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AntihypertensivesI
lecture 23a mumby
| Question | Answer |
|---|---|
| thiazide drugs: examples, site of action, relative strength | HCTZ, metolazone // DCT //mild-mod strength |
| mechanism of action of thiazide drugs | inhibit NaCl symporter on luminal side causing NaCl and water to stay in lumen. also cause modest dec in Ca excretion |
| adverse effects of thiazide drugs | nl doses: volume depletion, hypotension, hyponatremia and hypokalemia (they deliver Na distally to CT and ducts) // high doses: inc LDL and hyperglycemia |
| drugs secreted into tubular lumen by organic acid transporter in PCT, thus cross-rxn possible with probenecid | thiazides, loop diuretics |
| OJO! statement about therapeutic use | thaizides are ineffective for pts with GFR < 30-40 mL/min |
| loop drugs: examples, site of action, relative strength | furosemide, torsemide // LOH's TAL // strongest class of diuretics |
| mechanism of action of loop drugs | inhibit the Na/K/2Cl symporter, reducig lumen positive potential and inhibiting Ca and Mg reabsorption |
| pharmacological effects of loop drugs | increase excretion of Na, Cl, K, H, Ca and Mg; activate macula densa cells that think sodium is low and cause them to release renin - possible reflex sympathetic response due to vol depletion |
| main therapeutic use of loop diuretics | mainly for acute pulmonary edema, chronic CHF, can be used for HTN but it's not first choice |
| adverse effects of loop diurectics | obvi ones due to lyte wasting: hypokalemia, hypotension, hyponatremia, hyperuricemia, etc. other: ototoxicity, tinnitus and reversible deafness. avoid in osteopenic women |
| K-sparing drugs: exmaples, site of action, relative strength | traimterene & amiloride // principal cels of late distal tubule and CCD // relatively poor diuretics |
| mechanism of action of K-sparing drugs | inhibit Na channels in luminal side that usually drive movement of K to BL and luminal sides. without Na moving across cell, potentials are disrupted and Ca/Mg/K aren't secreted into lumen |
| aldosterone antagonists | spironolactone - bind MR and stop aldosterone from exerting effect within cell = no K wasting but diuretic and natriuretic (mild) |
| adverse effects of aldosterone antagonists | they can cause dangerous hyperkalemia; since they bind MR, they can also bind PR and AR causing gynecomastia, importence, dec libido, hirsutism, menstrual irregularities |
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sirprakes
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