10/26

Question 1

CCBs

Answer 1

inhibit influx of Ca across cardiac and smooth muscle cell membranes, block high-voltage (L-type) Ca channels resulting in vasodilation
-DHP vs non-DHP (different pharmacology but same antihypertensive effect)

Question 2

CCB indications

Answer 2

HTN, angina, arrythmias

Question 3

CCB CI

Answer 3

preexisting bradycardia, conduction defects, HF due to systolic dysfunction

Question 4

DHP CCBs

Answer 4

amlodipine, nifedipine

• more potent vasodilators than non-DHPs
• baroreceptor-mediated reflex tachycardia due to potent vasodilation
• do not alter AV conduction; not effective in supraventricular tachyarrythmias

Question 5

DHP AE

Answer 5

more reflex sympathetic discharge: tachycardia, dizziness, HA, flushing, peripheral edema, gingival hyperplasia

Question 6

non-DHP CCB CI

Answer 6

heart block

Question 7

non-DHP CCB

Answer 7

diltiazem, verapamil
-decrease HR, slow AV node conduction (may treat supraventricular tachyarrythmias), ER products preferred in HTN (block SA and AV nodes: reduce HR)

Question 8

non-DHP CCB AE

Answer 8

bradycardia, HA, dizziness, AV block, systolic HF, gingival hyperplasia, constipation

Question 9

non-DHP CCB drug interactions

Answer 9

inc CCB effect: grapefruit juice, cimetidine, ranitidine

dec CCB effect: rifampin, phenobarbital

Question 10

CCB monitoring parameters

Answer 10

BP, HR, peripheral edema, constipation

Question 11

beta blockers

Answer 11

“olols”

• second line in JNC8: preferred for compelling indications - reduce mortality in pts w HF and useful in treatment of atrial fibrilation
• decrease HR and force of contraction -> dec CO

Question 12

BB AE

Answer 12

bronchospasm, bradycardia, mask hypoglycemia, fatigue

Question 13

vasodilators (direct arterial vasculature)

Answer 13

last line in HTN - reserved for patients w special indication or very difficult-to-control BP
fluid retention and reflex tachycardia are frequent SE (drug-induced rash and lupus can occur w hydrazaline)
concomitant therapy w diuretic and HR-reducing agent usually needed

Question 14

hydrazaline

Answer 14

PO and IV

AE: palpations, tachycardia, chest pain, GI effects, HA, hematologic dyscrasias, hepatotoxicity, lupus

Question 15

minoxidil

Answer 15

more potent that hydrazaline
AE: palpations, tachycardia, chest pain, GI effects, HA, hematologic dyscrasias, hepatotoxicity
CI: dissecting aortic aneurysm

Question 16

minoxidil BBW

Answer 16

• pericarditis and pericardial effusion
• inc oxygen demand and exacerbate angina
• should be given w diuretic to minimize fluid gain and a BB to prevent tachycardia

Question 17

African american

Answer 17

inc prevalence and severity of HTN

use thiazides and CCBs

Question 18

elders

Answer 18

2/3 of people over 65 have HTN

goal:

Question 19

dementia

Answer 19

occurs more often in people w HTN

control HTN to slow progression

Question 20

women

Answer 20

contraception can inc BP

Question 21

pregnant women w THN

Answer 21

methyldopa, BBs and vasodialtors

ACE and ARB CI in pregnancy

Question 22

hypertensive crisis

Answer 22

BP > 180/120

TOD = emergency

Question 23

management of hypertensive crisis

Answer 23

gradually decrease BP to normal over 24-48 hours to avoid significant TOD
short acting drugs are recommended initially (clonidine, labetolol, captopril)

Question 24

emergency goal

Answer 24

decrease MAP 25% within 2 hours, decrease BP over next 2-6 hours
start IV drugs and decrease BP slowly

Question 25

resistant HTN treatment

Answer 25

aldosterone antagonists could be 4th line option

BB not great in practice

Question 26

combo products

Answer 26

thiazide, ARB, CCB