Agents that affect the RAAS to regulate blood pressure and fluid balance
3
What are some examples of diuretics?
Show answer
Examples include thiazide diuretics, loop diuretics, and potassium-sparing diuretics
4
What are the consequences of high blood pressure?
Show answer
Stroke, dementia, heart failure, vision loss, heart attack, kidney disease/ failure, and sexual dysfunction.
5
What is the American Heart Association?
Show answer
A non-profit organization dedicated to heart and stroke health.
6
What are the four main categories of antihypertensive agents?
Show answer
Sympatholytic agents, vasodilators, antagonizing the renin-angiotensin-aldosterone pathway, and diuretics.
7
Which class of antihypertensive agents includes renin inhibitors, ACE inhibitors, and Angiotensin II blockers?
Show answer
Antagonizing the renin-angiotensin-aldosterone pathway.
8
What is the Renin-Angiotensin-Aldosterone System (RAAS)?
Show answer
It is a system in the body that regulates blood pressure and fluid balance.
9
What are the steps in the RAAS pathway?
Show answer
Angiotensinogen is cleaved by renin to form Angiotensin I, which is then converted to Angiotensin II by ACE. Angiotensin II stimulates aldosterone production.
10
What are the effects of Renin Inhibitors on the RAAS?
Show answer
They block the conversion of Angiotensinogen to Angiotensin I, reducing the production of Angiotensin II and aldosterone.
11
What are the examples of ACE-inhibitors mentioned in the slide?
Show answer
Captopril (Capoten) and enalapril
12
What is the mechanism of action (MOA) of ACE-inhibitors?
Show answer
They block the angiotensin converting enzyme (ACE), reducing preload and afterload.
13
What do preload and afterload refer to in the context of ACE-inhibitors?
Show answer
Preload is the amount of blood received by the heart, and afterload is the resistance the heart needs to overcome to pump the blood out.
14
What is the effect of blocking ACE on bradykinin and how does it enhance vasodilation?
How do ACE inhibitors affect aldosterone secretion and what are the consequences?
Show answer
ACE inhibitors decrease aldosterone secretion, leading to decreased sodium and water retention and reduced blood volume.
16
What are the indications for using first-line anti-hypertensive agents?
Show answer
Heart disease, diabetes, chronic kidney disease, or coronary artery diseases.
17
What are the adverse effects of the first-line anti-hypertensive agents?
Show answer
Altered tasting sensation, orthostatic hypotension, dry cough, angioedema, and hyperkalemia.
18
What is the contraindication for using these agents?
Show answer
Pregnancy (teratogen).
19
What is the mechanism of action (MOA) of a renin inhibitor?
Show answer
Selective renin inhibitor
20
What is the indication for using a renin inhibitor?
Show answer
Hypertension
21
What are the precautions and adverse effects of a renin inhibitor?
Show answer
May cause angioedema, contraindicated in pregnancy, not combined with an ACE inhibitor or ARB
22
What are Angiotensin II receptor blockers (ARBs)?
Show answer
Competitive antagonists for the angiotensin-II receptor (AT1 receptor)
23
How do ARBs prevent the effects of Angiotensin II (Ag-II)?
Show answer
By blocking the AT1 receptor, preventing Ag-II from causing vasoconstriction and aldosterone action
24
What are the indications for using this medication as first-line agents for hypertension?
Show answer
Treatment of hypertension, especially in patients with diabetes, heart failure, or chronic kidney disease.
25
What are the precautions and adverse effects of this medication?
Show answer
More likely to cause hypotension than ACE inhibitors, can cause hyperkalemia, less likely to cause angioedema and coughing than ACE inhibitors, contraindicated in pregnancy due to teratogenic effect, not combined with an ACE inhibitor for hypertension management.
26
What is the potential impact of dry cough on dental procedures?
Show answer
Dry cough may interrupt lengthy procedures.
27
What is the likely cause of angioedema and perioral swelling in individuals with African American ancestry?
Show answer
Increased bradykinin levels.
28
What condition can be exacerbated by the concurrent use of CNS depressants with orthostatic hypotension?
Show answer
Orthostatic hypotension.
29
What is the low dose of Colchicine used for in adult patients with established atherosclerotic disease or multiple risk factors for cardiovascular disease?
Show answer
0.5 mg/day
30
What is the low dose of Aspirin used for in adult patients?
Show answer
81 mg/day
31
What are the effects of Aspirin on hemostasis?
Show answer
Can affect hemostasis depending on dosage, other medications, and patient's history.
32
What is the definition of a diuretic?
Show answer
A diuretic is a medication that increases urine production, leading to increased excretion of water and electrolytes.
33
What is the definition of an antidiuretic?
Show answer
An antidiuretic is a medication that decreases urine production, leading to reduced excretion of water and electrolytes.
34
What is the term for the interaction between the heart and kidneys?
Show answer
Cardio-Renal Interplay
35
What are the shared risk factors for chronic heart dysfunction and chronic kidney disease?
Increased blood volume serves as a circulatory compensation mechanism to help return cardiac output and blood pressure toward normal.
37
What is CHF and how does it affect the renal compensation mechanism?
Show answer
CHF (decreased cardiac efficiency) can cause low blood pressure, leading to increased renin, activation of the RAAS, and increased blood volume and sodium retention.
38
What are the long-term consequences of the renal compensation mechanism in CHF?
Show answer
The long-term consequences include circulatory congestion and pulmonary edema.
39
What are diuretics and how do they affect the body?
Show answer
Diuretics are drugs that increase urine volume, affecting electrolyte balance and acid/base equilibrium.
40
What are the different types of diuretics mentioned in the slide?
Show answer
The types mentioned are Thiazide diuretics, Loop diuretics, Potassium-sparing diuretics, Carbonic anhydrase inhibitors, and Osmotic diuretics.
41
What are edematous states and what causes fluid to build up in the extracellular space?
Show answer
Edematous states include heart failure, pulmonary edema, cirrhosis with ascites, and nephrotic syndrome. Fluid builds up in the extracellular space due to increased permeability of blood vessels and decreased oncotic pressure.
42
What are the effects of hypertension on plasma volume, cardiac output, and blood pressure?
Show answer
Hypertension leads to a decrease in plasma volume, cardiac output, and blood pressure.
43
What is the site of action for loop diuretics?
Show answer
Strongest diuretic action
44
Which diuretics are rarely used for diuresis?
Show answer
Osmotic diuretics
45
What is the weakest diuretic action among the listed diuretics?
Show answer
Aldosterone antagonists
46
What is the example of an osmotic diuretic?
Show answer
Mannitol (Osmotrol®)
47
What is the indication for using osmotic diuretics?
Show answer
IV route to manage cerebral edema or reduction of increased intracranial pressure.
48
How does Mannitol work as an osmotic diuretic?
Show answer
Mannitol is filtered through the glomerulus but not reabsorbed, leading to increased osmolarity of the tubular fluid, which facilitates water excretion and prevents its reabsorption.
49
What is the mechanism of action (MOA) of carbonic anhydrase inhibitors?
Show answer
Acetazolamide inhibits carbonic anhydrase, preventing bicarbonate and hydrogen formation, which leads to mild diuresis.
50
What are the indications for using carbonic anhydrase inhibitors?
Show answer
To reduce intraocular pressure in glaucoma patients and as prophylaxis against altitude sickness.
51
What are loop diuretics and what is their mechanism of action (MOA)?
Show answer
Loop diuretics are potent diuretics that block the Na+-K+-2Cl- symporter in the thick ascending limb of the loop of Henle, reducing reabsorption of Na+, K+, Ca2+, Cl-, H+, and Mg2+.
52
List the examples of loop diuretics and their natriuretic effect.
Show answer
Examples include Furosemide (Lasix®), bumetanide (Bumex®), and torsemide. They have a natriuretic effect.
53
What is the sigmoidal dose-response curve of loop diuretics?
Show answer
It has three parts: threshold effect, rapid increase in diuresis with small changes in drug concentration, and ceiling effect.
54
What is the threshold effect in the context of loop diuretics?
Show answer
It is the initial phase where there is no significant increase in diuresis with increasing drug concentration.
55
What is the ceiling effect in the context of loop diuretics?
Show answer
It is the point where further increases in drug concentration do not lead to a further increase in diuresis.
56
What is the indication for loop diuretics?
Show answer
Reduce acute pulmonary edema or edema associated with renal or liver impairment and in chronic congestive heart failure.
57
What are the side effects of loop diuretics?
Show answer
Hypokalemia, dose-related ototoxicity, nephrotoxicity, and orthostatic hypotension.
58
What is the effect of NSAIDs on the diuretic action of loop diuretics?
Show answer
NSAIDs can reduce the diuretic action of loop diuretics.
59
How do loop diuretics affect the nephrotoxic effect of some NSAIDs?
Show answer
Loop diuretics enhance the nephrotoxic effect of some NSAIDs.
60
What are Thiazide Diuretics and provide an example?
Show answer
Thiazide Diuretics are a class of diuretics that inhibit sodium and chloride reabsorption in the distal convoluted tubule (DCT) and increase calcium reabsorption in the distal tubule. Examples include Chlorothiazide (Diuril®) and Hydrochlorothiazide (microzide®).
61
What is the mechanism of action (MOA) of Thiazide Diuretics?
Show answer
Thiazide Diuretics act on the ion channels in the DCT to inhibit sodium and chloride reabsorption but increase calcium reabsorption in the distal tubule, leading to increased excretion of sodium and chloride and decreased excretion of calcium. They also reduce peripheral vascular resistance with long-term therapy.
62
What are the indications for using a particular medication?
Show answer
Hypertension, edema associated with heart, liver, and kidney diseases, and as an adjunct to prevent calcium loss.
63
How does the medication treat nephrogenic diabetes insipidus?
Show answer
It decreases urine output from 11 L to 3 L/d and produces a hyperosmolar urine.
64
What are the side effects of thiazide diuretics?
Show answer
Hypokalemia, hyperuricemia, orthostatic hypotension, hypercalcemia, and hyponatremia.
65
How do thiazide diuretics affect uric acid levels?
Show answer
They compete with the secretion of uric acid, leading to increased uric acid levels in the blood.
66
What is the mechanism of action of Spironolactone (Aldactone®)?
Show answer
Spironolactone is a synthetic steroid that antagonizes aldosterone receptors. It prevents Na+ reabsorption and enhances the Na+/K+ exchange, thereby preventing K+ and H+ secretion in the urine.
67
What are the indications for using potassium-sparing diuretics like Spironolactone?
Show answer
Potassium-sparing diuretics like Spironolactone can be used in the treatment of edema, hypokalemia, and refractory hypertension in combination with thiazide or loop diuretics.
68
What is the mechanism of action (MOA) of Amiloride?
Show answer
Amiloride blocks epithelial sodium channels, decreasing Na+/K+ exchange and increasing sodium excretion while preserving potassium.
69
What are the indications for using Amiloride?
Show answer
Amiloride can be used in the treatment of edema, hypokalemia, and refractory hypertension.
70
What is orthostatic hypotension?
Show answer
A sudden drop in blood pressure when a person stands up from a seated or lying position.
71
What are the dental implications of taking diuretics?
Show answer
Increased risk of orthostatic hypotension, dehydration, syncope, and xerostomia.
72
How do NSAIDs affect the efficacy of diuretics?
Show answer
NSAIDs can decrease the efficacy of several diuretic groups.
73
What are antidiuretics and what do they affect?
Show answer
Antidiuretics are ADH (Vasopressin) and its analogues, which affect the water permeability of the collecting duct.
74
What conditions are antidiuretics used to treat?
Show answer
Antidiuretics are used for central diabetes insipidus and nocturnal enuresis.
75
What are the uses of antagonists for ADH?
Show answer
Antagonists for ADH are used to manage hyponatremia and the syndrome of inappropriate antidiuretic hormone secretion.
76
What is the renal function decline with advanced age?
Show answer
Renal function slightly declines with advanced age >70 years old.
77
What are the mechanisms by which nephrotoxic medications can cause kidney damage?
Show answer
Nephrotoxic medications can cause kidney damage via various mechanisms, including alteration in its structure and function.
78
What is the recommended approach for patients with chronic or end-stage renal disease regarding nephrotoxic medications?
Show answer
It is recommended to avoid or adjust the dose of a nephrotoxic medication in a patient with eGFR < 60 mL/min/1.73 m².
79
What is pharmacology?
Show answer
The study of drugs and their effects on living organisms.
80
What are the two books shown in the slide?
Show answer
Pharmacology and Therapeutics for Dentistry and Lippincott Illustrated Reviews Pharmacology.