Batch 2: HF & HTN

Diuretics

• Loops (Furosemide): Block NKCC2 (Thick Ascending). Lose Calcium. Ototoxic. Sulfa allergy -> Ethacrynic Acid.
• Thiazides (HCTZ): Block NCC (DCT). Retain Calcium (Hypercalcemia). HyperGLUC (Glycemia, Lipids, Uric, Ca).
• K+ Sparing:
  • Spironolactone: Aldo Antagonist. Gynecomastia.
  • Triamterene/Amiloride: Block ENaC channel directly.
• Acetazolamide: Carbonic Anhydrase inhibitor (PCT). Causes metabolic acidosis. Altitude sickness.
• Mannitol: Osmotic. Contraindicated in HF/Anuria.

RAAS Inhibitors

• ACEI (-pril): Block Ang I->II. Increase Bradykinin (Cough, Angioedema). Teratogenic. Renal failure in bilateral artery stenosis.
• ARB (-sartan): Block AT1 Receptor. No cough.
• Aliskiren: Direct Renin Inhibitor.

Heart Failure Guidelines

• Mortality Benefit: Beta-blocker, ACEI/ARB/ARNI, Spironolactone, SGLT2i.
• Symptom Only: Loop diuretics, Digoxin.
• Sacubitril: Inhibits Neprilysin -> High ANP/BNP (Vasodilation/Natriuresis).

Vasodilators

• Hydralazine: Arterioles > Veins. Lupus (slow acetylators). Use with Nitrate for HF.
• Minoxidil: Opens K+ channels. Hypertrichosis (Rogaine).
• Nitroprusside: Arterioles = Veins. Cyanide toxicity.
• Fenoldopam: Dopamine D1 agonist. Renal vasodilation.