

Prototype drug: Clonidine
MOA: Decreases sympathetic response from brainstem to peripheral vessels, leading to vasodilation and lowered BP
Indications: Hypertension
Must be tapered over 2-4 days to avoid rebound hypertension
Side effects: Drowsiness, decreased HR, dry mouth
Educate patients to chew gum or hard candy to decrease dry mouth

Hydralazine

Vasodilator of arterioles
Decreases blood pressure
Available in oral and IV forms
Side effects: Reflex tachycardia, hypotension

HMG-CoA Reductase Inhibitors (Statins)

Suffix: Statins
MOA: Inhibit HMG-CoA reductase, a critical component of hepatic cholesterol synthesis
Prototype drugs: Atorvastatin, Simvastatin, Rosuvastatin, Lovastatin, Pravastatin
Side effects: Myopathy, rhabdomyolysis, diabetes, memory loss
Pose a risk of teratogenicity during pregnancy
Alternative medications: Bile sequestrant, Ezetimibe, Fibric acid derivatives

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Description

This quiz covers various aspects of diuretics, blood pressure, and the RAAS system. It includes questions on prototype drugs, diuretic effects, and more.