37. Hypertension (from Rx) Flashcards
A 30 year-old female has hypertension and asthma. She is already using hydrochlorothiazide 25 mg daily, but her blood pressure remains elevated at a range of 142-154/84-92 mmHg. She will be started on beta blocker therapy. Which of the following agents is most appropriate?
A. Carteolol
B. Carvedilol
C. Propranolol
D. Metoprolol
E. Timolol
D. With a chronic breathing condition (asthma, COPD, emphysema), the non-selective beta blockers should be avoided.
AMEBBA
Beta Blocking Agents: inhibit effects of catecholamines at beta-1 & beta-2 receptors to reduce BP and HR. Beta blockers with intrinsic sympathomimetic activity (ISA) partially stimulate beta receptors while blocking additional stimulation and are contraindicated in S/P MI patients. ISA agents are carteolol, acebutolol, penbutolol, pindolol (CAPP). Boxed warning: avoid abrupt withdrawal, must taper. CI: sinus bradycardia, 2nd or 3rd degree heart block, sick sinus syndrome, cardiogenic shock, active asthma exacerbation. Warning: caution in diabetes (hypoglycemia), asthma, severe COPD, Raynaud’s disease, may mask hyperthryoidism, aggravate psychiatric conditions. SE: decrease HR, hypotension, fatigue, dizziness, depression, decrease libido, impotence, hyperglycemia, hypoglycemia, hypertriglyceridemia, decrease HDL, most pregnancy (C)
Beta-1 selective blockers: AMEBBA.
acebutolol (Sectral): PO
esmolol (Brevibloc): IV
atenolol (Tenormin): PO
betaxolol: PO
bisoprolol (Zebeta): PO
metoprolol tartrate (Lopressor), metoprolol succinate (Toprol XL): PO, IV. Lopressor with food. IV:PO ratio 1:2.5
Beta-1 blocker with nitric oxide-dependent vasodilation
nebivolol (Bystolic): PO. CI in severe liver impairment. caution with 2D inhibitors
Beta-1 & Beta-2 blockers (non-selective)
nadolol (Corgard): PO
penbutolol (Levatol): PO
pindolol: PO
propranolol (Inderal LA, InnoPran XL): PO, IV, solution; most lipophilic, more CNS side effects (sedation, depression, cognitive effects)
timolol: PO
Alpha-1 and non-selective beta blocker
labetalol (Trandate): PO, IV; used commonly in hospital
Non-selective alpha and beta blocker
carvedilol (Coreg): PO. additional SE: weight gain, edema. 2D6 substrate. can increase digoxin & cyclosporin levels
A hospitalized patient was given sodium polystyrene sulfonate this morning. The pharmacist is reviewing her medications. Which of the following medications most likely should be discontinued in this patient?
A. Metoprolol
B. Clopidogrel
C. Olmesartan
D. Clonidine
E. Piperacillin-Tazobactam
C. The patient was given sodium polystyrene sulfonate (Kayexalate), which is used to treat hyperkalemia. Antihypertensive agents that retain potassium include ACEIs, ARBs, direct renin inhibitors, potassium-sparing diuretics and the aldosterone blockers (aldosterone and eplerenone).
Renin-Angiotensin Aldosterone System (RAAS) Inhibitors: ACE-I & ARB
First line in CKD, slow progression of kidney disease, HF, stroke. Do not use ACE-I and ARB together. Avoid in pregnancy (D), angioedema, bilateral renal artery stenosis, or with aliskiren in patients with DM or GFR
benazepril (Lotensin): PO
captopril (Capoten): PO, empty stomach
enalapril, enalaprilat IV (Vasotec): PO, IV, solution
lisinopril (Prinivil, Zestril): PO
moexipril (Univasc): PO, empty stomach
fosinopril (Monopril): PO
perindopril (Aceon): PO
quinapril (Accupril): PO
ramipril (Altace): PO
trandolapril (Mavik): PO
valsartan (Diovan): PO
losartan (Cozaar): PO
irbesartan (Avapro): PO
candesartan (Atacand): PO
olmesartan (Benicar): Sprue-like enteropathy (severe, chronic diarrhea with substantial weight loss) then stop Benicar
telmisartan (Micardis): PO
eprosartan (Teveten): PO
azilartan (Edarbi): PO, keep in original container
A patient gave the pharmacist a prescription for clonidine tablets for initial treatment of hypertension. The patient’s other medications include polyethylene glycol, fluoxetine and olanzapine (for treatment-resistant depression) and modafinil. The pharmacist should contact the physician to offer the following correct recommendations: (Select ALL that apply.)
A. Clonidine will worsen constipation.
B. Clonidine could worsen depression.
C. Clonidine could worsen fatigue.
D. There is a major drug interaction between clonidine and polyethylene glycol.
E. Clonidine can increase the risk of serotonergic syndrome.
A, B, C. Clonidine is not used first-line and has many side effects that make it a difficult drug for patients to tolerate, including constipation, dry mouth, bradycardia (start QHS), fatigue, lethargy, aggravation of depression and sexual dysfunction/impotence.
Centrally-Acting alpha-2 adrenergic agonist: stimulate alpha-2 in the brain resulting in reduced sympathetic outflow from CNS. CI: methyldopa only (active liver disease, concurrent use with MAO-I). SE: dry mouth, somnolence, headache, fatigue, dizziness, constipation, bradycardia hypotension, depression, behavioral changes, sexual dysfunction; patch (skin rash, pruritis, erythema, contact dermatitis). Methyldopa additional SE: hypersensitivity reactions, hepatitis, myocarditis, positive Coombs, drug-induced fever, drug-induced lupus erythematosus (DILE), can increase prolactin levels. Rebound hypertension if stopped abruptly, must taper. Pregnancy (B/C)
clonidine (Catapres, Duraclon inj): PO, patch, inj. patches Q weekly, remove patch before MRI. only form that comes as a patch in treating BP
guanfacine (Tenex) PO:
methyldopa: PO, inj
A patient gave the pharmacist a prescription for Accupril 40 mg PO daily. Which of the following is an appropriate generic substitution for Accupril?
A. Fosinopril
B. Ramipril
C. Triamterene
D. Clonidine
E. Quinapril
E. The generic name of Accupril is quinapril.
fosinopril (Monopril)
ramipril (Altace)
triamterene (Dyrenium)
clonidine (Catapres)
A patient gave the pharmacist a prescription for Altace 10 mg PO daily. Which of the following is an appropriate generic substitution for Altace?
A. Minoxidil
B. Ramipril
C. Triamterene
D. Spironolactone
E. Moexipril
B. The generic name of Altace is ramipril.
triamterene (Dyrenium)
spironolaction (Aldactone)
moexipril (Univasc)
A patient gave the pharmacist a prescription for Catapres TTS-1 #4. Choose the correct counseling statements for this medication. (Select ALL that apply.)
A. Take this medication by mouth four times daily.
B. This medication can be disposed of in the trash container with a lid.
C. Replace the patch every morning.
D. Rotate the site where you place the patch.
E. This is the highest dose available of this medication.
B, D. The clonidine patch is replaced every seven days. It is available in a higher dose.
A patient gave the pharmacist a prescription for Cozaar 50 mg by mouth daily #30. Which of the following is an appropriate generic substitution for Cozaar?
A. Olmesartan
B. Valsartan
C. Irbesartan
D. Losartan
E. Candesartan
D. The generic name of Cozaar is losartan.
olmesartan (Benicar)
valsartan (Diovan)
irbesartan (Avapro)
candesartan (Atacand)
A patient gave the pharmacist a prescription for Cozaar she needed filled. Her other medication is Yaz contraceptive pills. The pharmacy is in a supermarket and the pharmacist notices the patient has Morton Salt Balance in her shopping cart, which contains potassium chloride. Which of the following are correct counseling statements for this patient? (Select ALLthat apply.)
A. Your new medication is safe in pregnancy.
B. Yaz can increase potassium.
C. Your new medication can cause a dry, hacking cough.
D. Your new medication, and the salt substitute, can increase your potassium.
E. Your new medication can decrease the effectiveness of Yaz.
B, D. Cozaar can increase the risk of hyperkalemia and is not safe in pregnancy.
A patient gave the pharmacist a prescription for Diovan 80 mg by mouth daily #30. Which of the following is an appropriate generic substitution for Diovan?
A. Candesartan
B. Irbesartan
C. Olmesartan
D. Valsartan
E. Losartan
D. The generic name for Diovan is valsartan.
candesartan (Atacand)
irbesartan (Avapro)
olmesartan (Benicar)
losartan (Cozaar)
A patient gave the pharmacist a prescription for Exforge. Which of the following is the generic of Exforge?
A. Amlodipine and benazepril
B. Amlodipine and valsartan
C. Amlodipine, valsartan and hydrochlorothiazide
D. Amlodipine and olmesartan
E. Aliskiren and amlodipine
B. Exforge contains amlodipine and valsartan.
A patient gave the pharmacist a prescription for Lopressor 50 mg BID #60. Which of the following is an appropriate generic substitution for Lopressor?
A. Metoprolol
B. Bumetanide
C. Triamterene
D. Clonidine
E. Olmesartan
A. The generic name for Lopressor is metoprolol.
Beta Blocking Agents: inhibit effects of catecholamines at beta-1 & beta-2 receptors to reduce BP and HR. Beta blockers with intrinsic sympathomimetic activity (ISA) partially stimulate beta receptors while blocking additional stimulation and are contraindicated in S/P MI patients. ISA agents are carteolol, acebutolol, penbutolol, pindolol (CAPP). Boxed warning: avoid abrupt withdrawal, must taper. CI: sinus bradycardia, 2nd or 3rd degree heart block, sick sinus syndrome, cardiogenic shock, active asthma exacerbation. Warning: caution in diabetes (hypoglycemia), asthma, severe COPD, Raynaud’s disease, may mask hyperthryoidism, aggravate psychiatric conditions. SE: decrease HR, hypotension, fatigue, dizziness, depression, decrease libido, impotence, hyperglycemia, hypoglycemia, hypertriglyceridemia, decrease HDL, most pregnancy (C)
Beta-1 selective blockers: AMEBBA.
acebutolol (Sectral): PO
esmolol (Brevibloc): IV
atenolol (Tenormin): PO
betaxolol: PO
bisoprolol (Zebeta): PO
metoprolol tartrate (Lopressor), metoprolol succinate (Toprol XL): PO, IV. Lopressor with food. IV:PO ratio 1:2.5
Beta-1 blocker with nitric oxide-dependent vasodilation
nebivolol (Bystolic): PO. CI in severe liver impairment. caution with 2D inhibitors
Beta-1 & Beta-2 blockers (non-selective)
nadolol (Corgard): PO
penbutolol (Levatol): PO
pindolol: PO
propranolol (Inderal LA, InnoPran XL): PO, IV, solution; most lipophilic, more CNS side effects (sedation, depression, cognitive effects)
timolol: PO
Alpha-1 and non-selective beta blocker
labetalol (Trandate): PO, IV; used commonly in hospital
Non-selective alpha and beta blocker
carvedilol (Coreg): PO. additional SE: weight gain, edema. 2D6 substrate. can increase digoxin & cyclosporin levels
A patient gave the pharmacist a prescription for Catapres 0.1 mg 1 tablet BID #60. Which of the following is an appropriate generic substitution for Catapres?
A. Minoxidil
B. Hydralazine
C. Doxazosin
D. Clonidine
E. Clonazepam
D. The generic name of Catapres is clonidine.
hydralazine (Apresoline)
doxazosin (Cardura)
clonazepam (Klonopin)
A patient gave the pharmacist a prescription for Norvasc 10 mg daily #90. Which of the following is an appropriate generic substitution for Norvasc?
A. Amlodipine
B. Lisinopril
C. Nicardipine
D. Carvedilol
E. Diltiazem
A. The generic name of Norvasc is amlodipine.
amlodipine (Norvasc): least likely to cause reflex tachycardia/flushing, safest in HF patients
lisinopril (Zestril)
nicardipine (Cardene)
carvedilol (Coreg)
diltiazem (Cardizem)
A patient gave the pharmacist a prescription for Cardizem CD 120 mg 1 PO daily #30. Which of the following is an appropriate generic substitution for Cardizem CD?
A. Amlodipine extended-release capsule
B. Carteolol extended-release capsule
C. Verapamil extended-release capsule
D. Carvedilol extended-release capsule
E. Diltiazem extended-release capsule
E. Be careful when using the orange book to find a suitable generic alternative with diltiazem formulations. Cardizem CD is rated AB3, and needs an AB3 generic. Diltiazem has four different long-acting designations (AB1, AB2, AB3 and AB4).
non-DHP: negative inotrope and negative chronotrope, work peripherally and vasodilate coronary vasculature. both are 3A4 substrate and moderate 3A4 inhibitors. SE: edema, HA, dizziness, AV block, bradycardia, hypotension, arrhythmias, HF, constipation (more with verapamil), gingival hyperplasia, pregnancy (C). Avoid grapefruit juice.
diltiazem (Cardizem): PO, IV
verapamil (Calan): PO, IV requires protection from light during administration
amlodipine (Norvasc)
carvedilol (Coreg)
A patient gave the pharmacist a prescription for Tenormin 50 mg daily #30. Which of the following is an appropriate generic substitution for Tenormin?
A. Amiloride
B. Eplerenone
C. Atenolol
D. Terazosin
E. Nisoldipine
C. The generic name for Tenormin is atenolol.
amiloride (Midamor)
eplerenone (Inspra)
terazosin (Hytrin)
nisoldipine (Sular)
A patient gave the pharmacist a prescription for Zestril 5 mg daily #30. Which of the following is an appropriate generic substitution for Zestril?
A. Quinapril
B. Lisinopril
C. Benazepril
D. Fosinopril
E. Moexipril
B. The generic name for Zestril is lisinopril.
quinapril (Accupril)
benazepril (Lotensin)
moexipril (Univasc)
fosinopril (Monopril)
A patient has been started on hydrochlorothiazide 25 mg daily. Which of the following statements are correct? (Select ALLthat apply.)
A. Potassium can decrease
B. Calcium can decrease
C. Uric acid can increase
D. Sodium can increase
E. Magnesium can decrease
A. C. E. Thiazide diuretics can decrease potassium, sodium and magnesium and increase calcium, uric acid, blood glucose and cholesterol.
Thiazide-type Diuretics: inhibit Na reabsorption in the distal convoluted tubules of nephron causing increase excretion of Na, water, K, H+. K-sparing diuretics also work here as well. SE: decrease (K, Mg, Na), increase (UA, LDL, TG, BG, Ca), rash dizziness, photosensitivity, pregnancy (B). Good for the bones unlike loop-diuretics which causes loss of Ca. Take early in the day to avoid nocturia. Do not work when CrCl
chlorthalidone (Thalitone): max 25mg/day (no BP benefit at higher doses), longest half life
hydrochlorothiazide (Microzide, Oretic): max 25-50mg/day (no BP benefit after 25mg)
chlorothiazide (Diuril): PO, IV, suspension
indapamide: data in stroke prevention
metolazone (Zaroxolyn): has additional MoA at proximal tubule
methyclothiazide:
A patient gave the pharmacist a prescription for Avapro 150 mg by mouth daily #30. Which of the following is an appropriate generic substitution for Avapro?
A. Amlodipine
B. Irbesartan
C. Verapamil
D. Valsartan
E. Candesartan
B. The generic name of Avapro is irbesartan.
amlodipine (Norvasc)
verapamil (Calan)
valsartan (Diovan)
candesartan (Atacand)
A patient has high blood pressure, but a slow heart rate. The patient occasionally suffers from orthostatic hypotension and syncope. The physician is concerned and does not wish to use a blood pressure medication which can lower heart rate. Choose an agent that does not significantly lower heart rate:
A. Nadolol
B. Amlodipine
C. Diltiazem
D. Verapamil
E. Atenolol
B. Beta blockers (without ISA activity) and the non-dihydropyridine calcium channel blockers are anti-hypertensive agents that lower heart rate. This can be useful in a patient with a fast heart rate, or tachycardia. A normal heart rate ranges from 60-100 beats per minute (BPM).
nadolol (Corgard)
amlodipine (Norvasc)
diltiazem (Cardizem)
verapamil (Calan)
atenolol (Tenormin)
A patient gave the pharmacist a prescription for Benicar 20 mg by mouth daily #30. Which of the following is an appropriate generic substitution for Benicar?
A. Olmesartan
B. Telmisartan
C. Irbesartan
D. Eprosartan
E. Candesartan
A. The generic name for Benicar is olmesartan.
olmesartan (Benicar): Sprue-like enteropathy (severe, chronic diarrhea with substantial weight loss) then stop Benicar
telmisartan (Micardis)
irbesartan (Avapro)
eprosartan (Teveten)
candesartan (Atacand)
A patient is using chlorthalidone 25 mg daily and has a reported potassium level of 4.6 mEq/L. Which of the following statements is correct?
A. The patient needs an agent to lower her potassium level.
B. Chlorthalidone works by blocking Na+ reabsorption in the distal convoluted tubules.
C. Supplementation with prescription oral potassium is often required when thiazide diuretics are taken.
D. This is not an effective dose of chlorthalidone to lower BP.
E. Chlorthalidone has been shown to be less effective than other thiazide-type diuretics.
B. Patients can usually correct the mild potassium-lowering effect of thiazides by supplementing their diet with potassium-rich foods, including avocados, bananas and oranges.
Thiazide-type Diuretics: inhibit Na reabsorption in the distal convoluted tubules of nephron causing increase excretion of Na, water, K, H+. K-sparing diuretics also work here as well. SE: decrease (K, Mg, Na), increase (UA, LDL, TG, BG, Ca), rash dizziness, photosensitivity, pregnancy (B). Good for the bones unlike loop-diuretics which causes loss of Ca. Take early in the day to avoid nocturia. Do not work when CrCl
chlorthalidone (Thalitone): max 25mg/day (no BP benefit at higher doses), longest half life
hydrochlorothiazide (Microzide, Oretic): max 25-50mg/day (no BP benefit after 25mg)
chlorothiazide (Diuril): PO, IV, suspension
indapamide: data in stroke prevention
metolazone (Zaroxolyn): has additional MoA at proximal tubule
methyclothiazide:
A patient gave the pharmacist a prescription for Atacand 8 mg 1 tablet by mouth daily #30. Which of the following is an appropriate generic substitution for Atacand?
A. Valsartan
B. Candasartan
C. Irbesartan
D. Perindopril
E. Labetalol
B. The generic name for Atacand is candasartan.
candesartan (Atacand): PO
valsartan (Diovan)
irbesartan (Avapro)
perindopril (Aceon)
labetalol (Trandate)
A patient is using furosemide 20 mg QHS and has a reported potassium level of 2.9 mEq/L. Which of the following statements are correct regarding furosemide therapy? (Select ALL that apply.)
A. This medication can cause ototoxicity.
B. This medication is safe in patients with a severe sulfa allergy.
C. Furosemide should be taken in the morning, not at bedtime.
D. Potassium supplementation is often required when loop diuretics are taken.
E. The patient should be told to restrict calcium intake.
A, C, D. Loop diuretics are taken QAM or early enough in the day to prevent or reduce nocturia. Loop diuretics lower potassium, waste calcium and can cause ototoxicity. There is potential to cross-react with a sulfa allergy but this is rare.
Alex, a 68 year old white male, is being treated at your clinic for hypertension. Today his BP is 147/93. His PMH is significant for GERD, diabetes and gout. Alex is currently taking Janumet XR, Motrin, Hyzaar and Zantac. Which of the following medications would be appropriate to add for better BP control according to JNC 8?
A. Hydrochlorothiazide
B. Procardia XL
C. Cardura
D. Coreg
E. Alex does not need additional BP lowering.
B. Alex is currently taking Hyzaar (losartan + HCTZ); therefore calcium channel blockers are the only other first line agents according to JNC 8 (since we cannot combine an ACE-I with an ARB).
JNC-8
Age 60 and up: BP goal
Drug class recommendation for initial therapy: ACE-I (1st line for CKD), ARBs (1st line for CKD), CCBs (1st line in blacks), thiazide-type diuretics (1st line in blacks). All in addition to lifestyle modifications.
CKD over ethnicity: ACE-I or ARB. CKD is albuminuria >30mg of albumin/(g of creatinine)
No CKD, based on ethnicity: use CCB or thiazide in black patients. ACE-I, ARB, CCB, or thiazide in non-black patients.
If diabetes with no CKD, based on ethnicity: same as above.
Charles presents to the emergency room after a motor vehicle accident. He is found to have a blood pressure of 192/112 mmHg. He has no acute organ damage and is diagnosed as having hypertensive urgency. Which of the following medications would not be an appropriate option to treat this condition:
A. Captopril
B. Nifedipine sublingual
C. Clonidine
D. Labetalol
E. Losartan
B. Sublingual nifedipine can cause an uncontrollable drop in blood pressure, which can result in myocardial infarction and other ischemic complications, hence should not be used.
Choose the correct statement regarding carvedilol to carvedilol CR dosing:
A. Carvedilol 25 mg BID is equivalent to Coreg CR 40 mg daily.
B. Carvedilol 6.25 mg BID is equivalent to Coreg CR 20 mg daily.
C. Carvedilol 12.5 mg BID is equivalent to Coreg CR 30 mg daily.
D. Carvedilol 3.125 mg BID is equivalent to Coreg CR 5 mg daily.
E. None of the above.
B. The starting dose of carvedilol immediate release is 3.125 mg BID for heart failure (equivalent to Coreg CR 10 mg), or 6.25 BID for hypertension (equivalent to Coreg CR 20 mg). The Coreg CR doses are 10 mg, 20 mg, 40 mg or 80 mg daily.
A patient with diabetes, hypertension, and peptic ulcer disease is on aspirin, glyburide, enalapril, metoprolol, chlorthalidone, and famotidine. Which of the patient’s medications may block signs and symptoms of hypoglycemia?
A. Enalapril
B. Metoprolol
C. Aspirin
D. Chlorthalidone
E. Famotidine
B. The physiologic response to hypoglycemia is mediated by sympathetic/adrenergic stimulation. Therefore, beta-blockers can mask many signs and symptoms of hypoglycemia.
Beta Blocking Agents: inhibit effects of catecholamines at beta-1 & beta-2 receptors to reduce BP and HR. Beta blockers with intrinsic sympathomimetic activity (ISA) partially stimulate beta receptors while blocking additional stimulation and are contraindicated in S/P MI patients. ISA agents are carteolol, acebutolol, penbutolol, pindolol (CAPP). Boxed warning: avoid abrupt withdrawal, must taper. CI: sinus bradycardia, 2nd or 3rd degree heart block, sick sinus syndrome, cardiogenic shock, active asthma exacerbation. Warning: caution in diabetes (hypoglycemia), asthma, severe COPD, Raynaud’s disease, may mask hyperthryoidism, aggravate psychiatric conditions. SE: decrease HR, hypotension, fatigue, dizziness, depression, decrease libido, impotence, hyperglycemia, hypoglycemia, hypertriglyceridemia, decrease HDL, most pregnancy (C)
Choose the correct statements concerning Cleviprex: (Select ALL that apply.)
A. It comes in a milky white emulsion.
B. It is contraindicated in a soy or egg allergy.
C. It is an intravenous non-dihydropyridine calcium channel blocker.
D. The medication needs to be discarded after 4 hours of use.
E. The tubing for Cleviprex should be changed every 12 hours.
A, B, E. Cleviprex must be administered using strict aseptic technique and should be discarded 12 hours of use.
clevidipine (Cleviprex): IV, milky white emulsion provides 2kcal/mL, risk of infection & high TG, max hang time of 12 hours.
Calcium Channel Blockers (CCBs): 2 types (dihydropyridines [DHP] and non-DHPs).
DHPs: work in periphery causing peripheral vasodilation resulting in reflex tachycardia, flushing, HA, edema. Warning: angina/MI with initiation or titration, caution in aortic stenosis. SE: peripheral edema, fatigue, dizziness, headache, palpitation, flushing, tachycardia/reflex tachycardia, hypotension, gingival hyperplasia, pregnancy (C)
A 45 year-old female patient has gone to see her primary care physician. The doctor is looking at her blood work, which includes the following parameters: total cholesterol 202 mg/dL, HDL 52 mg/dL, LDL 130 mg/dL, TG 96 mg/dL, BUN 18 mg/dL, SCr 0.8 mg/dL, hCG+, with a blood pressure of 148/88 mmHg. Which of the following medications can be safely administered?
A. Hydrochlorothiazide
B. Lipitor
C. Zestril
D. Atenolol
E. Tekturna
A. The patient is pregnant (hCG+). She cannot use statins, ACE inhibitors, angiotensin-receptor blockers, direct renin inhibitors, or atenolol. These medications, if used, should be discontinued as soon as pregnancy is detected.
Pregnancy & HTN
Preeclampsia may be managed differently than HTN in pregnancy. Preeclampsia generally includes proteinuria in addtion to high BP.
Stop all teratogenic drugs: ACE-I, ARBs, aliskiren.
Treat when SBP>160 or DBP>105 with labetalol (most favorable), nifedipine ER (moderate SEs), methyldopa (most SEs) with a goal BP of 120-160 SBP and 80-105 DBP.
thiazide-like diuretics: pregnancy (B)
beta-blockers : pregnancy (C)
Frank comes to the clinic for a follow up visit for his hypertension and diabetes management. He has been taking four medications to control his blood pressure for a long time. Today, the pharmacist notices a butterfly rash across Frank’s nose and upper cheeks. Which of the following medications is most likely to cause this side effect?
A. Hydrochlorothiazide
B. Enalapril
C. Hydralazine
D. Eplerenone
E. Verapamil
C. Hydralazine (Apresoline) can cause lupus-like syndrome which is dose and duration related.
hydrochlorothiazide (Microzide)
enalapril (Vasotec)
eplerenon (Inspra)
verapamil (Calan)
In 2012, a contraindication was added to the labeling of aliskiren. This contraindication warns not to use aliskiren in combination with ACE inhibitors or ARBs in patients with:
A. Diabetes
B. Hepatitis
C. Raynaud’s syndrome
D. Myocardial infarction
E. Stroke
A.
Direct Renin Inhibitor (DRI):directly inhibits renen which is responsible for conversion of angiotensinogen to angiotensin I. Boxed warning: injury and death to developing fetus. CI: angioedema, do not use in bilateral renal artery stenosis, do not use with ACE-Is or ARBs in patients with diabetes. Warning: angioedema, avoid use with ACE-I or ARB, correct volume depletion prior to starting. SE: increase SCr and BUN, hyperkalemia, diarrhea, hypotension, pregnancy (D). metabolized by 3A4.
aliskiren (Tekturna): avoid high fat foods (decrease absorption)
Jackie presents to her doctor’s office with hypertension. She is prescribed Lotrel. This medication contains:
A. Benazepril and amlodipine
B. Olmesartan and amlodipine
C. Valsartan and aliskiren
D. Valsartan and amlodipine
E. Irbesartan and hydrochlorothiazide
A. Lotrel contains benazepril and amlodipine.
