Diuretics Classification Quiz

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Questions and Answers

Which type of diuretic is first-line for Acute pulmonary edema?

  • Loop diuretics (correct)
  • Thiazide diuretics
  • Carbonic Anhydrase Inhibitors
  • Potassium-sparing diuretics

What is the mechanism of action of Carbonic Anhydrase Inhibitors (CAIs)?

  • Enhancement of potassium excretion
  • Inhibition of Na+ reabsorption in the thick ascending limb
  • Blockade of bicarbonate absorption (correct)
  • Inhibition of carbonic anhydrase enzyme

Which diuretic interacts with Aminoglycosides?

  • Loop diuretics (correct)
  • Potassium-sparing diuretics
  • Carbonic Anhydrase Inhibitors
  • Thiazide diuretics

Why are Loop diuretics not considered first-line diuretics in general?

<p>They have a high potential for interactions (D)</p> Signup and view all the answers

Which condition is Carbonic Anhydrase Inhibitors (CAIs) commonly used to treat?

<p>Glaucoma (D)</p> Signup and view all the answers

Which diuretic is indicated for the treatment of altitude sickness?

<p>Carbonic Anhydrase Inhibitors (CAIs) (D)</p> Signup and view all the answers

Why are Loop diuretics not commonly considered first-line diuretics?

<p>They have a high potency (B)</p> Signup and view all the answers

Which diuretic is preferred when there is a concern about Creatinine Clearance (CrCl)?

<p>Thiazides (C)</p> Signup and view all the answers

Inhibiting which transporter is the primary mechanism of Loop diuretics?

<p>Na+ - K+ - 2Cl- symporter (B)</p> Signup and view all the answers

Which type of diuretic is specifically recommended as first-line for Acute pulmonary edema?

<p>Loop diuretics (D)</p> Signup and view all the answers

Which medication is known to cause cough as a side effect?

<p>Captopril (A)</p> Signup and view all the answers

Which class of medications blocks the binding of Angiotensin II to its receptor?

<p>Angiotension Receptor Blockers (ARBs) (D)</p> Signup and view all the answers

Which medication is specifically mentioned as the DOC (drug of choice) for pre-eclampsia?

<p>Nifedipine ER (B)</p> Signup and view all the answers

Which group of medications inhibits the release of neurotransmitters into the synaptic cleft?

<p>Centrally Acting α12 adrenergic Agonists (B)</p> Signup and view all the answers

Which type of Ca2+ channels are inhibited by Dihydropyridines?

<p>L-type Ca2+ channels (A)</p> Signup and view all the answers

Which medication inhibits VMAT-2, preventing vesicle turnover and depleting norepinephrine?

<p>Reserpine (D)</p> Signup and view all the answers

Which medication is NOT an ACE Inhibitor or an ARB but can still be used in pregnancy?

<p>Labetalol (C)</p> Signup and view all the answers

What lifestyle modification is recommended for individuals with hypertension in terms of alcohol consumption?

<p>Limit to no more than 2 drinks/day in men and 1 drink/day in women (C)</p> Signup and view all the answers

Which medication can exacerbate congestive heart failure and must be always given with a beta-blocker and diuretic?

<p>Hydralazine (D)</p> Signup and view all the answers

What is the approximate reduction in systolic blood pressure (SBP) associated with a weight loss of 10kg?

<p>5-20mmHg (D)</p> Signup and view all the answers

Which lifestyle modification is recommended in terms of dietary sodium intake for individuals with hypertension?

<p>Limit sodium intake to maximum 6g sodium chloride (A)</p> Signup and view all the answers

Which lab value range falls within the normal reference range for Potassium?

<p>3.5-5.0 (A)</p> Signup and view all the answers

What type of drug must always be given with a beta-blocker and diuretic to prevent certain adverse effects?

<p>Vasodilators (A)</p> Signup and view all the answers

'Olol' is a commonly used suffix for medications belonging to which class of drugs?

<p>Beta-blockers (C)</p> Signup and view all the answers

Which ACEI is a prodrug hydrolyzed by hepatic esterases to its active metabolite Enalaprilat?

<p>Enalapril (D)</p> Signup and view all the answers

Which ACEI is structurally similar to Enalapril and can be formulated as an oral solution called Qbrelis?

<p>Lisinopril (C)</p> Signup and view all the answers

Which ACEI is the third one approved for use in the U.S.?

<p>Lisinopril (B)</p> Signup and view all the answers

What effect does food have on the bioavailability of Lisinopril?

<p>Has no effect (C)</p> Signup and view all the answers

In which hypertensive state should ACEIs be avoided according to the provided text?

<p><strong>Hypertension due to primary aldosteronism</strong> (D)</p> Signup and view all the answers

What are the potential compensatory reflexes associated with Low dose of Organic Nitrates?

<p>Decreased pulmonary vascular resistance (B)</p> Signup and view all the answers

Which adverse effect is NOT commonly associated with excessive hypotension from Organic Nitrates?

<p>Bradycardia (D)</p> Signup and view all the answers

What is the primary mechanism of action of Minoxidil as a K+ Channel Opener?

<p>Increased potassium efflux (B)</p> Signup and view all the answers

Which effect is NOT associated with Minoxidil use in severe resistant hypertension?

<p>Decreased renin secretion (B)</p> Signup and view all the answers

What is the primary concern when using Minoxidil due to its vasodilator effects?

<p>Fluid retention (C)</p> Signup and view all the answers

Minoxidil is contraindicated in patients with which of the following conditions?

<p>Left ventricular hypertrophy (LVH) (C)</p> Signup and view all the answers

Minoxidil, similar to which medication, can cause reflex tachycardia requiring the use of β-blockers?

<p><strong>Hydralazine</strong> (D)</p> Signup and view all the answers

Minoxidil use is cautioned in patients with which specific tumor?

<p><strong>Pheochromocytoma</strong> (C)</p> Signup and view all the answers

Which receptors are involved in Angiotensin-II mediated biological effects?

<p>AT1 and AT2 (D)</p> Signup and view all the answers

What is a potential functional role of AT2 receptors?

<p>Antiproliferative effects (D)</p> Signup and view all the answers

Which receptors are primarily associated with preeclampsia?

<p>AT1 receptors (B)</p> Signup and view all the answers

Which class of medications includes ACE inhibitors?

<p>ARBs (D)</p> Signup and view all the answers

Which CCB is contraindicated in patients with egg or soy allergy, severe aortic stenosis, or defective lipid metabolism?

<p>Clevidipine (C)</p> Signup and view all the answers

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?

<p>Nifedipine (C)</p> Signup and view all the answers

Which calcium channel blocker is recommended as the drug of choice for hypertensive pre-eclampsia or eclampsia during pregnancy?

<p>Nifedipine (D)</p> Signup and view all the answers

Which medication should always be given with a beta-blocker when used concurrently due to potential interactions?

<p>Verapamil (A)</p> Signup and view all the answers

Which calcium channel blocker should not be used for acute blood pressure reduction?

<p>Clevidipine (B)</p> Signup and view all the answers

What is the mechanism of action of centrally acting α2 adrenergic agonists like clonidine and methyldopa?

<p>Bind to α2 receptors on presynaptic nerve terminals and inhibit neurotransmitter release (B)</p> Signup and view all the answers

What rare side effect is associated with Clevidipine?

<p>Hypertriglyceridemia (C)</p> Signup and view all the answers

What category is Nifedipine in pregnancy?

<p>Category C (B)</p> Signup and view all the answers

In African Americans, which class of antihypertensive medications shows reduced blood pressure responses compared to others?

<p>Beta-blockers (B)</p> Signup and view all the answers

For patients with Left Ventricular Systolic Dysfunction (LVSD), what is the recommended approach regarding ACE Inhibitors?

<p>Give ACE Inhibitors to all patients with LVSD unless contraindicated (B)</p> Signup and view all the answers

Which medication class is particularly useful in patients with Myocardial Infarction (MI) and coexisting hypertension and/or diabetes according to quality clinical studies?

<p>ACE Inhibitors (C)</p> Signup and view all the answers

What is a contraindication related to the use of ACE Inhibitors in patients with Acute MI?

<p>Neprilsyn sacubitril/valsartan use (B)</p> Signup and view all the answers

In which group of patients do ACE Inhibitors demonstrate the most effectiveness based on clinical studies like HOPE and EUROPA?

<p>All patients with LVSD (D)</p> Signup and view all the answers

Which combination of antihypertensive drug classes eliminates differential responses observed in African Americans?

<p>ACE Inhibitors + Diuretics (B)</p> Signup and view all the answers

What should be the immediate action regarding ACE Inhibitors in patients with Acute MI?

<p>Start ACE Inhibitors immediately unless contraindicated (B)</p> Signup and view all the answers

What significant impact do combinations of ACE Inhibitors with other drugs have on African Americans' responses compared to monotherapies?

<p>Increased response rates (A)</p> Signup and view all the answers

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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

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