57 Questions
Which type of diuretic is first-line for Acute pulmonary edema?
Loop diuretics
What is the mechanism of action of Carbonic Anhydrase Inhibitors (CAIs)?
Blockade of bicarbonate absorption
Which diuretic interacts with Aminoglycosides?
Loop diuretics
Why are Loop diuretics not considered first-line diuretics in general?
They have a high potential for interactions
Which condition is Carbonic Anhydrase Inhibitors (CAIs) commonly used to treat?
Glaucoma
Which diuretic is indicated for the treatment of altitude sickness?
Carbonic Anhydrase Inhibitors (CAIs)
Why are Loop diuretics not commonly considered first-line diuretics?
They have a high potency
Which diuretic is preferred when there is a concern about Creatinine Clearance (CrCl)?
Thiazides
Inhibiting which transporter is the primary mechanism of Loop diuretics?
Na+ - K+ - 2Cl- symporter
Which type of diuretic is specifically recommended as first-line for Acute pulmonary edema?
Loop diuretics
Which medication is known to cause cough as a side effect?
Captopril
Which class of medications blocks the binding of Angiotensin II to its receptor?
Angiotension Receptor Blockers (ARBs)
Which medication is specifically mentioned as the DOC (drug of choice) for pre-eclampsia?
Nifedipine ER
Which group of medications inhibits the release of neurotransmitters into the synaptic cleft?
Centrally Acting α12 adrenergic Agonists
Which type of Ca2+ channels are inhibited by Dihydropyridines?
L-type Ca2+ channels
Which medication inhibits VMAT-2, preventing vesicle turnover and depleting norepinephrine?
Reserpine
Which medication is NOT an ACE Inhibitor or an ARB but can still be used in pregnancy?
Labetalol
What lifestyle modification is recommended for individuals with hypertension in terms of alcohol consumption?
Limit to no more than 2 drinks/day in men and 1 drink/day in women
Which medication can exacerbate congestive heart failure and must be always given with a beta-blocker and diuretic?
Hydralazine
What is the approximate reduction in systolic blood pressure (SBP) associated with a weight loss of 10kg?
5-20mmHg
Which lifestyle modification is recommended in terms of dietary sodium intake for individuals with hypertension?
Limit sodium intake to maximum 6g sodium chloride
Which lab value range falls within the normal reference range for Potassium?
3.5-5.0
What type of drug must always be given with a beta-blocker and diuretic to prevent certain adverse effects?
Vasodilators
'Olol' is a commonly used suffix for medications belonging to which class of drugs?
Beta-blockers
Which ACEI is a prodrug hydrolyzed by hepatic esterases to its active metabolite Enalaprilat?
Enalapril
Which ACEI is structurally similar to Enalapril and can be formulated as an oral solution called Qbrelis?
Lisinopril
Which ACEI is the third one approved for use in the U.S.?
Lisinopril
What effect does food have on the bioavailability of Lisinopril?
Has no effect
In which hypertensive state should ACEIs be avoided according to the provided text?
Hypertension due to primary aldosteronism
What are the potential compensatory reflexes associated with Low dose of Organic Nitrates?
Decreased pulmonary vascular resistance
Which adverse effect is NOT commonly associated with excessive hypotension from Organic Nitrates?
Bradycardia
What is the primary mechanism of action of Minoxidil as a K+ Channel Opener?
Increased potassium efflux
Which effect is NOT associated with Minoxidil use in severe resistant hypertension?
Decreased renin secretion
What is the primary concern when using Minoxidil due to its vasodilator effects?
Fluid retention
Minoxidil is contraindicated in patients with which of the following conditions?
Left ventricular hypertrophy (LVH)
Minoxidil, similar to which medication, can cause reflex tachycardia requiring the use of β-blockers?
Hydralazine
Minoxidil use is cautioned in patients with which specific tumor?
Pheochromocytoma
Which receptors are involved in Angiotensin-II mediated biological effects?
AT1 and AT2
What is a potential functional role of AT2 receptors?
Antiproliferative effects
Which receptors are primarily associated with preeclampsia?
AT1 receptors
Which class of medications includes ACE inhibitors?
ARBs
Which CCB is contraindicated in patients with egg or soy allergy, severe aortic stenosis, or defective lipid metabolism?
Clevidipine
What should be the alternative choice of calcium channel blocker for a patient on carbamazepine, phenobarbital, phenytoin, rifampin, or St. John’s wort due to significant drug interactions?
Nifedipine
Which calcium channel blocker is recommended as the drug of choice for hypertensive pre-eclampsia or eclampsia during pregnancy?
Nifedipine
Which medication should always be given with a beta-blocker when used concurrently due to potential interactions?
Verapamil
Which calcium channel blocker should not be used for acute blood pressure reduction?
Clevidipine
What is the mechanism of action of centrally acting α2 adrenergic agonists like clonidine and methyldopa?
Bind to α2 receptors on presynaptic nerve terminals and inhibit neurotransmitter release
What rare side effect is associated with Clevidipine?
Hypertriglyceridemia
What category is Nifedipine in pregnancy?
Category C
In African Americans, which class of antihypertensive medications shows reduced blood pressure responses compared to others?
Beta-blockers
For patients with Left Ventricular Systolic Dysfunction (LVSD), what is the recommended approach regarding ACE Inhibitors?
Give ACE Inhibitors to all patients with LVSD unless contraindicated
Which medication class is particularly useful in patients with Myocardial Infarction (MI) and coexisting hypertension and/or diabetes according to quality clinical studies?
ACE Inhibitors
What is a contraindication related to the use of ACE Inhibitors in patients with Acute MI?
Neprilsyn sacubitril/valsartan use
In which group of patients do ACE Inhibitors demonstrate the most effectiveness based on clinical studies like HOPE and EUROPA?
All patients with LVSD
Which combination of antihypertensive drug classes eliminates differential responses observed in African Americans?
ACE Inhibitors + Diuretics
What should be the immediate action regarding ACE Inhibitors in patients with Acute MI?
Start ACE Inhibitors immediately unless contraindicated
What significant impact do combinations of ACE Inhibitors with other drugs have on African Americans' responses compared to monotherapies?
Increased response rates
Study Notes
Diuretics
- Increase rate of urine flow by increasing rate of Na+ and Cl- excretion
- Carbonic Anhydrase Inhibitors (CAIs) end in -zolamide and are used for glaucoma and altitude sickness
- Block absorption of bicarbonate, which acts as a buffer
- Inhibit Na+ - K+ - 2Cl- symporter in the thick ascending limb
- Not a first-line treatment because they are very potent
- First-line treatment for acute pulmonary edema
- Interacts with Aminoglycosides
- Preferred diuretic when CrCl < 30 mL/min
ACE Inhibitors
- End in -pril
- Good for diabetes, CHF, and acute MI
- Captopril is the only one with a sulfhydryl group
- Inhibits ACE, which increases AT2, which increases IBP
- Side effects: cough, may increase lithium levels, and hyperkalemia
Angiotensin Receptor Blockers (ARBs)
- End in -sartan
- Blocks binding of AT2 to its receptor
- Used if patients get a cough from ACEIs
- Side effect: hyperkalemia
Direct Renin Inhibitors
- Blocks conversion of Angiotensinogen to AngI
- Do not use with ARBs or ACEIs with diabetes or GFR < 60 mL/min
- Example: Aliskiren
Calcium Channel Blockers
- Inhibit L-type Ca2+ channels, which decreases Ca2+ influx in vascular and cardiac cells
- Examples: Dihydropyridines, which end in -dipine
- Vasodilation, decreases PVR
- Effective when combined with β-blockers or diuretics
- CYP3A4 inhibitors: avoid grapefruit
- Interacts with antiarrhythmic drugs
- Nifedipine ER is DOC for pre-eclampsia
Centrally Acting α2 Adrenergic Agonists
- Inhibit release of neurotransmitters into synaptic cleft
- Decrease sympathetic outflow
- Examples: Methyldopa, Clonidine, Guanfacine
- Used in pregnancy
Adrenergic Neuronal Blockers
- Reserpine: inhibits VMAT-2, preventing vesicle turnover, depleting NE
- A- Receptor Antagonists: Doxazosin, Prazosin, Terazosin
- Hypertension and BPH
- Vasodilators: increase water retention
- Hydralazine: CHF exacerbation, must always be given with β-blocker and diuretic
- Nat Nitroprusside: metabolized to cyanide
B-Blockers
- Do not suddenly discontinue treatment
- Masks symptoms of hypoglycemia
- Sexual dysfunction
- Modification
- Physical activity
- Weight management
- DASH diet
- Reduce sodium consumption
- Limit alcohol consumption
- Lifestyle modifications
Lab Values
- Calcium: 8.2-10.2
- Potassium: 3.5-5.0
- Sodium: 136-142
- Chloride: 96-106
- Magnesium: 1.3-2.1
Test your knowledge on different types of diuretics including Carbonic Anhydrase Inhibitors, Loop Diuretics, and their specific uses and interactions. Learn about these medications that increase urine flow by affecting electrolyte levels in the body.
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